The American Academy of Pediatrics (AAP) recommends exclusive breastfeeding for about six months, continuing breastfeeding for two years or longer as mutually desired by parent and infant. But with increasing diagnoses of tongue-tie (ankyloglossia) in recent years, conversations among pediatricians, lactation specialists, and parents have ramped up. So, what’s the deal with tongue-tie, and when does it really matter?
Understanding Ankyloglossia
Ankyloglossia, commonly known as tongue-tie, is a variation of normal oral anatomy where the lingual frenulum – the tissue connecting the tongue to the floor of the mouth – appears shorter or more restrictive. There are no universally accepted diagnostic criteria for ankyloglossia, but during an exam, the tongue may appear tethered to the floor of the mouth, limiting its movement, and/or the tip of the tongue may appear heart-shaped.
Ankyloglossia in an older child
[Image attribution: Gzzz, CC BY-SA 4.0 <https://creativecommons.org/licenses/by-sa/4.0>, via Wikimedia Commons]
While this condition can be concerning, especially when it comes to breastfeeding, it is crucial to differentiate between normal anatomical variations and symptomatic ankyloglossia that truly impacts feeding.
In the AAP’s report “Identification and Management of Ankyloglossia and its Effects on Breastfeeding Infants: Clinical Report,” published in August 2024 Pediatrics, they review the research on diagnosis and treatment of ankyloglossia and offer evidence-based recommendations to help providers care for the breastfeeding infant. Let’s break it down!
What is “Symptomatic Ankyloglossia?”
Symptomatic ankyloglossia is characterized by a restrictive lingual frenulum that significantly interferes with breastfeeding, leading to issues such as:
These symptoms should be addressed through comprehensive lactation support before considering other interventions. In cases where breastfeeding problems persist despite thorough support, a minor surgical procedure called frenotomy may be considered to alleviate pain and improve feeding effectiveness. However, it is important to recognize that not all infants with ankyloglossia require intervention, especially those with normal feeding patterns.
Clarifying Misconceptions
The term “posterior ankyloglossia” has gained traction but remains poorly defined and lacks expert consensus. It should not be used as the sole reason for performing a frenotomy. Similarly, labial and buccal frenae are normal oral structures typically unrelated to breastfeeding mechanics and do not necessitate surgical correction. Another common finding on the lips of newborns is sucking blisters, which are normal and typically resolve on their own.
A Multidisciplinary Approach to Breastfeeding Difficulties
Breastfeeding is a complex process influenced by various factors. When nursing is painful or ineffective, a thorough breastfeeding assessment by a lactation specialist is a great starting point. Multidisciplinary communication between lactation specialists, feeding therapists, and pediatricians is crucial to ensuring the best outcomes for parents and infants. For infants with potential symptomatic ankyloglossia, close monitoring during the newborn period, including early follow-up and frequent weight checks after discharge, is recommended.
When frenotomy is deemed necessary, it should be performed by a trained professional. Infant frenotomy is most commonly performed by scissor clipping of the frenulum, though recently, there has been an increase in the use of lasers for frenotomy. According to the AAP, no evidence supports the use of laser over other methods of frenotomy.
Curious to dive deeper? Tune in to Peds RAP’s January 2024 episode, where we unpack the latest insights on tongue-tie and breastfeeding, featuring expert advice and practical tips for your practice. Don’t miss it!