Association of Feeding Evaluation With Frenotomy Rates in Infants With Breastfeeding Difficulties

Key PointsQuestionCan a comprehensive feeding assessment providing targeted interventions for infants referred for frenotomy to treat breastfeeding difficulties reduce the percentage of procedures required? FindingsThis quality improvement study of 115 infants referred for frenotomy evaluates a program of feeding examination by a pediatric speech and language pathologist; 72 (62.6%) of the infants in the program subsequently were not recommended for procedures. MeaningMany patients referred for surgical treatment of ankyloglossia were not recommended for procedures following comprehensive feeding assessment; close collaboration and formation of multidisciplinary teams are imperative for treating these children. In this quality improvement study, a multidisciplinary team evaluated a comprehensive feeding examination program for infants with ankyloglossia who were having breastfeeding difficulties to determine whether frenotomy was necessary. ImportanceInpatient surgical release of lingual frenulums rose 10-fold between 1997 and 2012 despite insufficient evidence that frenotomy for ankyloglossia is associated with improvements in breastfeeding. Clear indications for surgical release remain murky, and best practice guidelines have yet to be developed. ObjectiveTo determine whether infants referred for frenotomy to treat breastfeeding difficulties should undergo procedures after comprehensive feeding examination, during which the primary cause of feeding issues was identified, and targeted intervention was provided. Design, Setting, and ParticipantsThis observational quality improvement study followed mother-infant dyads between March and December of 2018 who were referred to our tertiary care center for difficulty with breastfeeding. All infants underwent a comprehensive feeding evaluation by speech and language pathologists who examined the infants' ability to breastfeed prior to a surgical consultation for initial frenotomy. Data analysis was performed between January 2019 and May 2019. InterventionsA multidisciplinary feeding evaluation that examined infants' oral structure and function and their ability to breastfeed and that offered techniques for mothers to address any feeding difficulties prior to surgical intervention was developed. Infants either found success in feeding and weight gain through this program or underwent procedures. Main Outcomes and MeasuresThe primary outcome was the percentage of frenotomy procedures following implementation of a multidisciplinary feeding team evaluation. The secondary outcome was the percentage of infants referred for lingual frenotomy who later had either combined lingual and labial frenotomy or labial frenotomy alone. ResultsIncluded in the study were 115 patients (median age, 34 days [interquartile range, 19-56 days], 68 (59%) were male) referred for surgical division of the lingual frenum. Following the development of a program with feeding examination with a pediatric speech and language pathologist, 72 (62.6%) patients subsequently did not undergo surgical procedures. Although all of the referrals were for lingual frenotomy, 10 (8.7%) underwent labial frenotomy alone and 32 (27.8%) underwent both labial and lingual frenotomy. Conclusions and RelevanceThe majority of patients referred for ankyloglossia may benefit from alternative intervention strategies following comprehensive feeding evaluation. Close collaboration and formation of multidisciplinary teams are imperative for treating these children.