Removal and Sucking Mechanism as Imaged by Ultrasound Frenulotomy for Breastfeeding Infants With Ankyloglossia: Effect on Milk

OBJECTIVE. There is evidence that infants with ankyloglossia can experience breastfeeding difficulties including poor attachment to the breast, suboptimal weight gain, and maternal nipple pain, which may lead to early weaning of the infant. No studies have investigated the cause of these breastfeeding difficulties. The objective of this study was to determine the effectiveness of frenulotomy in infants experiencing persistent breastfeeding difficulties despite professional assistance by measuring changes in milk transfer and tongue movement during breastfeeding before and after frenulotomy. PATIENTS AND METHODS. Twenty-four mother-infant dyads (infant age: 33 28 days) that were experiencing persistent breastfeeding difficulties despite receiving professional advice were recruited. Submental ultrasound scans (Acuson XP10) of the oral cavity were performed both before and 7 days after frenulotomy. Milk transfer, pain, and LATCH (latch, audible swallowing, type of nipple, comfort, and hold) scores were recorded before and after frenulotomy. Infant milk intake was measured by using the test-weigh method. RESULTS. For all of the infants, milk intake, milk-transfer rate, LATCH score, and maternal pain scores improved significantly postfrenulotomy. Two groups of infants were identified on ultrasound. One group compressed the tip of the nipple, and the other compressed the base of the nipple with the tongue. These features either resolved or lessened in all except 1 infant after frenulotomy. CONCLUSIONS. Infants with ankyloglossia experiencing persistent breastfeeding difficulties showed less compression of the nipple by the tongue postfrenulotomy, which was associated with improved breastfeeding defined as better attachment, increased milk transfer, and less maternal pain. In the assessment of breastfeeding difficulties, ankyloglossia should be considered as a potential cause. Pediatrics 2008;122:e188–e194 P ANKYLOGLOSSIA IS defined as a short lingual frenulum that results in restricted range of tongue movement such as limitation of the forward protrusion of the tongue and/or lateral mobility of the tongue.1 The reported incidence of ankyloglossia ranges from 3.2% to 10.7%.2–4 There is evidence associating this condition with feeding, swallowing, and speech difficulties.3–6 In particular, between 12.8% and 44% of infants reportedly experience breastfeeding problems,3,4 yet the clinical significance of ankyloglossia still remains controversial.6 With heightened awareness of the risks to infants not receiving breast milk,7–9 breastfeeding rates have increased since the early 1970s. However, despite increased initiation, the duration of breastfeeding is often short, with only approximately half of Australian and West Australian women still exclusively breastfeeding at 3 months10 and 1% at 6 months.10,11 The main causes given for early weaning of the infant are either real or perceived insufficient milk supply and nipple pain. Both of these symptoms have been associated with ankyloglossia, and, therefore, ankyloglossia should be considered as a contributing factor when assessing women with breastfeeding difficulties. www.pediatrics.org/cgi/doi/10.1542/ peds.2007-2553 doi:10.1542/peds.2007-2553