Association of Tongue-tie Practitioners. What is a Tongue-Tie?. 2013. (accessed 2 October 2015)

Akobeng AK Principles of evidence based medicine. Arch Dis Child. 2005; 90:(8)837-40

Aveyard HMaidenhead: Open University Press; 2007

Bai DL, Fong DY, Tarrant M Previous breastfeeding experience and duration of any and exclusive breastfeeding among multiparous mothers. Birth. 2015; 42:(1)70-7

Bonuck KA, Freeman K, Trombley M Country of origin and race/ethnicity: impact on breastfeeding intentions. J Hum Lact. 2005; 21:(3)320-6

British Medical Journal. Table E. Critical appraisal checklist for a questionnaire study. 2015. (accessed 2 October 2015)

Critical Appraisal Skills Programme. 11 Articles to help you make sense of a trial. 2013. (accessed 2 October 2015)

Dollberg S, Botzer E, Grunis E, Mimouni FB Immediate nipple pain relief after frenotomy in breast-fed infants with ankyloglossia: a randomized, prospective study. J Pediatr Surg. 2006; 41:(9)1598-600

Dollberg S, Marom R, Botzer E Lingual frenotomy for breastfeeding difficulties: a prospective follow-up study. Breastfeed Med. 2014; 9:(6)286-9

Edmunds J, Miles SC, Fulbrook P Tongue-tie and breastfeeding: a review of the literature. Breastfeed Rev. 2011; 19:(1)19-26

Edmunds J, Hazelbaker A, Murphy JG, Phillip B Tongue Tie. J Hum Lact. 2012; 25:(1)14-17

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)189-95

Finigan V ‘It's on the tip of my tongue’: Evaluation of a new frenulotomy service in Northern England. MIDIRS. 2009; 19:(3)396-400

Freud SNew York: Basic Books; 1905

Glasson M Foreword. In: Fernadez C Maryborough, VIC: Australian Print Group; 1998

Griffiths DM Do tongue ties affect breastfeeding?. J Hum Lact. 2004; 20:(4)409-14

Hall DMB, Renfrew MJ Tongue tie: Common problem or old wives tale?. Arch Dis Child. 2005; 90:(12)1211-15

Hogan M, Westcott C, Griffiths M Randomized, controlled trial of division of tongue-tie in infants with feeding problems. J Paediatr Child Health. 2005; 41:(5–6)246-50

Inch S Infant Feeding, 15th edn. In: Fraser DM, Cooper MA London: Elsevier; 2009

Jensen D, Wallace S, Kelsay P LATCH: a breastfeeding charting system and documentation tool. J Obstet Gynecol Neonatal Nurs. 1994; 23:(1)27-32

Kull I, Wickman M, Lilja G, Nordvall SL, Pershagen G Breast feeding and allergic diseases in infants-a prospective birth cohort study. Arch Dis Child. 2002; 87:(6)478-81

Telephone Helpline. 2015. (accessed 2 October 2015)

McBride C Tongue-tie. J Paediatr Child Health. 2005; 41:(5–6)

Mettias B, O'Brien 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

National Childbirth Trust. One-to-One Support. 2012. (accessed 2 October 2015)

National Institute for Health and Care Excellence. Division of ankyloglossia (tongue-tie) for breastfeeding. 2005. (accessed 2 October 2015)

London: NMC; 2009

O'Callahan C, Macary S, Clemente S The effects of office-based frenotomy for anterior and posterior ankyloglossia on breastfeeding. Int J Pediatr Otorhinolaryngol. 2013; 77:(5)827-32

Oddy WH, Holt PG, Sly PD Association between breast feeding and asthma in 6 year old children: findings of a prospective birth cohort study. BMJ. 1999; 319:(7213)815-9

Rees CLondon: Elsevier; 2011

Ricke LA, Baker NJ, Madlon-Kay DJ, DeFor TA Newborn tongue-tie: prevalence and effect on breast-feeding. J Am Board Fam Pract. 2005; 18:(1)1-7

Ridgers I, McCombe K, McCombe A A tongue-tie clinic and service. British Journal of Midwifery. 2009; 17:(4)230-3

Simmie E Breastfeeding: different ethnic background, different perceptions?. British Journal of Midwifery. 2006; 14:(1)20-6

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

The Breastfeeding Network. Independent, confidential, mother-centred, non-judgemental breastfeeding support and information. 2014. (accessed 2 October 2015)

Tyson P, Tyson RLondon: Yale University Press; 1990

UNICEF. Baby Friendly Initiative. 2010. (accessed 2 October 2015)

Is frenotomy effective in improving breastfeeding in newborn babies with tongue-tie? A literature review

02 November 2015
Volume 23 · Issue 11



This literature review explores whether frenotomy can result in more successful breastfeeding of newborn infants with ankyloglossia.


A systematic literature search was carried out. Nine pieces of research were chosen and appraised using two critical appraisal tools.


Three main themes emerged: the mother's experiences of breastfeeding; duration of breastfeeding; and latch. The majority of studies found that frenotomy could improve latch and alleviate nipple pain. However, there is little information available about outcomes for babies with ankyloglossia who do not undergo the frenotomy procedure.


Frenotomy is a procedure that can benefit breastfeeding mothers and babies, but the cultural and social background of families is not addressed in much of the research, nor is the risk of distress to the infant and parents.

With the increasingly persuasive evidence that breastfeeding provides infants and mothers with significant health benefits (Oddy et al, 1999; Kull et al, 2002; UNICEF, 2010), midwives and other health professionals should be doing everything possible to support women to initiate and continue breastfeeding. In some cases, ankyloglossia (or tongue-tie) is considered to inhibit breastfeeding, and current National Institute for Health and Care Excellence (NICE, 2005) guidelines support frenotomy—division of the tongue-tie—as an intervention to rectify this. However, the guidelines recognise that there is limited evidence to justify this; in addition, the guidelines are now dated, which makes the subject of this literature review highly topical. The literature available on frenotomy for tongue-tie is controversial (McBride, 2005; Edmunds et al, 2012) and lacks reliable, objective primary research studies (Hall and Renfrew, 2005).

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