Early Frenotomy Improves Breastfeeding Outcomes for Tongue-Tied Infants

Praborini, Asti; Purnamasari, Hani; Munandar, Agusnawati; Wulandari, Ratih Ayu

doi:10.1891/2158-0782.6.1.9

Cited by 8 publications

(6 citation statements)

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“…Classes 3 and 4 lip-tie may contribute to breastfeeding problems and require revision (Kotlow, 2011). Similar to our population, Pransky, Lago, and Hong (2015) also reported frequent anterior and posterior tongue-ties, upper lip-ties, or their combinations, with upper lip-tie release improving breastfeeding in all cases.…”

Section: Discussionsupporting

confidence: 84%

“…Frenotomy, which describes the cutting of the lingual frenulum, has been shown to effectively resolve breastfeeding difficulties in infants with tongue-tie in clinical studies (Garbin et al, 2013;Kumar & Kalke, 2012). Early frenotomy in an infant during lactogenesis II prior to day 8 appears to have a larger impact on weight gain and lactation performance than late frenotomy after Day 8, which while improving latching, only results in small weight increases due to reduced maternal milk supply (Praborini, Purnamasari, Munandar, & Wulandari, 2015). Therefore, following frenotomy, we suggest a combinatorial treatment in a baby with nutritional problems and a mother with low milk supply consisting of supplementation with lactation aid, domperidone, and acupuncture.…”

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confidence: 99%

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A Holistic Supplementation Regimen for Tongue-Tied Babies With Slow Weight Gain and Failure to Thrive

Praborini¹,

Setiani²,

Munandar³

et al. 2018

Clin Lactation

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Breastfeeding is the best way to feed infants, but optimal milk transfer and weight gain depend on good latching. Tongue- and lip-tie can prevent successful latching and prevent adequate nutrition. Tongue- and lip-tied babies can either have slow weight gain (SWG) or failure to thrive (FTT). We examine the effect of a holistic supplementation regimen on tongue-tied babies with SWG and FTT. This was a descriptive, cross-sectional study of 55 tongue- and lip-tied babies with SWG and FTT at KMC Hospital, Jakarta, Indonesia. All babies underwent frenotomy and received supplementation with formula (64%) or pasteurized donor breast milk, using either a modified lactation aid (78%) or the Medela Supplemental Nursing System (22%). All mothers received domperidone and acupuncture to improve milk supply. A majority of babies had type 3 tongue-tie (46%) and class 3 upper lip-tie. Twenty-five subjects (45%) had SWG, and 30 subjects (55%) had FTT. All mothers had low milk supply. At-the-breast supplementation improved the nutritional status of 44/55 subjects (80%,p< .001), whereas 11 subjects received early complementary feeding at 4 months of age. By the end of the study, all subjects were solely breastfed without at-the-breast supplementation. The holistic management of tongue- and lip-tied babies with SWG or FTT consisting of frenotomy, at-the-breast supplementation, domperidone, and acupuncture improved infant nutritional status and the mother’s milk supply. Babies could breastfeed without supplementation after treatment and gained weight.

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Section: Discussionsupporting

confidence: 84%

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confidence: 99%

A Holistic Supplementation Regimen for Tongue-Tied Babies With Slow Weight Gain and Failure to Thrive

Praborini¹,

Setiani²,

Munandar³

et al. 2018

Clin Lactation

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“…52 Once a mother has stopped breastfeeding, she will rarely restart, even if she has maintained her milk supply with pumping. The consensus group could not agree on a specific patient age where infant frenotomy would be most helpful but generally agreed with published studies advocating for early frenotomy, including infants who are \1 month of age [52][53][54] (Table 10).…”

Section: Frenotomy Indications and Informed Consentmentioning

confidence: 99%

Clinical Consensus Statement: Ankyloglossia in Children

Messner

Walsh

Rosenfeld

et al. 2020

Otolaryngol.--head neck surg.

113

157

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Objective To identify and seek consensus on issues and controversies related to ankyloglossia and upper lip tie in children by using established methodology for American Academy of Otolaryngology–Head and Neck Surgery clinical consensus statements. Methods An expert panel of pediatric otolaryngologists was assembled with nominated representatives of otolaryngology organizations. The target population was children aged 0 to 18 years, including breastfeeding infants. A modified Delphi method was used to distill expert opinion into clinical statements that met a standardized definition of consensus, per established methodology published by the American Academy of Otolaryngology–Head and Neck Surgery. Results After 3 iterative Delphi method surveys of 89 total statements, 41 met the predefined criteria for consensus, 17 were near consensus, and 28 did not reach consensus. The clinical statements were grouped into several categories for the purposes of presentation and discussion: ankyloglossia (general), buccal tie, ankyloglossia and sleep apnea, ankyloglossia and breastfeeding, frenotomy indications and informed consent, frenotomy procedure, ankyloglossia in older children, and maxillary labial frenulum. Conclusion This expert panel reached consensus on several statements that clarify the diagnosis, management, and treatment of ankyloglossia in children 0 to 18 years of age. Lack of consensus on other statements likely reflects knowledge gaps and lack of evidence regarding the diagnosis, management, and treatment of ankyloglossia. Expert panel consensus may provide helpful information for otolaryngologists treating patients with ankyloglossia.

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“…They found that there was no difference in the total length of breastfeeding between groups that underwent frenotomy within the first week of life or after the first week of life, but there was a subjective benefit, as reported by the mother, in the infant’s ability to feed if frenotomy was performed within the first week of life. In a small study by Praborini et al, 30 it was found that infants who underwent frenotomy before 8 days of age gained significantly more weight than those infants who underwent frenotomy after 8 days. A retrospective study by Sharma and Jayaraj 31 found improved breastfeeding unrelated to whether division was before 30 days of age or after.…”

Section: Resultsmentioning

confidence: 95%

How to Treat a Tongue-tie: An Evidence-based Algorithm of Care

Shekher

Lin

Zhang

et al. 2021

Plastic and Reconstructive Surgery - Global Open

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Background: Ankyloglossia, or tongue-tie, is characterized by a short or thickened lingual frenulum; this can be associated with impaired breastfeeding, speech, and dentofacial growth. The indications for performing frenotomy, frenuloplasty, or other operative interventions are unclear. Methods: A meta-analysis was performed to identify the extent of the benefit from frenotomy in breastfeeding measures, degree of tongue-tie, and maternal pain during feeding in randomized controlled trials. A structured literature review analyzed the optimal type and timing of repair. An algorithm was developed to incorporate this evidence into a management pathway. Results: Among 424 studies reviewed, 5 randomized controlled trials met inclusion criteria for meta-analysis. Frenotomy significantly improved the degree of tongue-tie, with a 4.5-point decrease in Hazelbaker Assessment Tool for Lingual Frenulum Function score compared with a decrease of 0 in those who did not undergo frenotomy ( P < 0.00001). This was associated with improved self-reported breastfeeding (relative risk [RR] = 3.48, P < 0.00001) and decreased pain (Short-Form McGill Pain Questionnaire, P < 0.00001); however, Breastfeeding Self-Efficacy–Short Form and Latch, Audible Swallowing, Type of Nipple, Comfort, Hold scores did not significantly improve. Multiple studies demonstrated significant improvements following frenuloplasty when compared with frenotomy but demonstrated mixed results as to the effect of timing of tongue-tie division. Conclusions: Frenotomy is associated with breastfeeding improvements that vary individually but trend toward significance collectively during a critical time in infant development. Among patients with a severe Hazelbaker Assessment Tool for Lingual Frenulum Function score or difficulty breastfeeding, we conclude that simple frenotomy without anesthetic is generally indicated in infancy and frenuloplasty under general anesthesia for older children.

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Early Frenotomy Improves Breastfeeding Outcomes for Tongue-Tied Infants

Cited by 8 publications

References 0 publications

A Holistic Supplementation Regimen for Tongue-Tied Babies With Slow Weight Gain and Failure to Thrive

A Holistic Supplementation Regimen for Tongue-Tied Babies With Slow Weight Gain and Failure to Thrive

Clinical Consensus Statement: Ankyloglossia in Children

How to Treat a Tongue-tie: An Evidence-based Algorithm of Care

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