Evidence of Improved Milk Intake After Frenotomy: A Case Report

Abstract

Ankyloglossia (tongue tie) is a well-recognized cause of breastfeeding difficulties and, if untreated, can cause maternal nipple pain and trauma, ineffective feeding, and poor infant weight gain. In some cases, this condition will result in a downregulation of the maternal milk supply. Milk-production measurements (24-hour) for a breastfeeding infant with ankyloglossia revealed the ineffective feeding of the infant (78 mL/24 hours), and a low milk supply (350 mL/24 hours) was diagnosed. Appropriate management increased milk supply (1254 mL/24 hours) but not infant milk intake (190 mL/24 hours). Test weighing convincingly revealed the efficacy of frenotomy, increasing breastfeeding milk transfer from 190 to 810 mL/24 hours. Postfrenotomy, breastfeeding almost completely replaced bottle-feeding of expressed breast milk. This case study confirms that ankyloglossia may reduce maternal milk supply and that frenotomy can improve milk removal by the infant. Milk-production measurements (24-hour) provided the evidence to confirm these findings.

Acquired palatal groove and delayed oral feeding in preterm infants

“…We have shown that palatal grooving itself significantly delayed, but did not disturb, the acquisition of oral feeding ability. During breast‐feeding, sucking of the breast produces a strong negative pressure in the pharynx of the infant, whereas a positive pressure is produced by pressing the nipple and breast against the palate, until “let down” or milk ejection reflux starts. After breast milk starts to flow, the infants may need less frequent sucking effort than at the beginning.…”

The Breastfeeding Dilemma: Misdiagnosed TOTS or Just Ignoring their Existence?

“…These TOTs are usually a combination of tongue-ties, medically known as ankyloglossia and upper lip-ties. They benefit breastfeeding by the release of the maxillary lip-tie and in some instances upper buccal restrictive frenum attachments which prevent the infant from achieving a good latch onto the mother's areola [1][2][3].…”

Ankyloglossia and breastfeeding

“…(14)(15)(16)(17) To nurse successfully, an infant must latch on to the areola using the upper gum ridge, buccal fatty pads and tongue. Suckling begins with forward movement of the jaw and tongue.…”