Does frenotomy improve breastfeeding problems in neonates with ankyloglossia?
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.
To critically appraise contemporary literature regarding the effectiveness of frenotomy on reducing breastfeeding problems.
An electronic literature search was systematically performed using CINAHL, PubMed and Cochrane databases. Back-chaining and a hand search of bibliographies were also used.
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.
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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