References

Amir LH. Breastfeeding—managing supply difficulties. Aust Fam Physician. 2006; 35:(9)686-9

Amir LH, James JP, Donath SM Reliability of the hazelbaker assessment tool for lingual frenulum function. Int Breastfeed J.. 2006; 1:(1)3-8 https://doi.org/https://doi.org/10.1186/1746-4358-1-3

Baghurst P, Pincombe J, Peat B, Henderson A, Reddin E, Antoniou G Breast feeding self-efficacy and other determinants of the duration of breast feeding in a cohort of first-time mothers in Adelaide, Australia. Midwifery. 2007; 23:(4)382-91 https://doi.org/https://doi.org/10.1016/j.midw.2006.05.004

Bandura A. Self-efficacy: toward a unifying theory of behavioral change. Psychol Rev.. 1977; 84:(2)191-215 https://doi.org/https://doi.org/10.1037/0033-295X.84.2.191

Berry J, Griffiths M, Westcott C A double-blind, randomized, controlled trial of tongue-tie division and its immediate effect on breastfeeding. Breastfeed Med.. 2012; 7:(3)189-93 https://doi.org/https://doi.org/10.1089/bfm.2011.0030

Braccio S, Chadderton Z, Sherridan A, Upadhyaya M Tongue-tie division. Is it worth it? A retrospective cohort study. British Journal of Midwifery. 2016; 24:(5)317-21 https://doi.org/https://doi.org/10.12968/bjom.2016.24.5.317

Brookes A, Bowley DM Tongue tie: the evidence for frenotomy. Early Hum Dev.. 2014; 90:(11)765-68 https://doi.org/https://doi.org/10.1016/j.earlhumdev.2014.08.021

Buryk M, Bloom D, Shope T Efficacy of neonatal release of ankyloglossia: a randomized trial. Pediatrics. 2011; 128:(2)280-8 https://doi.org/https://doi.org/10.1542/peds.2011-0077

Campbell D, Sandy J Experimental and Quasi-experimental Design.Chicago, IL: Rand McNally; 1963

Centre for Evidence Based Medicine. Oxford Centre for Evidence-based Medicine—Levels of Evidence. 2009. http://www.cebm.net/oxford-centre-evidence-based-medicine-levels-evidence-march-2009/ (accessed 15 February 2018)

Cluett E, Bluff R Principles and Practice of Research in Midwifery.Edinburgh: Balliere Tindall; 2005

Critical Appraisal Skills Programme. 11 questions to help you make sense of a trial. 2017a. http://media.wix.com/ugd/dded87_4239299b39f647ca9961f30510f52920.pdf (accessed 15 February 2018)

Critical Appraisal Skills Programme. 10 questions to help you make sense of a qualitative research. 2017b. http://docs.wixstatic.com/ugd/dded87_25658615020e427da194a325e7773d42.pdf (accessed 15 February 2018)

Critical Appraisal Skills Programme. 12 questions to help you make sense of a cohort study. 2017c. http://docs.wixstatic.com/ugd/dded87_5ad0ece77a3f4fc9bcd3665a7d1fa91f.pdf (accessed 15 February 2018)

Department of Education, Department of Health and Social Care. 2010 to 2015 government policy: children's health. 2015. https://www.gov.uk/government/publications/2010-to-2015-government-policy-childrens-health/2010-to-2015-government-policy-childrens-health (accessed 15 February 2018)

Department of Health and Social Care. Research Governance Framework for Health and Social Care. 2005. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/139565/dh_4122427.pdf (accessed 15 February 2018)

Department of Health and Social Care. Healthy Child Programme: Pregnancy and the first 5 years of life. 2009. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/167998/Health_Child_Programme.pdf (accessed 15 February 2018)

Department of Health and Social Care. Governance arrangements for research ethics committees. A harmonised edition. 2011. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/213753/dh_133993.pdf (accessed 15 February 2018)

Dodds R, Neiger D Perspectives on tongue-tie. Pract Midwife. 2014; 17:(9)23-6

Edmunds JE, Fulbrook P, Miles S Understanding the experiences of mothers who are breastfeeding an infant with tongue-tie: a phenomenological study. J Hum Lact.. 2013; 29:(2)190-5 https://doi.org/https://doi.org/10.1177/0890334413479174

Emond A, Ingram J, Johnson D Randomised controlled trial of early frenotomy in breastfed infants with mild–moderate tongue-tie. Arch Dis Child Fetal Neonatal Ed.. 2014; 99:(3)F189-95 https://doi.org/https://doi.org/10.1136/archdischild-2013-305031

Francis DO, Krishnaswami S, McPheeters M Treatment of ankyloglossia and breastfeeding outcomes: a systematic review. Pediatrics. 2015; 135:(6)e1458-66 https://doi.org/https://doi.org/10.1542/peds.2015-0658

Garbin CP, Sakalidis VS, Chadwick LM, Whan E, Hartmann PE, Geddes DT Evidence of improved milk intake after frenotomy: a case report. Pediatrics. 2013; 132:(5)e1413-17 https://doi.org/https://doi.org/10.1542/peds.2012-2651

Geddes DT, Langton DB, Gollow I, Jacobs LA, Hartmann PE, Simmer K Frenulotomy for breastfeeding infants with ankyloglossia: effect on milk removal and sucking mechanism as imaged by ultrasound. Pediatrics. 2008; 122:(1)e188-94 https://doi.org/https://doi.org/10.1542/peds.2007-2553

Gomm R, Needham G, Bullman A Evaluating Research in Health and Social Care.London: SAGE Publications; 2000

Hazelbaker AK. Newborn tongue-tie and breast-feeding. J Am Board Fam Med.. 2005; 18:(4) https://doi.org/https://doi.org/10.3122/jabfm.18.4.326

Henry L, Hayman R Ankyloglossia its impact breastfeeding. Nurs Womens Health. 2014; 18:(2)122-9 https://doi.org/https://doi.org/10.1111/1751-486X.12108

Hong P, Lago D, Seargeant J, Pellman L, Magit AE, Pransky SM Defining ankyloglossia: A case series of anterior and posterior tongue ties. Int J Pediatr Otorhinolaryngol.. 2010; 74:(9)1003-6 https://doi.org/https://doi.org/10.1016/j.ijporl.2010.05.025

International Confederation of Midwives. Essential competencies for basic midwifery practice. 2013. http://www.internationalmidwives.org/assets/uploads/documents/CoreDocuments/ICM%20Essential%20Competencies%20for%20Basic%20Midwifery%20Practice%202010,%20revised%202013.pdf (accessed 15 February 2018)

International Confederation of Midwives. International code of ethics for midwives. 2014. http://www.internationalmidwives.org/assets/uploads/documents/CoreDocuments/CD2008_001%20V2014%20ENG%20International%20Code%20of%20Ethics%20for%20Midwives.pdf (accessed 15 February 2018)

Jackson R. Improving breastfeeding outcomes: the impact of tongue-tie. Community Pract.. 2012; 85:(6)42-4

Khoo AKK, Dabbas N, Sudhakaran N, Ade-Ajayi N, Patel S Nipple pain at presentation predicts success of tongue-tie division for breastfeeding problems. Eur J Pediatr Surg.. 2009; 19:(06)370-3 https://doi.org/https://doi.org/10.1055/s-0029-1234041

Kotlow LA. Ankyloglossia (tongue-tie): a diagnostic and treatment quandary. Quintessence Int.. 1999; 30:(4)259-62

Lawson A. To snip or not to snip: the dilemmas of tongue-tie. Arch Dis Child Fetal Neonatal Ed.. 2014; 99:(3)F178-9 https://doi.org/https://doi.org/10.1136/archdischild-2013-305493

Madlon-Kay DJ, Ricke LA, Baker NJ, DeFor TA Case series of 148 tongue-tied newborn babies evaluated with the assessment tool for lingual frenulum function. Midwifery. 2008; 24:(3)353-7 https://doi.org/https://doi.org/10.1016/j.midw.2006.02.005

Masaitis NS, Kaempf JW Developing a frenotomy policy at one medical center: a case study approach. J Hum Lact.. 1996; 12:(3)229-32 https://doi.org/https://doi.org/10.1177/089033449601200321

Mettias B, OBrien R, Abo Khatwa MM, Nasrallah L, Doddi M Division of tongue tie as an outpatient procedure. Technique, efficacy and safety. Int J Pediatr Otorhinolaryngol.. 2013; 77:(4)550-2 https://doi.org/https://doi.org/10.1016/j.ijporl.2013.01.003

Miranda BH, Milroy CJ A quick snip – A study of the impact of outpatient tongue tie release on neonatal growth and breastfeeding. J Plast Reconstr Aesthet Surg.. 2010; 63:(9)e683-5 https://doi.org/https://doi.org/10.1016/j.bjps.2010.04.003

Morse JM, Field PA. Nursing research: The application of qualitative approaches, 2nd edn. London: Chapman & Hill; 1996

Division of ankyloglossia (tongue-tie) for breastfeeding (IPG149).London: NICE; 2005

Notestine GE. The importance of the identification of ankyloglossia (short lingual frenulum) as a cause of breastfeeding problems. J Hum Lact.. 1990; 6:(3)113-15 https://doi.org/https://doi.org/10.1177/089033449000600316

Polit D, Beck C Essentials of Nursing Research, 7th edn. Philadelphia, PA: Lippincott, Williams & Wilkins; 2010

Pransky SM, Lago D, Hong P Breastfeeding difficulties and oral cavity anomalies: the influence of posterior ankyloglossia and upper-lip ties. Int J Pediatr Otorhinolaryngol.. 2015; 79:(10)1714-17 https://doi.org/https://doi.org/10.1016/j.ijporl.2015.07.033

Public Health England. New mothers are anxious about breastfeeding in public. 2015. https://www.gov.uk/government/news/new-mothers-are-anxious-about-breastfeeding-in-public (accessed 15 February 2018)

Rees C. Introduction to Research for Midwives, 2nd edn. London: Elsevier; 2005

Ricke LA, Baker NJ, Madlon-Kay DJ, DeFor TA Newborn tongue-tie: prevalence and effect on breast-feeding. J Am Board Fam Med.. 2005; 18:(1)1-7 https://doi.org/https://doi.org/10.3122/jabfm.18.1.1

Schulz KF. Assessing allocation concealment and blinding in randomised controlled trials: why bother?. Evidence-Based Nursing. 2001; 4:(1)4-6 https://doi.org/https://doi.org/10.1136/ebn.4.1.4

Sethi N, Smith D, Kortequee S, Ward VMM, Clarke S Benefits of frenulotomy in infants with ankyloglossia. Int J Pediatr Otorhinolaryngol.. 2013; 77:(5)762-5 https://doi.org/https://doi.org/10.1016/j.ijporl.2013.02.005

Steehler MW, Steehler MK, Harley EH A retrospective review of frenotomy in neonates and infants with feeding difficulties. Int J Pediatr Otorhinolaryngol.. 2012; 76:(9)1236-40 https://doi.org/https://doi.org/10.1016/j.ijporl.2012.05.009

Suter VGA, Bornstein MM Ankyloglossia: facts and myths in diagnosis and treatment. J Periodontol.. 2009; 80:(8)1204-19 https://doi.org/https://doi.org/10.1902/jop.2009.090086

UNICEF. Breastfeeding in the UK. 2017a. https://www.unicef.org.uk/babyfriendly/what-is-baby-friendly/breastfeeding-in-the-uk/ (accessed 15 February 2018)

UNICEF. Failing to breastfeed costs the global economy around US$302 billion every year. 2017b. https://www.unicef.org.uk/babyfriendly/lancet-increasing-breastfeeding-worldwide-prevent-800000-child-deaths-every-year/ (accessed 15 February 2018)

Webb AN, Hao W, Hong P The effect of tongue-tie division on breastfeeding and speech articulation: A systematic review. Int J Pediatr Otorhinolaryngol.. 2013; 77:(5)635-46 https://doi.org/https://doi.org/10.1016/j.ijporl.2013.03.008

World Health Organization. Health topics: Breastfeeding. 2017. http://www.who.int/topics/breastfeeding/en (accessed 15 February 2018)

Does frenotomy improve breastfeeding problems in neonates with ankyloglossia?

02 March 2018
15 min read
Volume 26 · Issue 3

Abstract

Background

There are global and national initiatives to improve breastfeeding rates and ankyloglossia appears to be contributing to breastfeeding cessation, despite significant controversy regarding the need for frenotomy and the success of the intervention on breastfeeding outcomes.

Aims

To critically appraise contemporary literature regarding the effectiveness of frenotomy on reducing breastfeeding problems.

Methods

An electronic literature search was systematically performed using CINAHL, PubMed and Cochrane databases. Back-chaining and a hand search of bibliographies were also used.

Findings

Four key themes were identified from the literature; challenges diagnosing ankyloglossia including lack of a universally recognised assessment tool, apparent maternal breastfeeding improvements, breastfeeding improvements for the neonate, and issues with determining the longevity of breastfeeding.

Conclusion

Overall the literature was of differing validity and applicability, therefore further longer-term RCTs are required with larger sample sizes to be able to account for cross-over of participants from comparison to frenotomy group. The evidence has shown that frenotomy may improve breastfeeding outcomes but since breastfeeding is a complex interaction between mother and baby, releasing ankyloglossia does not universally remove all breastfeeding problems.

Breastfeeding is the natural way of providing neonates with all the nutrients they need for growth and development; with exclusive breastfeeding recommended for the first 6 months of life (World Health Organization (WHO), 2017). In the UK, the breastfeeding landscape is complex: more mothers are breastfeeding but the continuation rates are amongst the lowest worldwide (UNICEF, 2017a). It is reported that 74% of women start breastfeeding their child from birth, but by 6-8 weeks only 47% of women are breastfeeding at all (partially or exclusively) (Public Health England, 2015). There is increasing national and global focus on improving breastfeeding rates due to the wide evidence of health, development and bonding benefits for mother and baby but also the social and economic benefits to the wider population (Department of Health and Social Care (DHSC), 2009; Department of Education and DHSC, 2015; UNICEF, 2017b). It has therefore been argued that, to avoid early cessation, efforts to promote breastfeeding should be refocused to include early correction of problems that interfere with breastfeeding (Lawson, 2014).

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