Prevalence of ankyloglossia among infants with breastfeeding difficulties: a systematic review.

BACKGROUND

Ankyloglossia is a lingual frenulum alteration that restricts tongue movements and may be related to breastfeeding difficulties. This study aimed to determine the estimated proportion of ankyloglossia among infants with breastfeeding difficulties.

METHODS

The protocol was registered in PROSPERO (#CRD42023394743). Eight electronic databases were searched up to March 20th, 2023, and updated to January 14th, 2025. Inclusion criteria were observational studies that evaluated ankyloglossia among infants up to 24 months with breastfeeding difficulties, using any assessment tool to diagnose ankyloglossia and breastfeeding difficulties. The risk of bias was assessed using the Joanna Briggs Institute (JBI) appraisal tool for prevalence studies. The estimated proportion of ankyloglossia and 95 % confidence intervals (CI) were calculated through a random-effect model meta-analysis of proportion.

RESULTS

Twelve studies (ten cross-sectional, two cohort) with 8538 infants were included. The overall estimated proportion of ankyloglossia among breastfeeding difficulties was 34 % (95 %CI: 12 %-61 %) using an ankyloglossia and a breastfeeding difficulties assessment tool. The estimated proportion varied from 9 % using UNICEF Breastfeeding Assessment and Observation Protocol (95 %CI: 0-34 %) to 74 % (95 %CI: 60 %-84 %) using LATCH Breastfeeding Assessment Tool. The estimated proportion of breastfeeding difficulties was 30 % (95 %CI: 19 %-43 %).

CONCLUSIONS

Close to 34 % of infants with breastfeeding difficulties have ankyloglossia, and the overall estimated proportion of breastfeeding difficulties was around 30 %. The proportion may vary depending on the assessment tool used. As seven out of 10 infants had breastfeeding difficulties not due to ankyloglossia, clinicians should carefully evaluate other causes that impact breastfeeding before referring the patient to surgical interventions.