Laurie Barclay, MD
Nov. 7, 2002 - Frenuloplasty is a successful strategy to resolve ankyloglossia, a common problem in newborns that disrupts normal breastfeeding, according to a report published online in the November issue of Pediatrics.
"Ankyloglossia in breastfeeding infants can cause ineffective latch, inadequate milk transfer, and maternal nipple pain, resulting in untimely weaning," write Jeanne L. Ballard, MD, and colleagues from the University of Cincinnati in Ohio. "The question of whether the performance of a frenuloplasty benefits the breastfeeding dyad in such a situation remains controversial."
In 2,763 inpatient infants and 273 outpatient infants with breastfeeding problems, ankyloglossia was diagnosed in 88 inpatients (3.2%) and in 35 outpatients (12.8%). Mean scores on the Hazelbaker Assessment Tool for Lingual Frenulum Function were similar in mother-infant pairs who had poor latch or nipple pain. Median infant age at presentation was 1.2 days in those with poor latch and 2.0 days in those with nipple pain.
"We believe that inspection of the tongue and its function should be a part of the routine neonatal examination, whether the infant is breastfeeding or not," the authors write. "Thus, parents can be apprised of the presence and severity of ankyloglossia and made aware of potential feeding, speech, and dental problems."
Infants with impaired lingual function underwent frenuloplasty, with no operative complications, and were returned to their mothers for breastfeeding. Latch improved in all cases, and maternal pain levels graded on a 1 to 10 scale decreased from 6.9 ± 2.31 preoperatively to 1.2 ± 1.52 postoperatively.
Because of study limitations, including lack of control group without frenuloplasty, limited follow-up of breastfeeding duration, and no controlled validation of the Hazelbaker assessment, the investigators recommend randomized controlled trials.
"Ankyloglossia is a relatively common finding in the newborn population and represents a significant proportion of breastfeeding problems," the authors write. "Careful assessment of the lingual function, followed by frenuloplasty when indicated, seems to be a successful approach to the facilitation of breastfeeding in the presence of significant ankyloglossia."
Pediatrics. 2002;110:e63
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