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Tongue-tie and frenotomy in infants with breastfeeding difficulties: achieving a balance.
Arch Dis Child 2015; 100(5):489-94AD

Abstract

AIMS

Currently there is debate on how best to manage young infants with tongue-tie who have breastfeeding problems. One of the challenges is the subjectivity of the outcome variables used to assess efficacy of tongue-tie division. This structured review documents how the argument has evolved. It proposes how best to assess, inform and manage mothers and their babies who present with tongue-tie related breastfeeding problems.

METHODS

Databases were searched for relevant papers including Pubmed, Medline, and the Cochrane Library. Professionals in the field were personally contacted regarding the provision of additional data. Inclusion criteria were: infants less than 3 months old with tongue-tie and/or feeding problems. The exclusion criteria were infants with oral anomalies and neuromuscular disorders.

RESULTS

There is wide variation in prevalence rates reported in different series, from 0.02 to 10.7%. The most comprehensive clinical assessment is the Hazelbaker Assessment Tool for lingual frenulum function. The most recently published systematic review of the effect of tongue-tie release on breastfeeding concludes that there were a limited number of studies with quality evidence. There have been 316 infants enrolled in frenotomy RCTs across five studies. No major complications from surgical division were reported. The complications of frenotomy may be minimised with a check list before embarking on the procedure.

CONCLUSIONS

Good assessment and selection are important because 50% of breastfeeding babies with ankyloglossia will not encounter any problems. We recommend 2 to 3 weeks as reasonable timing for intervention. Frenotomy appears to improve breastfeeding in infants with tongue-tie, but the placebo effect is difficult to quantify. Complications are rare, but it is important that it is carried out by a trained professional.

Authors+Show Affiliations

Department of Neonatology, The National Maternity Hospital, Dublin, Ireland.Department of Neonatology, The National Maternity Hospital, Dublin, Ireland.

Pub Type(s)

Journal Article
Review
Systematic Review

Language

eng

PubMed ID

25381293

Citation

Power, R F., and J F. Murphy. "Tongue-tie and Frenotomy in Infants With Breastfeeding Difficulties: Achieving a Balance." Archives of Disease in Childhood, vol. 100, no. 5, 2015, pp. 489-94.
Power RF, Murphy JF. Tongue-tie and frenotomy in infants with breastfeeding difficulties: achieving a balance. Arch Dis Child. 2015;100(5):489-94.
Power, R. F., & Murphy, J. F. (2015). Tongue-tie and frenotomy in infants with breastfeeding difficulties: achieving a balance. Archives of Disease in Childhood, 100(5), pp. 489-94. doi:10.1136/archdischild-2014-306211.
Power RF, Murphy JF. Tongue-tie and Frenotomy in Infants With Breastfeeding Difficulties: Achieving a Balance. Arch Dis Child. 2015;100(5):489-94. PubMed PMID: 25381293.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Tongue-tie and frenotomy in infants with breastfeeding difficulties: achieving a balance. AU - Power,R F, AU - Murphy,J F, Y1 - 2014/11/07/ PY - 2014/07/01/received PY - 2014/10/15/accepted PY - 2014/11/9/entrez PY - 2014/11/9/pubmed PY - 2015/6/26/medline KW - Frenotomy KW - Frenulotomy KW - Infant Feeding KW - Neonatology KW - tongue-tie SP - 489 EP - 94 JF - Archives of disease in childhood JO - Arch. Dis. Child. VL - 100 IS - 5 N2 - AIMS: Currently there is debate on how best to manage young infants with tongue-tie who have breastfeeding problems. One of the challenges is the subjectivity of the outcome variables used to assess efficacy of tongue-tie division. This structured review documents how the argument has evolved. It proposes how best to assess, inform and manage mothers and their babies who present with tongue-tie related breastfeeding problems. METHODS: Databases were searched for relevant papers including Pubmed, Medline, and the Cochrane Library. Professionals in the field were personally contacted regarding the provision of additional data. Inclusion criteria were: infants less than 3 months old with tongue-tie and/or feeding problems. The exclusion criteria were infants with oral anomalies and neuromuscular disorders. RESULTS: There is wide variation in prevalence rates reported in different series, from 0.02 to 10.7%. The most comprehensive clinical assessment is the Hazelbaker Assessment Tool for lingual frenulum function. The most recently published systematic review of the effect of tongue-tie release on breastfeeding concludes that there were a limited number of studies with quality evidence. There have been 316 infants enrolled in frenotomy RCTs across five studies. No major complications from surgical division were reported. The complications of frenotomy may be minimised with a check list before embarking on the procedure. CONCLUSIONS: Good assessment and selection are important because 50% of breastfeeding babies with ankyloglossia will not encounter any problems. We recommend 2 to 3 weeks as reasonable timing for intervention. Frenotomy appears to improve breastfeeding in infants with tongue-tie, but the placebo effect is difficult to quantify. Complications are rare, but it is important that it is carried out by a trained professional. SN - 1468-2044 UR - https://www.unboundmedicine.com/medline/citation/25381293/Tongue_tie_and_frenotomy_in_infants_with_breastfeeding_difficulties:_achieving_a_balance_ L2 - http://adc.bmj.com/cgi/pmidlookup?view=long&pmid=25381293 DB - PRIME DP - Unbound Medicine ER -