Tongue-tie raises the risk of breastfeeding problems

Newborn infants with tongue-tie (ankyloglossia) are more likely to have severe breastfeeding problems than infants without the condition, according to an observational study carried out in Germany in newborn mother-infant pairs. Low birth weight and prematurity also have a significant negative impact on breastfeeding, the investigation showed.

During a 10-month period, researchers enrolled 776 mother-infant pairs at a maternity unit nursery; all the infants were born after at least 35 weeks of gestation. To obtain data about the association of various factors with breastfeeding problems, investigators reviewed participants’ medical records related to pregnancy and birth; assessed infants’ frenulum using the Assessment Tool for Lingual Frenulum Function (ATLFF) score; used a breastfeeding questionnaire to explore mothers’ perception of breastfeeding; and administered a maternal pain scale as well as 2 objective breastfeeding scales to assess the effectiveness of breastfeeding.

Of total newborns, 116 (15%) had a tongue-tie, more than half of whom (55%) had breastfeeding problems compared with 42% of infants without a tongue-tie. In addition, severe breastfeeding problems were more common in newborn infants with tongue-tie than in those without it. Compared with the infants without tongue-tie, those with the condition had lower scores on the breastfeeding scales and their mothers had higher pain levels, indicating poorer latch and lower levels of milk transfer. Analysis showed that other risk factors for breastfeeding problems were no breastfeeding experience, low birth weight, prematurity, and birth by cesarean delivery.

Mothers who reported breastfeeding problems received support from a lactation consultant and, in infants with tongue-tie, a frenulotomy was performed, if indicated. Follow-up phone calls and administration of breastfeeding scales showed a significant reduction in breastfeeding problems after frenulotomy. Of the 33 infants with a clear indication for frenulotomy, those who underwent the procedure had significantly fewer breastfeeding problems after the surgery. Specifically, only 3 of 23 of the infants who had the procedure still had breastfeeding problems compared with 6 of the 10 who did not undergo a frenulotomy (Schlatter SM, et al. Acta Paediatr. 2019;108[12]:2214-2221).

Thoughts from Dr. Farber

Years ago, we didn’t clip tongue-tie because it doesn’t interfere with speech when the child is older. I agree that some children benefit but I am not convinced it is as many as reported here. Lactation support outside the hospital should reduce the number, as was demonstrated by Caloway and colleagues (Caloway C, et al. JAMA Otolaryngol Head Neck Surg. July 11, 2019. Epub ahead of print), who also report a surgical fee of $850 for the procedure. As more doctors (and dentists!) take up clipping tongues, we’re also going to see more complications.