Frenotomy for tongue-tie in newborn infants.

BACKGROUND

Tongue-tie (ankylglossia) occurs when there is an anterior attachment near the tip of the tongue resulting in restricted tongue movement. It is reported to be a cause of poor breastfeeding in infants and nipple pain in breastfeeding mothers.

OBJECTIVES

The objectives of the study were to determine whether frenotomy is safe and effective in improving ability to feed orally among infants.

INTERVENTION/

METHODS

Frenotomy may correct the restriction of tongue movement and allow improved breast feeding and reduced maternal nipple pain. Randomised, quasi-randomised cluster-randomised controlled trials that compared frenotomy verses no frenotomy or frenotomy verses sham procedure were included in the review. Participants were infants with tongue-tie experiencing feeding problems, or whose breast feeding mothers were experiencing nipple pain.

RESULTS

Five studies (N = 302) met the inclusion criteria. Pooled analysis of two studies showed no change following frenotomy (mean difference (MD) -0.1, 95% confidence interval (CI) -0.6 to 0.5 units on a 10-point feeding scale). A third study showed objective improvement on a 12-point feeding scale (MD 3.5, 95% CI 3.1 to 4.0 units of a 12-point feeding scale). Pooled analysis of three studies (n = 212) showed a reduction in maternal pain scores following frenotomy (MD -0.7, 95% CI -1.4 to -0.1 units on a 10-point pain scale). These studies had serious methodological shortcomings.

CONCLUSION

Investigators did not find a consistent positive effect on infant breastfeeding following frenotomy. A short-term reduction in breast pain was found among breastfeeding mothers. Small trial numbers and methodological issues meant no definitive benefit for frenotomy in infants with tongue-tie could be proved.