Effect of frenotomy for tongue-tie on improving breastfeeding

Authors

  • Christine Chi-Oi LAM
  • Sze-Ki WONG
  • Florence Chi-Ying WONG

DOI:

https://doi.org/10.12809/hkjgom.20.2.02

Keywords:

Ankyloglossia, Breast feeding

Abstract

Introduction: Tongue-tie is a congenital anomaly that may hinder effective breastfeeding. This study aimed to review outcomes of frenotomy on breastfeeding in babies with tongue-tie and their mothers at a lactation clinic.
Methods: Since 2016, the lactation clinic of Department of Obstetrics and Gynaecology, Queen Elizabeth Hospital has taken a more active role to help babies with tongue-tie and breastfeeding difficulties. If feeding problems persisted, the babies were referred to a paediatric hospital for treatment. When indicated, frenotomy was suggested and performed upon consents using bipolar diathermy forceps under no anaesthesia. After frenotomy, the self-rated improvement on feeding condition was assessed in a scale of 0 (no improvement at all) to 10 (excellent improvement). At babies’ 4 months of age, mothers were followed up by phone about feeding condition.
Results: From July 2016 to June 2018, 49 babies with tongue-tie and persistent breastfeeding problems were referred for consultation for frenotomy. Of them, four were deemed no need for frenotomy and were excluded, 36 underwent frenotomy and were categorised as the frenotomy group, and the remaining 9 who did not attend consultation or refuse surgery were categorised as the non-frenotomy group. In the frenotomy group, the most common breastfeeding difficulties was poor attachment (61.11%), followed by sore nipples (30.56%), ineffective
suckling (5.56%), and poor weight gain (2.78%). After frenotomy, sore nipple was the most improved symptom with a mean rating of 8.18 (n=11), followed by poor attachment with a mean rating of 6.91 (n=22). In the non-frenotomy group, the most common breastfeeding difficulties was poor attachment (55.56%), followed by ineffective suckling (33.33%) and sore nipples (11.11%). At babies’ 4 months of age, the proportion of mothers remaining direct breastfeeding was higher in the frenotomy group than the non-frenotomy group (80.56% vs 44.4%, p=0.028). Direct breastfeeding at 4 months was associated with frenotomy (87.88% vs 58.33%, p=0.028).
Conclusions: Frenotomy improved maternal nipple soreness during breastfeeding and the direct breastfeeding rate and duration.

References

O’Shea JE, Foster JP, O’Donnell CP, et al. Frenotomy for tongue-tie in newborn infants. Cochrane Database Syst Rev 2017;3:CD011065.

Joseph KS, Kinniburgh B, Metcalfe A, Razaz N, Sabr Y, Lisonkova S. Temporal trends in ankyloglossia and frenotomy in British Columbia, Canada, 2004-2013: a population-based study. CMAJ Open 2016;4:E33-40.

Kapoor V, Douglas PS, Hill PS, Walsh LJ, Tennant M. Frenotomy for tongue-tie in Australian children, 2006-2016: an increasing problem. Med J Aust 2018;208:88-9.

Walsh J, Links A, Boss E, Tunkel D. Ankyloglossia and lingual frenotomy: national trends in inpatient diagnosis and management in the United States, 1997-2012. Otolaryngol Head Neck Surg 2017;156:735-40.

Segal LM, Stephenson R, Dawes M, Feldman P. Prevalence, diagnosis, and treatment of ankyloglossia: methodologic review. Can Fam Physician 2007;53:1027-33.

Hall DMB, Renfrew MJ. Tongue tie. Arch Dis Child 2005;90:1211-5.

Messner AH, Lalakea ML, Aby J, Macmahon J, Bair E. Ankyloglossia: incidence and associated feeding difficulties. Arch Otolaryngol Head Neck Surg 2000;126:36-9.

Monaci G, Woolridge M. Ultrasound video analysis for understanding infant breastfeeding. 18th IEEE International Congress of Image Processing, Brussels, Belgium, 11-14 September 2011.

Geddes DT, Langton DB, Gollow I, Jacobs LA, Hartmann PE, Simmer K. Frenulotomy for breastfeeding infants with ankyloglossia: effect on milk removal and sucking mechanism as imaged by ultrasound. Pediatrics 2008;122:e188-94.

Woolridge MW. Evidence that a short frenulum hampers the establishment of breastfeeding. Paediatr Int Child Health 2013;33:59-60.

Messner AH, Lalakea ML. Ankyloglossia: controversies in management. Int J Pediatr Otorhinolaryngol 2000;54:123-31.

Griffiths DM. Do tongue ties affect breastfeeding? J Hum Lact 2004;20:409-14.

Ballard JL, Auer CE, Khoury JC. Ankyloglossia: assessment, incidence, and effect of frenuloplasty on the breastfeeding dyad. Pediatrics 2002;110:e63.

Berry J, Griffiths M, Westcott C. A double-blind, randomized, controlled trial of tongue-tie division and its immediate effect on breastfeeding. Breastfeed Med 2012;7:189-93.

Bowley DM, Arul GS. Fifteen-minute consultation: the infant with a tongue-tie. Arch Dis Child Educ Pract Ed 2014;99:127-9.

Muldoon K, Gallagher L, McGuinness D, Smith V. Effect of frenotomy on breastfeeding variables in infants with ankyloglossia (tongue-tie): a prospective before and after cohort study. BMC Pregnancy Childbirth 2017;17:373.

Schlatter SM, Schupp W, Otten JE, et al. The role of tonguetie in breastfeeding problems: a prospective observational study. Acta Paediatr 2019;108:2214-21.

Edmunds J, Miles SC, Fulbrook P. Tongue-tie and breastfeeding: a review of the literature. Breastfeed Rev 2011;19:19-26.

Francis DO, Chinnadurai S, Morad A, et al. Treatments for ankyloglossia and ankyloglossia with concomitant liptie. Rockville (MD): Agency for Healthcare Research and Quality (US); 2015. Report No.: 15-EHC011-EF.

Buryk M, Bloom D, Shope T. Efficacy of neonatal release of ankyloglossia: a randomized trial. Pediatrics 2011;128:280-8.

Avau B, Bekkering T, Cools F. Frenotomy in newborns with tongue-tie may improve maternal nipple pain, but its effect on breastfeeding is unclear. Cochrane Corner.

Breastfeeding Survey 2017. Department of Health, Hong Kong; 2017.

Tarrant M, Fong DY, Wu KM, et al. Breastfeeding and weaning practices among Hong Kong mothers: a prospective study. BMC Pregnancy Childbirth 2010;10:27.

Fu ICY, Fong DYT, Heys M, Lee ILY, Sham A, Tarrant M. Professional breastfeeding support for first-time mothers: a multicentre cluster randomised controlled trial. BJOG 2014;121:1673-83.

Leiter J, Naegeli J, Walkley L. The effect of lactation consultation on the duration of breastfeeding in new mothers: a systematic review. Available at: http://ideaexchange.uakron.edu/honors_research_projects/720. Accessed 2 June 2020.

Lawson A. To snip or not to snip: the dilemmas of tongue-tie. Arch Dis Child Fetal Neonatal Ed 2014;99:F178-9.

Dixon B, Gray J, Elliot N, Shand B, Lynn A. A multifaceted programme to reduce the rate of tongue-tie release surgery in newborn infants: observational study. Int J Pediatr Otorhinolaryngol 2018;113:156-63.

Ingram J, Johnson D, Copeland M, Churchill C, Taylor H, Emond A. The development of a tongue assessment tool to assist with tongue-tie identification. Arch Dis Child Fetal Neonatal Ed 2015;100:F344-8.

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Published

2023-04-06

How to Cite

1.
LAM CC-O, WONG S-K, WONG FC-Y. Effect of frenotomy for tongue-tie on improving breastfeeding. Hong Kong J Gynaecol Obstet Midwifery [Internet]. 2023 Apr. 6 [cited 2024 Mar. 28];20(2). Available from: https://hkjgom.org/home/article/view/282

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