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Thomas J, Bunik M, Holmes A, Keels MA, Poindexter B, Meyer A, Gilliland A. Identification and Management of Ankyloglossia and Its Effect on Breastfeeding in Infants: Clinical Report. Pediatrics 2024; 154:e2024067605. [PMID: 39069819 DOI: 10.1542/peds.2024-067605] [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: 05/23/2024] [Revised: 05/23/2024] [Accepted: 05/24/2024] [Indexed: 07/30/2024] Open
Abstract
Ankyloglossia refers to a congenitally tight lingual frenulum that limits the motion of the tongue. Whether the release of a tight lingual frenulum in neonates improves breastfeeding is not clear. Because many of the symptoms of ankyloglossia overlap those of other breastfeeding difficulties, a team partnership is necessary.
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Affiliation(s)
- Jennifer Thomas
- Department of Pediatrics, Advocate Aurora Health, Milwaukee, Wisconsin
| | - Maya Bunik
- Department of Pediatrics, University of Colorado, School of Medicine, and Children's Hospital Colorado, Aurora, Colorado
| | - Alison Holmes
- Section of Pediatric Hospital Medicine, Department of Pediatrics, Dartmouth Health Children's/Geisel School of Medicine, Lebanon, New Hampshire
| | - Martha Ann Keels
- Department of Pediatrics, Duke University, and Division of Pediatric Dentistry and Public Health, Adams School of Dentistry, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina
| | - Brenda Poindexter
- Department of Pediatrics, Children's Healthcare of Atlanta and Emory University School of Medicine, Atlanta, Georgia
| | - Anna Meyer
- Department of Pediatrics, University of California San Francisco School of Medicine, and University of California San Francisco Benioff Children's Hospital San Francisco, San Francisco, California
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McKenna MK, Rosen-Carole C, Burtner M, Wilson JL, Greenman S, Shah S, Allen P. Tongue-tie in the Neonatal Intensive Care Unit Compared to Healthy Newborns. Laryngoscope 2024. [PMID: 39021346 DOI: 10.1002/lary.31615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 06/07/2024] [Accepted: 06/17/2024] [Indexed: 07/20/2024]
Abstract
OBJECTIVE We sought to characterize the prevalence of ankyloglossia in our neonatal intensive care unit (NICU) population and to determine characteristics of this cohort compared to infants in the birth center (BC). METHODS Prospective data were collected using a standardized flow sheet. Breastfeeding infants undergoing evaluation for tongue-tie in the BC and NICU were included. Coryllos type, tip to frenulum length, tongue function, frequency of frenotomy, and breastfeeding outcomes were compared. RESULTS Of 20,879 infants birthed at or admitted to the institution during the study period, there were fewer patients diagnosed with ankyloglossia in the BC compared to the NICU (3.3% BC vs. 5.4% NICU, p < 0.01). Of these, 163 underwent frenotomy: 86 in the BC and 77 in the NICU. For those undergoing frenotomy, gestational age (39.1 ± 1.3 BC, 34.4 ± 4.4 NICU, p < 0.01) and age at time of procedure (3.2 days BC, 29.2 NICU, p < 0.01) were the only demographic factors significantly different between the groups. There was no difference in Coryllos type or function score. In a subset of NICU infants with multiple assessments over time, function scores after frenotomy were significantly improved compared to pre-frenotomy (p < 0.01). CONCLUSION Standard assessment tools appear to be appropriate for use in infants in the NICU, despite the higher rates of prematurity, low birth weights, and increased comorbidities. Assessment and intervention for tongue-tie can be one critical intervention to move these patients closer to oral feeding and discharge to home. LEVEL OF EVIDENCE Level 3 Laryngoscope, 2024.
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Affiliation(s)
- Margo K McKenna
- Department of Otolaryngology, University of Rochester Medical Center, Rochester, New York, U.S.A
| | - Casey Rosen-Carole
- Division of Breastfeeding and Lactation Medicine, Department of Obstetrics and Gynecology and Pediatrics, University of Rochester Medical Center, Rochester, New York, U.S.A
| | - Michele Burtner
- Division of Breastfeeding and Lactation Medicine, Department of Obstetrics and Gynecology and Pediatrics, University of Rochester Medical Center, Rochester, New York, U.S.A
| | - John L Wilson
- Department of Otolaryngology, University of Rochester Medical Center, Rochester, New York, U.S.A
| | - Suzie Greenman
- University of Rochester School of Medicine and Dentistry, Rochester, New York, U.S.A
| | - Shalini Shah
- University of Rochester School of Medicine and Dentistry, Rochester, New York, U.S.A
| | - Paul Allen
- Department of Otolaryngology, University of Rochester Medical Center, Rochester, New York, U.S.A
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3
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Batista CLC, Pereira ALP. Influence of Neonatal Ankyloglossia on exclusive breastfeeding in the six first months of life: a cohort study. Codas 2024; 36:e20230108. [PMID: 38922259 PMCID: PMC467001 DOI: 10.1590/2317-1782/20242023108pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 09/25/2023] [Indexed: 06/27/2024] Open
Abstract
PURPOSE To analyze the influence of ankyloglossia on the prevalence and duration of exclusive breastfeeding of full-term infants up to the sixth month of life. METHODS Prospective cohort study, carried out with 225 mother-infant dyads who were followed up in the first six months of life in a center specialized in breastfeeding in a tertiary hospital. Full-term infants with asymptomatic ankyloglossia (no need for surgery) were compared with infants without change at monthly follow-up. Ankyloglossia was diagnosed using the Bristol Tongue Assessment Tool, with a positive diagnosis being considered for those with a score less than or equal to 5 considering functional and anatomical aspects. Statistical analyzes were performed using descriptive statistics, logistic regression (weaning determinants), relative risk, and survival curves (to analyze breastfeeding duration between groups with and without ankyloglossia). RESULTS Ankyloglossia was associated with weaning (considered even partial) before the sixth month of life. After adjusted analysis, a higher risk of weaning was detected in infants with this alteration, with a risk present from the second month of life. In the survival analysis, the duration of breastfeeding in infants with ankyloglossia was shorter when compared to children without alterations. CONCLUSION Compared to infants with normal lingual frenulum, babies with ankyloglossia had shorter exclusive breastfeeding time, but well above the average observed in the general population. The risk of weaning for this group was also higher.
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Affiliation(s)
| | - Alex Luiz Pozzobon Pereira
- Programa de Pós-graduação em Odontologia, Universidade Federal do Maranhão – UFMA - São Luís (MA), Brasil.
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Maya-Enero S, Ruiz-Guzmán L, Candel-Pau J, Duran-Jordà X, López-Vílchez MÁ. Impact of Neonatal Frenotomy on Breastfeeding in the Medium Term: A Cross-Sectional Study. Indian J Pediatr 2024; 91:630. [PMID: 38010556 DOI: 10.1007/s12098-023-04967-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 11/21/2023] [Indexed: 11/29/2023]
Affiliation(s)
- Silvia Maya-Enero
- Department of Neonatology, Service of Pediatrics, Hospital del Mar, Parc de Salut Mar, Universitat Pompeu Fabra, Passeig Marítim 25-29, 08003, Barcelona, Spain.
| | - Luis Ruiz-Guzmán
- Breastfeeding Unit, Gavà Salut Familiar, Cap de Creus 21, 08850, Gavà, Spain
- UDIADEAN, Tongue-tie Clinic, Service of Pediatrics, Primary Health Care Centre 17 de Setembre, Institut Català de la Salut, El Prat de Llobregat, Spain
| | - Júlia Candel-Pau
- Department of Neonatology, Service of Pediatrics, Hospital del Mar, Parc de Salut Mar, Universitat Pompeu Fabra, Passeig Marítim 25-29, 08003, Barcelona, Spain
| | - Xavier Duran-Jordà
- AMIB (Assessoria Metodològica i Bioestadística) (Methodological and Biostatistical Consultancy), IMIM (Institut Hospital del Mar d'Investigacions Mèdiques) (Hospital del Mar Institute for Medical Research), Doctor Aiguader 88, 08003, Barcelona, Spain
| | - María Ángeles López-Vílchez
- Department of Neonatology, Service of Pediatrics, Hospital del Mar, Parc de Salut Mar, Universitat Pompeu Fabra, Passeig Marítim 25-29, 08003, Barcelona, Spain
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Hirani SAA. Barriers Affecting Breastfeeding Practices of Refugee Mothers: A Critical Ethnography in Saskatchewan, Canada. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:398. [PMID: 38673311 PMCID: PMC11050554 DOI: 10.3390/ijerph21040398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 03/16/2024] [Accepted: 03/22/2024] [Indexed: 04/28/2024]
Abstract
Refugee mothers are vulnerable to cultural stereotyping and socioeconomic hardships when they migrate to a new country. This vulnerability often has a negative impact on refugee mothers' breastfeeding practices. Saskatchewan is one of the growing provinces in Canada that has a noticeable increase in refugee population with young children and limited availability of healthcare settings with baby-friendly status. Considering existing gaps in knowledge, this critical ethnographic study aimed to explore barriers that impede the breastfeeding practices of refugee mothers in Saskatchewan. After seeking ethics approval, data were collected using multiple methods, including in-depth interviews undertaken with 27 refugee mothers with young children of age range 1 day to 24 months, a review of media communications and field observations of community-based services/facilities available to refugee mothers. Findings suggest that psychosocial barriers, healthcare barriers, environmental barriers, and maternal and child health-related barriers impede the breastfeeding practices of refugee mothers in Saskatchewan. Breastfeeding practices of refugee mothers can be promoted through healthcare support, culturally appropriate services, interpretation services in healthcare settings, implementation of baby-friendly initiatives, hospital and community-based breastfeeding campaigns, and follow-up services. Collaborative efforts by healthcare settings, healthcare providers, policymakers, public health agencies, service providers, and governments are essential to support the breastfeeding practices of refugee mothers.
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Affiliation(s)
- Shela Akbar Ali Hirani
- Faculty of Nursing, University of Regina, 516 RIC, 3737 Wascana Parkway, Regina, SK S4S 0A2, Canada
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Jackson L, Fallon V, Harrold JA, De Pascalis L. Psychosocial predictors of post-natal anxiety and depression: Using Structural Equation Modelling to investigate the relationship between pressure to breastfeed, health care professional support, post-natal guilt and shame, and post-natal anxiety and depression within an infant feeding context. MATERNAL & CHILD NUTRITION 2024; 20:e13558. [PMID: 37752680 PMCID: PMC10750005 DOI: 10.1111/mcn.13558] [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: 01/05/2023] [Revised: 06/30/2023] [Accepted: 08/03/2023] [Indexed: 09/28/2023]
Abstract
High perceived pressure to breastfeed and poor perceived quality of health care professional support have been associated with early breastfeeding cessation, guilt, and shame. This is problematic because guilt and shame significantly predict post-natal anxiety and depression. No previous attempts have been made to provide quantitative evidence for relationships mapped between the post-natal social context, infant feeding method and post-natal emotional well-being. The current study aimed to empirically investigate aforementioned pathways. Structural equation modelling was applied to survey data provided online by 876 mothers. Guilt and shame both significantly predicted anxiety and depression. Poor health care professional support and high pressure to breastfeed increased anxiety and depression, and these effects were explained by indirect pathways through increases in guilt and shame. Formula feeding exclusivity was negatively correlated with post-natal anxiety symptoms. This finding may be explained by feelings of relief associated with observed infant weight gain and being able to share infant feeding responsibilities others e.g., with one's partner. This relationship was counterbalanced by an indirect pathway where greater formula feeding exclusivity positively predicted guilt, which increased post-natal anxiety score. While guilt acted as mediator of infant feeding method to increase post-natal depression and anxiety, shame acted independently of infant feeding method. These identified differences provide empirical support for the transferability of general definitions of guilt (i.e., as remorse for having committed a moral transgression) and shame (i.e., internalisation of transgressive remorse to the self), to an infant feeding context. Recommendations for health care practitioners and the maternal social support network are discussed.
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Affiliation(s)
- Leanne Jackson
- Department of Psychological SciencesUniversity of LiverpoolLiverpoolMerseysideUK
| | - Vicky Fallon
- Department of Psychological SciencesUniversity of LiverpoolLiverpoolMerseysideUK
| | - Joanne A. Harrold
- Department of Psychological SciencesUniversity of LiverpoolLiverpoolMerseysideUK
| | - Leonardo De Pascalis
- Department of Psychological SciencesUniversity of LiverpoolLiverpoolMerseysideUK
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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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Akbari D, Bogaardt H, Docking K. Ankyloglossia in Central Australia: Prevalence, identification and management in infants. Int J Pediatr Otorhinolaryngol 2023; 170:111604. [PMID: 37224737 DOI: 10.1016/j.ijporl.2023.111604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 05/15/2023] [Accepted: 05/19/2023] [Indexed: 05/26/2023]
Abstract
PURPOSE To investigate the prevalence and management of ankyloglossia for infants in Central Australia. METHOD Retrospective chart review consisting of a medical file audit of infants (n = 493) <2 years old diagnosed with ankyloglossia from January 2013 to December 2018 in the primary hospital in Central Australia. Patient characteristics, reason for diagnosis, reason for procedure and outcomes of procedures routinely recorded in the patient clinical files were recorded. RESULTS The overall prevalence of ankyloglossia in this population was 10.2%. Frenotomy was performed in 97.9% of infants diagnosed with ankyloglossia. Infants with ankyloglossia were more likely to be male (58% vs 42%), diagnosed and managed with a frenotomy on the third day of life. Most ankyloglossia diagnoses were identified by a midwife (>92%). Most frenotomy procedures were completed by lactation consultants who were also midwives (99%) using blunt-ended scissors. More infants were classified with posterior ankyloglossia than anterior ankyloglossia (23% vs 15%). A frenotomy procedure resolved feeding issues in 54% of infants with ankyloglossia. CONCLUSIONS The prevalence of ankyloglossia and rate of frenotomy procedures were high when compared to previous reports in the general population. Frenotomy for ankyloglossia in infants with breastfeeding difficulties was found to be effective in more than half of the reported sample, improving breastfeeding and decreasing maternal nipple pain. A standardised approach and validated screening or comprehensive assessment tool for the identification of ankyloglossia is indicated. Guidelines and training for relevant health professionals on non-surgical management of the functional limitations of ankyloglossia are also recommended.
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Affiliation(s)
- Donna Akbari
- The University of Sydney, Sydney School of Health Sciences, Faculty of Medicine and Health, Australia.
| | - Hans Bogaardt
- The University of Adelaide, School of Allied Health Science and Practice, Australia
| | - Kimberley Docking
- The University of Sydney, Sydney School of Health Sciences, Faculty of Medicine and Health, Australia
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Borowitz SM. What is tongue-tie and does it interfere with breast-feeding? - a brief review. Front Pediatr 2023; 11:1086942. [PMID: 37181430 PMCID: PMC10167863 DOI: 10.3389/fped.2023.1086942] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 04/07/2023] [Indexed: 05/16/2023] Open
Abstract
The most common symptom attributed to ankyloglossia is difficulty breast feeding due to poor latch, inefficient milk extraction and/or maternal nipple pain. During the past two decades, despite a declining birth rate, there has been a dramatic increase in the number of infants diagnosed with and treated for ankyloglossia in the United States, Canada and Australia. Despite a dramatic increase in the diagnosis and treatment of ankyloglossia in these countries, there remains no universally agreed upon definition of ankyloglossia and none of the published scoring systems have been rigorously validated. However ankyloglossia is defined, the majority of infants with ankyloglossia are asymptomatic. Perhaps, infants with ankyloglossia have a greater incidence of difficulty breast feeding. Lingual frenulotomy may decrease maternal pain and at least transiently improve the quality of breast feeding in some infants however no published studies take into account the fact that sucking and feeding are soothing to infants and the observed improvements immediately following frenulotomy may be a response to the pain associated with the procedure rather than a result of the procedure itself. While there are almost certainly some infants in whom tongue-tie interferes with breast-feeding, there is currently no good evidence lingual frenulotomy leads to longer duration of breast-feeding. Frenulotomy appears to be a generally safe procedure however there are reports of serious complications. Finally, there are no studies of long-term outcomes following frenulotomy during infancy and given traditional thinking that the lingual frenulum is a cord of connective tissue tethering the tongue to the floor of the mouth may be incorrect and the frenulum contains motor and sensory branches of the lingual nerve, the procedure may be less benign than previously thought.
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Affiliation(s)
- Stephen M. Borowitz
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, University of Virginia, Charlottesville, VA, United States
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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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11
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Batista CLC, Pereira ALP. Does neonatal ankyloglossia interfere in the growth of infants during the first 6 months of life? A case series nested in a cohort study. J Med Case Rep 2022; 16:394. [PMID: 36307818 PMCID: PMC9617444 DOI: 10.1186/s13256-022-03578-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 08/19/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ankyloglossia is commonly reported as one of the major causes of breastfeeding difficulty. There is a lack of research on infant growth and latching performance with clinical measures. CASES PRESENTATION We describe a series of eight clinical cases (three female and five male infants) in a specialized breastfeeding center in a tertiary hospital in Northeast Brazil. The mothers were of mixed race and ranged from 13 to 41 years of age. Ankyloglossia was diagnosed within the first 48 hours after delivery. We measured the standards of growth, the mothers' perception of breastfeeding, and a pain indicator, and performed an assessment of breastfeeding. The regularity of breastfeeding was maintained despite the early diagnosis of ankyloglossia. Growth indicators were not affected in the sixth month in any of the babies, with only one measuring below expectations in the third month, with no impact on general health. CONCLUSIONS In the cases reported in this paper, the infants overcame the initial difficulties in breastfeeding and maintained their normal growth course in the first 6 months of life.
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Affiliation(s)
- Christyann Lima Campos Batista
- Human Milk Bank, University Hospital, Federal University of Maranhão, Rua Silva Jardim, 215, São Luís, Maranhão, CEP: 65020-560, Brazil.
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Hatami A, Dreyer CW, Meade MJ, Kaur S. Effectiveness of tongue-tie assessment tools in diagnosing and fulfilling lingual frenectomy criteria: a systematic review. Aust Dent J 2022; 67:212-219. [PMID: 35689515 PMCID: PMC9796854 DOI: 10.1111/adj.12921] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2022] [Indexed: 01/07/2023]
Abstract
It is unclear how effective tongue-tie classification assessment tools are in diagnosing symptomatic tongue-tie and fulfilling lingual frenectomy criteria. The purpose of this systematic review is to determine and evaluate any association between tongue-tie severity, as measured by pre-treatment assessment tools, and post-operative outcome following tongue-tie division. PubMed, EMBASE, and the Cochrane search engines were used to retrieve articles published between 1947 and 2021. Included studies consisted of patients with symptomatic tongue-tie, assessment by either the Coryllos, Kotlow, or Hazelbaker Assessment Tool for Lingual Frenulum Function (HATLFF) classification tool, and tongue-tie division. A total of 205 abstracts were identified; 31 studies met the criteria for a full-text review, of which, only 14 studies met the criteria for data extraction and analysis. Six studies used the HATLFF, 2 studies used the Kotlow, 5 studies used the Coryllos, and 1 study used a combination of both Kotlow and Coryllos methods. Significant heterogeneity was evident across all studies. No statistical correlation between the two variables could be determined. Although tongue-tie division procedures appear to provide benefits in breastfeeding and speech, there are no data to suggest a statistically significant association between the severity of tongue-tie, and the correct identification of patients who would benefit from tongue-tie division. © 2022 Australian Dental Association.
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Affiliation(s)
- A Hatami
- Adelaide Dental School, Faculty of Health and Medical SciencesThe University of AdelaideAdelaideAustralia
| | - CW Dreyer
- Adelaide Dental School, Faculty of Health and Medical SciencesThe University of AdelaideAdelaideAustralia
| | - MJ Meade
- Adelaide Dental School, Faculty of Health and Medical SciencesThe University of AdelaideAdelaideAustralia
| | - S Kaur
- Adelaide Dental School, Faculty of Health and Medical SciencesThe University of AdelaideAdelaideAustralia
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Hill RR, Lyons KS, Kelly-Weeder S, Pados BF. Effect of Frenotomy on Maternal Breastfeeding Symptoms and the Relationship Between Maternal Symptoms and Problematic Infant Feeding. Glob Pediatr Health 2022; 9:2333794X211072835. [PMID: 35071696 PMCID: PMC8771742 DOI: 10.1177/2333794x211072835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 12/20/2021] [Indexed: 11/26/2022] Open
Abstract
The relationship between maternal symptoms and problematic infant feeding in the context of tongue-tie is unknown. In a sample of infants with tongue-tie undergoing frenotomy and their mothers, the aims of this study were to: (1) describe changes in maternal symptoms pre- and post-frenotomy, and (2) evaluate the relationships between maternal symptoms and symptoms of problematic feeding pre- and post-frenotomy. Mother-infant dyads were recruited from 1 pediatric dental office between July and November 2020. The sample included 102 mother-infant dyads; 84 completed the follow-up survey. Maternal symptoms of painful and difficult latch, creased/cracked nipples, bleeding, or abraded nipples, chewing of the nipple, and feelings of depression were significantly less common after tongue-tie revision. Poor latch onto the breast was associated with feeding difficulties at both time points. Frenotomy resulted in a decrease of symptoms in breastfeeding mothers. Maternal symptoms and feeding problems persisting post-frenotomy warrant further evaluation.
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Humbert G. [Impact of mode of delivery on the weight kinetics of the breastfed infant]. SOINS. PÉDIATRIE, PUÉRICULTURE 2021; 42:40-46. [PMID: 34489081 DOI: 10.1016/j.spp.2021.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
In various studies, the introduction of infant formulas during the stay in the maternity ward has been shown to increase the risk of breastfeeding failure and the development of cow's milk protein allergy. How can they be avoided when the infant loses weight in an "abnormal" way? A team from the Polyclinique Majorelle, in Nancy, studied the impact of the mode of delivery on the weight of the newborn in order to improve its accompaniment while respecting the real needs and rhythms of each child.
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Affiliation(s)
- Gwénaëlle Humbert
- Maternité de la polyclinique Majorelle, 95 rue Ambroise-Paré, 54000 Nancy, France.
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LeFort Y, Evans A, Livingstone V, Douglas P, Dahlquist N, Donnelly B, Leeper K, Harley E, Lappin S. Academy of Breastfeeding Medicine Position Statement on Ankyloglossia in Breastfeeding Dyads. Breastfeed Med 2021; 16:278-281. [PMID: 33852342 DOI: 10.1089/bfm.2021.29179.ylf] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
| | - Amy Evans
- Center for Breastfeeding Medicine, Community Regional Medical Center, Fresno, California, USA.,UCSF-Fresno, Fresno, California, USA
| | - Verity Livingstone
- Vancouver Breastfeeding Clinic, Department of Family Medicine, UBC, Vancouver, Canada
| | - Pamela Douglas
- Maternity Newborn and Families Research Collaborative MHIQ, Griffith University, Queensland, Australia.,Discipline of General Practice, University of Queensland, Queensland, Australia
| | - Nanette Dahlquist
- Westside Breastfeeding Center, Hillsboro Pediatric Clinic, Hillsboro, Oregon, USA
| | - Brian Donnelly
- General Pediatrician, Allegheny Health Network, Pediatrics Adjunct Professor Pediatrics, Carlow University, Clinical Instructor of Pediatrics, Duquesne University, Pittsburgh, Pennsylvania, USA
| | - Kathy Leeper
- Milkworks Non-profit Breastfeeding Center, Lincoln and Omaha, Nebraska, USA
| | - Earl Harley
- School of Medicine, Georgetown University, Washington, District of Columbia, USA
| | - Susan Lappin
- Family Medicine, Dalhousie University, Director of Newborn Services, IWK Hospital and Medical Direct Collaborative Breastfeeding, Halifax, Canada
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Maya-Enero S, Pérez-Pérez M, Ruiz-Guzmán L, Duran-Jordà X, López-Vílchez MÁ. Prevalence of neonatal ankyloglossia in a tertiary care hospital in Spain: a transversal cross-sectional study. Eur J Pediatr 2021; 180:751-757. [PMID: 32803423 DOI: 10.1007/s00431-020-03781-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 07/31/2020] [Accepted: 08/10/2020] [Indexed: 12/01/2022]
Abstract
Ankyloglossia, or tongue-tie, is a congenital anomaly in which a short lingual frenulum or a highly attached genioglossus muscle restricts tongue movement. The reported prevalence of neonatal ankyloglossia varies between less than 1 and 12.1% depending upon the study population and criteria used to define and grade ankyloglossia. Our hypothesis was that ankyloglossia had a higher prevalence among our newborn population than previously reported. We conducted an observational, transversal cross-sectional study which included all neonates born in our center between January 1 and December 31, 2018, and actively assessed for tongue-tie. We considered "clinically significant" or "symptomatic" ankyloglossia using the Hazelbaker tool for appearance and function when the mother experienced nipple pain or bruises, or when the neonate had difficulty latching onto the breast. A total of 1392 neonates were born at our center in 2018. Tongue-tie was identified in 645 infants (46.3%), of which 453 were symptomatic (70.2%). Thus, clinically significant ankyloglossia was present in 32.5% of the neonates born in 2018. Their distribution according to Coryllos's types were as follows: 45 type 1 (7.0%), 230 type 2 (35.6%), 321 type 3 (49.8%), and 42 type 4 (6.5%).Conclusion: The prevalence of symptomatic ankyloglossia in our population is higher (32.5%) than studies have reported to date. Actively assessing for tongue-tie increases its diagnosis. What is Known: • There are four types of tongue-tie according to Coryllos (1, 2, 3, and 4), of which the two anterior types (1 and 2) are the most apparent and easy to diagnose. • The reported prevalence of ankyloglossia generally varies from < 1 to 12.1%, although some recent studies report a higher prevalence. What is New: • We found a prevalence of neonatal ankyloglossia of 46.3%, of which 70.2% was symptomatic (clinically significant ankyloglossia was present in 32.5% of the neonates born in 2018 at our hospital). • Actively assessing for ankyloglossia and posterior tongue-ties, which are likely more often undiagnosed, increases its diagnosis.
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Affiliation(s)
- Silvia Maya-Enero
- Department of Neonatology, Service of Pediatrics, Hospital del Mar, Parc de Salut Mar, Universitat Autònoma de Barcelona, Passeig Marítim 25-29, 08003, Barcelona, Spain.
| | - Maria Pérez-Pérez
- Department of Neonatology, Service of Pediatrics, Hospital del Mar, Parc de Salut Mar, Universitat Autònoma de Barcelona, Passeig Marítim 25-29, 08003, Barcelona, Spain
| | - Luis Ruiz-Guzmán
- Breastfeeding Unit, Gavà Salut Familiar, Cap de Creus 21, 08850, Gavà, Spain.,UDIADEAN, Tongue-tie Clinic, Service of Pediatrics, Primary Health Care Centre 17 de Setembre, Institut Català de la Salut, El Prat de Llobregat, Spain
| | - Xavier Duran-Jordà
- AMIB (Assessoria Metodològica i Bioestadística) (Methodological and Biostatistical Consultancy), IMIM (Institut Hospital del Mar d'Investigacions Mèdiques) (Hospital del Mar Institute for Medical Research), Doctor Aiguader 88, 08003, Barcelona, Spain
| | - María Ángeles López-Vílchez
- Department of Neonatology, Service of Pediatrics, Hospital del Mar, Parc de Salut Mar, Universitat Autònoma de Barcelona, Passeig Marítim 25-29, 08003, Barcelona, Spain
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Bawazir O, Bawazir A, Bawazir R, Bawazir F, Halabi N. Experiences and outcomes of frenotomy in children with ankyloglossia in multiple tertiary centers in Saudi Arabia. J Clin Neonatol 2021. [DOI: 10.4103/jcn.jcn_151_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Hill RR, Pados BF. Symptoms of problematic feeding in infants under 1 year of age undergoing frenotomy: A review article. Acta Paediatr 2020; 109:2502-2514. [PMID: 32654280 DOI: 10.1111/apa.15473] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 07/06/2020] [Accepted: 07/07/2020] [Indexed: 12/18/2022]
Abstract
AIM The aims of this systematic review were to first identify and summarise original research that compared symptoms of problematic feeding in infants with tongue tie before and after frenotomy and then evaluate the quality of measures used to assess problematic feeding. METHODS CINAHL and PubMed were searched for ((tongue-tie) or (ankyloglossia)) and ((feeding) or (breastfeeding) or (bottle-feeding)) and ((frenotomy) or (frenectomy) or (frenulectomy) or (frenulotomy)). Original research reporting on feeding before and after frenotomy in infants under 1 year old was included. RESULTS Maternal nipple pain, breastfeeding self-efficacy and LATCH scores improved after frenotomy. Few data are available on the effect of frenotomy on infant feeding. The measures used to assess infant feeding were not comprehensive and did not possess strong psychometric properties. CONCLUSION Literature suggests that maternal nipple pain, self-efficacy and LATCH scores improve in breastfeeding mother-infant dyads after frenotomy. However, current literature does not provide adequate data regarding the effect of frenotomy on the infant's ability to feed or which infants benefit from the procedure. Future research should utilise comprehensive, psychometrically sound measures to assess infants for tongue tie and to evaluate infant feeding to provide stronger evidence for the effect of frenotomy on feeding in infants with tongue tie.
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Affiliation(s)
- Rebecca R. Hill
- MGH Institute of Health Professions School of Nursing Boston MA USA
| | - Britt F. Pados
- Boston College William F. Connell School of Nursing Chestnut Hill MA USA
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Van Biervliet S, Van Winckel M, Vande Velde S, De Bruyne R, D'Hondt M. Primum non nocere: lingual frenotomy for breastfeeding problems, not as innocent as generally accepted. Eur J Pediatr 2020; 179:1191-1195. [PMID: 32506218 DOI: 10.1007/s00431-020-03705-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 05/18/2020] [Accepted: 05/22/2020] [Indexed: 11/25/2022]
Abstract
The frenotomy or surgical release of the lingual frenulum is performed with increasing frequency. Restricted tongue mobility, ankyloglossia, is the main indication for this procedure. This clinical diagnosis is often used as synonym for tongue-tie which is blamed for many feeding difficulties resulting in an increase in performed frenotomies. Until recently, little was known about the anatomical structure and normal variation of the tongue-tie. Different grading systems have been developed. Some are exclusively based on appearance of the tongue-tie; others also include functional elements. There is, however, no established relation between the tongue-tie score and the observed feeding problems or outcomes following frenotomy. Therefore, caution is warranted before submitting babies to this procedure.Conclusion: This narrative review aims to give an overview of current knowledge and concerns regarding the tongue-tie, which need to be considered before referral for a frenotomy. What is Known: • The presence of a tongue-tie is associated with a higher frequency of breastfeeding problems. • Hence, frenotomy is advocated and increasingly performed in infants with breastfeeding problems. Current tongue-tie classifications do not allow to predict breastfeeding problems. What is New: • New anatomy insights caution for possible complications resulting from this seemingly innocent practice of frenotomy. • Frenotomy should only be performed after multidisciplinary evaluation of feeding problems, following exclusion and remediation of other causative factors.
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Affiliation(s)
- Stephanie Van Biervliet
- Paediatric Gastro-enterology and Nutrition, Ghent University Hospital, C. Heymanslaan 10, 9000, Gent, Belgium.
| | - Myriam Van Winckel
- Paediatric Gastro-enterology and Nutrition, Ghent University Hospital, C. Heymanslaan 10, 9000, Gent, Belgium
| | - Saskia Vande Velde
- Paediatric Gastro-enterology and Nutrition, Ghent University Hospital, C. Heymanslaan 10, 9000, Gent, Belgium
| | - Ruth De Bruyne
- Paediatric Gastro-enterology and Nutrition, Ghent University Hospital, C. Heymanslaan 10, 9000, Gent, Belgium
| | - Marleen D'Hondt
- Paediatric Gastro-enterology and Nutrition, Ghent University Hospital, C. Heymanslaan 10, 9000, Gent, Belgium
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