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Black K. Posterior tongue tie: that is a thing? Curr Opin Otolaryngol Head Neck Surg 2024; 32:282-285. [PMID: 38869616 DOI: 10.1097/moo.0000000000000982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2024]
Abstract
PURPOSE OF REVIEW The purpose of this review is to examine the current research of the posterior tongue tie and how it relates to breast feeding, solid feeding, and speech. RECENT FINDINGS Recent findings show that the posterior tongue tie may play a role in effective breast feeding. SUMMARY Ankyloglossia is the term used for the restriction of the movement of the tongue that impairs certain functions such as breastfeeding or bottle feeding, feeding with solids, and speech. Cadaver studies have shown that there can be a restriction of the tongue and oral tissues in some people relative to others. In some breast-feeding studies, releasing the posterior tie has been shown to improve certain aspects of tongue movement. There is little evidence for or against posterior tongue ties contributing to other problems such as speech and solid feeding. This article goes into depth about the current studies on posterior ankyloglossia.
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Affiliation(s)
- Kaelan Black
- Otolaryngology Associates, PC, Fairfax, Virginia, USA
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Bacarreza-Nogales DV, Ruiz-Castillo MA, Cázares-Méndez JM, Chávez-Barrera JA, Fernández-Ortiz SJ, Guillén-Chávez A, Hernández-Vez G, López-Ugalde MV, Montijo-Barrios E, Toro-Monjaraz E, Trauernicht-Mendieta S, Garza J, Rodríguez L. The consensus of the Asociación Mexicana de Gastroenterología on the diagnosis and treatment of gastroesophageal reflux and gastroesophageal reflux disease in infants. REVISTA DE GASTROENTEROLOGIA DE MEXICO (ENGLISH) 2024; 89:265-279. [PMID: 38789310 DOI: 10.1016/j.rgmxen.2024.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 02/28/2024] [Indexed: 05/26/2024]
Abstract
Gastroesophageal reflux (GER) is a frequent normal phenomenon in children of any age. It is more common in infants, in whom the majority of episodes are short-lived and cause no other symptoms or complications, differentiating it from gastroesophageal reflux disease (GERD). The diagnosis and management of GER and GERD continue to be a challenge for the physician. Therefore, the aim of the Asociación Mexicana de Gastroenterología was to adapt international documents to facilitate their adoption by primary care physicians, with the goal of standardizing quality of care and reducing the number of diagnostic tests performed and inappropriate medication use. The ADAPTE methodology was followed, and the recommendations were approved utilizing the Delphi strategy. The executive committee carried out the review of the guidelines, position papers, and international reviews that met the a priori quality criteria and possible applicability in a local context. The recommendations were taken from those sources and adapted, after which they were approved by the working group. The consensus consists of 25 statements and their supporting information on the diagnosis and treatment of GER and GERD in infants. The adapted document is the first systematic effort to provide an adequate consensus for use in Mexico, proposing a practical approach to and management of GER and GERD for healthcare providers.
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Affiliation(s)
| | - M A Ruiz-Castillo
- Servicio de Gastroenterología Pediátrica, Hospital del niño DIF, Pachuca, Hidalgo, Mexico.
| | | | - J A Chávez-Barrera
- Departamento de Gastroenterología, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - S J Fernández-Ortiz
- Instituto de Pediatría Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Nuevo León, Mexico
| | - A Guillén-Chávez
- Servicio de Neonatología, Hospital de Ginecoobstetricia No 7, Instituto Mexicano del Seguro Social, Tijuana, Baja California, Mexico
| | | | - M V López-Ugalde
- Centro Médico San Cristobal, San Cristobal de Las Casas, Chiapas, Mexico
| | - E Montijo-Barrios
- Departamento de Gastroenterología y Nutrición, Instituto Nacional de Pediatría, Mexico City, Mexico
| | - E Toro-Monjaraz
- Departamento de Gastroenterología y Nutrición, Instituto Nacional de Pediatría, Mexico City, Mexico
| | - S Trauernicht-Mendieta
- Departamento de Gastroenterología y Nutrición, Hospital Infantil de México Federico Gómez, Instituto Nacional de Salud, Mexico City, Mexico
| | - J Garza
- GI Care for Kids Children's Healthcare of Atlanta, Georgia, United States
| | - L Rodríguez
- Centro de Neuro-gastroenterología y Motilidad, Universidad de Yale, New Haven, Connecticut, United States
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Cordray H, Raol N, Mahendran GN, Tey CS, Nemeth J, Sutcliffe A, Ingram J, Sharp WG. Quantitative impact of frenotomy on breastfeeding: a systematic review and meta-analysis. Pediatr Res 2024; 95:34-42. [PMID: 37608056 DOI: 10.1038/s41390-023-02784-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 07/31/2023] [Indexed: 08/24/2023]
Abstract
BACKGROUND Symptoms related to infant ankyloglossia/tongue-tie may deter mothers from breastfeeding, yet frenotomy is controversial. METHODS Databases included PubMed, Embase, CINAHL, PsycINFO, Web of Science, and Google Scholar from 1961-2023. Controlled trials and cohort studies with validated measures of surgical efficacy for breastfeeding outcomes were eligible. Meta-analyses synthesized data with inverse-variance weighting to determine standardized mean differences (SMD) between pre-/postoperative scores. RESULTS Twenty-one of 1568 screened studies were included. Breastfeeding self-efficacy improved significantly post-frenotomy: medium effect after 5-10 days (SMD 0.60 [95% CI: 0.48, 0.71; P < 0.001]), large effect after 1 month (SMD 0.91 [CI: 0.79, 1.04; P < 0.001]). Nipple pain decreased significantly post-frenotomy: large effect after 5-15 days (SMD -1.10 [CI: -1.49, -0.70; P < 0.001]) and 1 month (SMD -1.23 [CI: -1.79, -0.67; P = 0.002]). Frenotomy had a medium effect on infant gastroesophageal reflux severity at 1-week follow-up (SMD -0.63 [CI: -0.95, -0.31; P = 0.008]), with continued improvement at 1 month (SMD -0.41 [CI: -0.78, -0.05; P = 0.04]). From LATCH scores, breastfeeding quality improved after 5-7 days by a large SMD of 1.28 (CI: 0.56, 2.00; P = 0.01). CONCLUSIONS Providers should offer frenotomy to improve outcomes in dyads with ankyloglossia-associated breastfeeding difficulties. PROTOCOL REGISTRATION PROSPERO identifier CRD42022303838 . IMPACT This systematic review and meta-analysis showed that breastfeeding self-efficacy, maternal pain, infant latch, and infant gastroesophageal reflux significantly improve after frenotomy in mother-infant dyads with breastfeeding difficulties and ankyloglossia. Providers should offer frenotomy to improve breastfeeding outcomes in symptomatic mother-infant dyads who face challenges associated with ankyloglossia.
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Affiliation(s)
- Holly Cordray
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- Children's Healthcare of Atlanta, Atlanta, GA, USA
- Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Nikhila Raol
- Children's Healthcare of Atlanta, Atlanta, GA, USA.
- Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, GA, USA.
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.
| | - Geethanjeli N Mahendran
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, MA, USA
| | - Ching Siong Tey
- Children's Healthcare of Atlanta, Atlanta, GA, USA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
- Department of Psychology, University of Georgia, Athens, GA, USA
| | - John Nemeth
- Emory University Woodruff Health Sciences Center Library, Atlanta, GA, USA
| | - Alastair Sutcliffe
- Population, Policy, and Practice Department, Institute of Child Health, University College London, London, UK
| | | | - William G Sharp
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
- Marcus Autism Center, Atlanta, GA, USA
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Shaw MA, Liu A. Nutritional Considerations for the First Year of Life. Pediatr Ann 2023; 52:e316-e321. [PMID: 37695279 DOI: 10.3928/19382359-20230720-08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
Feeding during the first year of life is a dynamic process with unique questions, concerns, and milestones emerging at every step. This article will review a small selection of specific questions and concerns related to feeding in the first 12 months of infancy. The aim of this article is to inform and support pediatric providers and parents during this crucial developmental period. [Pediatr Ann. 2023;52(9):e316-e321.].
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Cordray H, Mahendran GN, Tey CS, Nemeth J, Sutcliffe A, Ingram J, Raol N. Severity and prevalence of ankyloglossia-associated breastfeeding symptoms: A systematic review and meta-analysis. Acta Paediatr 2023; 112:347-357. [PMID: 36437565 DOI: 10.1111/apa.16609] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 11/07/2022] [Accepted: 11/25/2022] [Indexed: 11/29/2022]
Abstract
AIM To evaluate breastfeeding symptoms associated with ankyloglossia/tongue-tie. METHODS Databases included PubMed, Embase, CINAHL, PsycINFO, Web of Science, and Google Scholar. Eligible studies reported baseline breastfeeding symptoms/severity from tongue-tied infants. Two reviewers independently screened studies, extracted data, and assessed quality. Low-quality studies were excluded. Main outcomes were weighted mean severity scores for dyads with ankyloglossia relative to reference values for successful breastfeeding. Meta-analyses used inverse-variance-weighted random-effects models. RESULTS Of 1328 screened studies, 39 were included (5730 infants with ankyloglossia). The mean LATCH score for patients with untreated ankyloglossia, 7.1 (95% CI: 6.7-7.4), was significantly below the good-breastfeeding threshold. The mean Infant Breastfeeding Assessment Tool score, 10.0 (8.2-11.7), was not significantly below the good-breastfeeding threshold. The mean Infant-Gastroesophageal Reflux Questionnaire-Revised score, 18.2 (10.5-26.0), was consistent with gastroesophageal reflux disease. The mean Breastfeeding Self-Efficacy Scale-Short Form score, 43.7 (39.3-48.1), indicated significant risk of cessation of exclusive breastfeeding within 1-3 months. Mean nipple pain was 4.9 (4.1-5.7) on a 0-10 scale, greater than typical scores for breastfeeding mothers without nipple damage. Total prevalence of breastfeeding difficulties was 49.3% (95% CI: 47.3-51.4%). Early, undesired weaning occurred in 20.3% (18.5-22.2%) of cases before intervention. CONCLUSION Ankyloglossia is adversely associated with breastfeeding success and maternal well-being.
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Affiliation(s)
- Holly Cordray
- Children's Healthcare of Atlanta, Atlanta, Georgia, USA.,Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Geethanjeli N Mahendran
- Emory University School of Medicine, Atlanta, Georgia, USA.,Rollins School of Public Health, Atlanta, Georgia, USA
| | - Ching Siong Tey
- Children's Healthcare of Atlanta, Atlanta, Georgia, USA.,Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA.,Department of Psychology, University of Georgia, Athens, Georgia, USA
| | - John Nemeth
- Emory University Woodruff Health Sciences Center Library, Atlanta, Georgia, USA
| | - Alastair Sutcliffe
- Population, Policy, and Practice Department, Institute of Child Health, University College London, London, UK
| | | | - Nikhila Raol
- Children's Healthcare of Atlanta, Atlanta, Georgia, USA.,Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, Georgia, USA.,Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
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Hill RR, Pados BF. Gastrointestinal Symptom Improvement for Infants Following Tongue-Tie Correction. Clin Pediatr (Phila) 2023; 62:136-142. [PMID: 35945826 DOI: 10.1177/00099228221117459] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Treatment of tongue-tie in infants suggests improvements for breastfeeding mothers, including reduced nipple pain and improved latching onto the breast. The effects of frenotomy on infant feeding and gastrointestinal dysfunction remain controversial, with insufficient evidence on the relationship between tongue-tie and disorders of the gastrointestinal tract. The purpose of this study was to compare symptoms of gastrointestinal (GI) distress and gastroesophageal reflux (GER) prior to and 2 weeks following frenotomy in infants with tongue-tie. Parents were surveyed prior to frenotomy and 2 weeks post procedure, using the Gastrointestinal and Gastroesophageal Reflux (GIGER) Scale for Infants and Toddlers. Eighty-four participants completed surveys at both time points, with significant improvements in GI and GER symptoms 2 weeks after frenotomy. Younger infants and those with more severe tongue-tie had the greatest improvements in GI and GER symptoms. Infants with tongue-tie and symptoms of GI tract distress may experience improvement in symptoms after frenotomy.
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Affiliation(s)
- Rebecca R Hill
- MGH Institute of Health Professions School of Nursing, Boston, MA, USA
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Slagter KW, Raghoebar GM, Hamming I, Meijer J, Vissink A. Reply to the editor concerning: Effect of frenotomy on breastfeeding and reflux: results from the BRIEF prospective longitudinal cohort study. Clin Oral Investig 2021; 25:5115-5116. [PMID: 33988762 DOI: 10.1007/s00784-021-03974-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 04/30/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Kirsten W Slagter
- Department of Oral and Maxillofacial Surgery, University of Groningen and University Medical Center Groningen, Groningen, the Netherlands
| | - Gerry M Raghoebar
- Department of Oral and Maxillofacial Surgery, University of Groningen and University Medical Center Groningen, Groningen, the Netherlands
| | | | - Jiska Meijer
- General Practitioners Research Institute, Groningen, the Netherlands
| | - Arjan Vissink
- Department of Oral and Maxillofacial Surgery, University of Groningen and University Medical Center Groningen, Groningen, the Netherlands.
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Paul SP, Heaton PA. Letter to the Editor about the article published in Clinical Oral Investigations titled "Effect of frenotomy on breastfeeding and reflux: results from the BRIEF prospective longitudinal cohort study" (Slagter KW, Raghoebar GM, Hamming I, Meijer J, Vissink A. Clin Oral Investig. doi: 10.1007/s00784-020-03665-y). Clin Oral Investig 2021; 25:5117-5118. [PMID: 33950372 DOI: 10.1007/s00784-021-03973-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 04/29/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Siba Prosad Paul
- Department of Paediatrics, Yeovil District Hospital, Higher Kingston, Yeovil, BA21 4AT, UK.
| | - Paul Anthony Heaton
- Department of Paediatrics, Yeovil District Hospital, Higher Kingston, Yeovil, BA21 4AT, UK
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