Tongue Tie or Ankyloglossia

Mothers may experience

• Sore nipples.
• Nipple trauma.
• Engorgement.
• Plugged ducts.
• Breast infections.
• Secondary low supply if not corrected due to inadequate milk removal.

Babies may experience

• Compromised weight gain.
• Slow feeding.
• Frustration during feeding.
• Refusal to feed.

• Thorough breastfeeding history and feeding assessment.
• Infant oral assessment for structure and function.
• Mother concerns such as sore nipples, engorgement, plugged ducts, low milk supply should be addressed.
• The mother should begin pumping with a hospital-grade electric breast pump immediately.
  • If baby is transferring milk, the mother should pump after every feeding to increase her milk supply. Baby can be fed expressed breastmilk at the breast with a supplemental feeding system or an alternative feeder.
  • If a baby is not transferring milk, the mother should pump 8-12 times per 24-hour until baby is back to the breast and transferring adequate amounts.
• If the mother’s milk supply is compromised, a supplemental breastfeeding substitute should be considered.
• Frenotomy or frenectomy (procedure to cut the tongue) if indicated.
  • Follow-up at 4 days following procedure.

Clinical Guidelines

• LeFort, Y., Evans, A., Livingstone, V., Douglas, P., Dahlquist, N., Donnelly, B., Leeper, K., Harley, E., & Lappin, S. (2021). Academy of Breastfeeding Medicine Position Statement on Ankyloglossia in Breastfeeding Dyads. Breastfeeding Medicine, 16(4), 278–281. 
• Kellams, A., Harrel, C., Omage, S., Gregory, C., & Rosen-Carole, C. (2017). ABM Clinical Protocol #3: Supplementary Feedings in the Healthy Term Breastfed Neonate, Revised 2017. Breastfeeding Medicine, 12, 188–198. 

References

1. Campanha, S., Martinelli, R., & Palhares, D. B. (2019). Association between ankyloglossia and breastfeeding. CoDAS, 31(1), e20170264. 
2. Campbell, S. H., Lauwers, J., Mannel, R., & Spencer, B. (2019). Core curriculum for interdisciplinary lactation care. Jones & Bartlett Learning. 
3. Francis, D. O., Krishnaswami, S., & McPheeters, M. (2015). Treatment of ankyloglossia and breastfeeding outcomes: a systematic review. Pediatrics, 135(6), e1458–e1466. 
4. Lawrence, R. A., & Lawrence, R. M. (2016). Breastfeeding: A guide for the medical profession (8th ed.). Elsevier. 
5. O'Shea, J. E., Foster, J. P., O'Donnell, C. P., Breathnach, D., Jacobs, S. E., Todd, D. A., & Davis, P. G. (2017). Frenotomy for tongue-tie in newborn infants. The Cochrane Database of Systematic Reviews, 3(3), CD011065. 
6. Walker, R. D., Messing, S., Rosen-Carole, C., & McKenna Benoit, M. (2018). Defining Tip-Frenulum Length for Ankyloglossia and Its Impact on Breastfeeding: A Prospective Cohort Study. Breastfeeding Medicine, 13(3), 204–210.