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Does Frenulotomy Improve Breast-Feeding?

Ankyloglossia can cause breast-feeding difficulties, and frenulotomy can help.

Tongue tie or ankyloglossia — a short lingual frenulum — has been cited as a possible cause of breast-feeding failure, but little is known about the effectiveness of corrective frenulotomy (a small cut at the anterior portion of the frenulum). Investigators in Australia used objective measures to examine the effects of frenulotomy in 24 mother–infant pairs (mean age of infants, 33 days) with breast-feeding difficulties that persisted after the mothers received professional lactation advice.

Compared with measures taken before frenulotomy, mean LATCH scores (measuring latch, audible swallowing, type of nipple, comfort, and hold) improved significantly at 7 to 29 days after frenulotomy (from 7.9 to 9.4 on a 10-point scale). Mean milk intake (measured by weighing infants) during one breast-feeding also increased significantly (from 51 to 69 g), as did mean 24-hour milk production (from 455 to 615 g) among the six mothers who provided 24-hour milk production details. Ultrasound scans of suck cycles suggested improvement in tongue movement in 19 infants.

Comment: This study provides objective and subjective evidence that frenulotomy can improve breast-feeding in infants with breast-feeding difficulties, although lack of controls who received counseling but not frenulotomy is a limitation of the study. At our institution, where frenulotomy has become increasingly popular during the past 2 to 3 years, professional lactation advice is always provided before surgical procedures are performed.

— Howard Bauchner, MD

Published in Journal Watch General Medicine July 10, 2008

Citation(s):

Geddes DT et al. Frenulotomy for breastfeeding infants with ankyloglossia: Effect on milk removal and sucking mechanism as imaged by ultrasound. Pediatrics 2008 Jul; 122:e188. (http://dx.doi.org/10.1542/peds.2007-2553)

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