Identification and Management of Ankyloglossia and Its Effect on Breastfeeding in Infants

Publication Date: July 29, 2024
Last Updated: July 29, 2024

Conclusions and Recommendations

  1. Ankyloglossia is a variation of a normal oral structure. Symptomatic ankyloglossia is defined as a restrictive lingual frenulum that causes problems with breastfeeding that are not improved with lactation support. Infants with ankyloglossia and normal feeding patterns need no intervention. Frenotomy for other problems or to prevent issues such as speech articulation or obstructive sleep apnea in the future is not evidence based.18
  2. Posterior ankyloglossia is a poorly defined term, lacking agreement from experts, and should not be used as a reason to perform surgical intervention on an infant.
  3. Labial and buccal frenae are normal oral structures unrelated to breastfeeding mechanics and do not require surgical intervention to improve breastfeeding. Sucking blisters are a normal finding in newborn infants, and as such, are not suggestive of pathology.
  4. Suboptimal breastfeeding is a complex issue and every nursing dyad with painful or ineffective feeding should have a complete breastfeeding assessment before any treatment is offered.65,66 Here, multidisciplinary communication and management between lactation specialists, feeding therapists, surgeons, and pediatricians are paramount for the best outcome for the family.
  5. Newborn infants with possible symptomatic ankyloglossia need close monitoring, support of breastfeeding while in the hospital, early post discharge follow-up, and monitoring of weight gain in their medical home.
  6. Surgical intervention for symptomatic ankyloglossia, versus laser, can reasonably be offered after other causes of breastfeeding problems have been evaluated and treated. Frenotomy may decrease maternal nipple pain.6,17,67 Although the evidence is not strong, addressing pain is important for successful continued breastfeeding.
  7. Frenotomy should be performed by a trained professional, either the medical home provider or another to whom the medical home refers the patient. The performing professional should be experienced in the medical care of newborns and older infants and should maintain needed privileges for the procedure. As with any surgical procedure, before performing a frenotomy, the performing provider should take a “time out” to:
    1. Obtain a signed consent
    2. Discuss alternatives, risks, and benefits of the procedure
    3. Discuss and provide pain control options
    4. Document previous receipt of intramuscular vitamin K
    5. Provide information on postsurgical care and follow-up
  8. Attention to prevention of surgical complications, hemorrhage risk, pain mitigation, and evidence-based postsurgical care is recommended. Postoperative stretching exercises are not evidence-based and are not recommended.
  9. Further research including a standardized approach to identifying and classifying ankyloglossia, long-term outcome measures, and a good description of the natural history of ankyloglossia by severity, including long-term risk of feeding problems, is needed.

Recommendation Grading

Disclaimer

The information in this patient summary should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health.

Overview

Title

Identification and Management of Ankyloglossia and Its Effect on Breastfeeding in Infants

Authoring Organization

American Academy of Pediatrics

Publication Month/Year

July 29, 2024

Last Updated Month/Year

August 27, 2024

Document Type

Consensus

Country of Publication

US

Inclusion Criteria

Female, Adult, Infant

Health Care Settings

Ambulatory, Outpatient

Intended Users

Nurse, nurse practitioner, physician, physician assistant

Scope

Diagnosis, Assessment and screening, Treatment, Management

Diseases/Conditions (MeSH)

D000072676 - Ankyloglossia

Keywords

breast feeding, Ankyloglossia

Source Citation

Jennifer Thomas, Maya Bunik, Alison Holmes, Martha Ann Keels, Brenda Poindexter, Anna Meyer, Alison Gilliland, SECTION ON BREASTFEEDING, SECTION ON ORAL HEALTH, COUNCIL ON QUALITY IMPROVEMENT AND PATIENT SAFETY, COMMITTEE ON FETUS & NEWBORN, SECTION ON OTOLARYNGOLOGY-HEAD AND NECK SURGERY; Identification and Management of Ankyloglossia and Its Effect on Breastfeeding in Infants: Clinical Report. Pediatrics 2024; e2024067605. 10.1542/peds.2024-067605