Ankyloglossia: Assessment, incidence, and effect of frenuloplasty on the breastfeeding dyad

Objective. Ankyloglossia in breastfeeding infants can cause ineffective latch, inadequate milk transfer, and maternal nipple pain, resulting in untimely weaning. The question of whether the performance of a frenuloplasty benefits the breastfeeding dyad in such a situation remains controversial. We wished to 1) define significant ankyloglossia, 2) determine the incidence in breastfeeding infants, and 3) measure the effectiveness of the frenuloplasty procedure with respect to solving specific breastfeeding problems in mother-infant dyads who served as their own controls. Methods. We examined 2763 breastfeeding inpatient infants and 273 outpatient infants with breastfeeding problems for possible ankyloglossia and assessed each infant with ankyloglossia, using the Hazelbaker Assessment Tool for Lingual Frenulum Function. We then observed each dyad while breastfeeding. When latch problems were seen, we asked the mother to describe the sensation and quality of the suck at the breast. When pain was described, we asked the mother to grade her pain on a scale of 1 to 10. When lingual function was impaired, we discussed the frenuloplasty procedure with the parent(s) and obtained informed consent. After the procedure, the infants were returned to their mothers for breastfeeding. Infant latch and maternal nipple pain were reassessed at this time. Results. Ankyloglossia was diagnosed in 88 (3.2%) of the inpatients and in 35 (12.8%) of the outpatients. Mean Hazelbaker scores were similar for the presenting symptoms of poor latch and nipple pain. Median infant age (25th and 75th percentiles) at presentation was lower for poor latch than for nipple pain: 1.2 days (0.7, 2.0) versus 2.0 days (1.0, 12.0), respectively. All frenuloplasties were performed without incident. Latch improved in all cases, and maternal pain levels fell significantly after the procedure: 6.9 +/- 2.31 down to 1.2 +/- 1.52. Conclusion. Ankyloglossia is a relatively common finding in the newborn population and represents a significant proportion of breastfeeding problems. Poor infant latch and maternal nipple pain are frequently associated with this finding. Careful assessment of the lingual function, followed by frenuloplasty when indicated, seems to be a successful approach to the facilitation of breastfeeding in the presence of significant ankyloglossia.