Ankyloglossia, or Tongue-Tie, is a common topic of conversation for primary care providers and breastfeeding families. The Academy of Breastfeeding Medicine Position Statement on Ankyloglossia in the Breastfeeding Dyad (2021) and the American Academy of Pediatrics Clinical Report on the Identification and Management of Ankyloglossia and Its Effect on Breastfeeding in Infants (2024) are helpful resources when navigating the discussion.
Key Points:
- Ankyloglossia, or "tongue-tie" refers to a linqual frenulum that limits the motion of the tongue.
- Symptomatic ankyloglossia indicates the presence of a tight frenulum, with limited tongue movement, along with the presence of breastfeeding difficulties (i.e. pain, difficulty latching) that do not improve with lactation support.
- There are multiple causes of breastfeeding difficulties, so it is important to evaluate and consider all the factors before deciding on treatment.
- Families experience variability in diagnosis and treatment recommendations as there is not accepted diagnostic criteria, or standard indications for frenotomy treatment.
- While research is limited, and follow-up is generally short-term (~2 weeks), small randomized trials of frenotomy show a reduction in nipple pain following frenotomy, an important outcome given pain is a major reason for weaning.
- Further research on identifying ankyloglossia, long-term outcomes, and the natural history of ankyloglossia is needed.
Helpful starting points:
- Remember to evaluate breastfeeding and look at function. This is where integrating with your lactation colleagues can be very helpful!
- Before considering frenotomy, make certain the nursing dyad has a complete breastfeeding assessment to evaluate and address other potential causes of suboptimal breastfeeding.
- If choosing conservative management, make certain the family has follow-up in a setting with breastfeeding support, and future availability of frenotomy if needed.
Keep in mind:
- As the research evolves, patients need a balanced evidence-based discussion and the opportunity for shared decision making to help balance the variety of opinions received elsewhere.
- Multi-disciplinary team-based care has been shown to reduce frequency of unnecessary frenotomies without negatively impacting breastfeeding.
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