ABM Clinical Protocol #11: Guidelines for the Evaluation and Management of Neonatal Ankyloglossia and Its Complications in the Breastfeeding Dyad: The Academy of Breastfeeding Medicine: ABM Protocols

Abstract

A central goal of The Academy of Breastfeeding Medicine is the development of clinical protocols for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient.

Definition

Ankyloglossia, partial: The presence of a sublingual frenulum that changes the appearance or function of the infant’s tongue because of its decreased length, lack of elasticity, or attachment too distal beneath the tongue or too close to or onto the gingival ridge. In this document we will refer to partial ankyloglossia as simply “ankyloglossia.” “True” or “complete ankyloglossia,” extensive fusion of the tongue to the floor of the mouth, is extremely rare and is not within the scope of this discussion.

Background

At birth, the infant’s tongue is normally able to extend over and past the mandibular gum pad. Significant ankyloglossia prevents an infant from anteriorly extending and elevating the tongue, and many breastfeeding experts believe that these limitations alter the normal peristaltic motion of the tongue during feeding, resulting in the potential for nipple trauma and problems with effective milk transfer and infant weight gain.

Ankyloglossia, commonly known as tongue-tie, occurs in approximately 3.2% to 4.8% of consecutive term infants at birth and in 12.8% of infants with breastfeeding problems. The condition has been associated with an increased incidence of breastfeeding difficulties: 25% in affected versus 3% in unaffected infants.

Various methods have been suggested to diagnose and evaluate the severity of ankyloglossia and to determine the criteria for intervention. Short- and long-term consequences of ankyloglossia may include feeding and speech difficulties, as well as orthodontic and mandibular abnormalities and psychological problems.

In the 1990s a number of case reports and observational studies were published that documented an association between ankyloglossia and breastfeeding problems. There is considerable controversy regarding the significance of ankyloglossia and its management, both within and among medical specialty groups. Both the diagnosis of ankyloglossia and the use of frenotomy, an incision or “snipping” of the frenulum, to treat ankyloglossia vary widely. The frenotomy procedure, carefully performed, has recently been shown to decrease maternal nipple pain to improve infant latch, and to improve milk transfer (personal communication, J. Ballard, July 27, 2004). There is a growing tendency among breastfeeding medicine specialists to favor releasing the tongue of the infant to facilitate breastfeeding and to protect the breastfeeding experience. To date, no randomized trials exist to demonstrate frenotomy for ankyloglossia is effective in treating infant or maternal breastfeeding problems.