Restricted tongue movement in infants with ankyloglossia often causes persistent difficulties with breastfeeding, researchers in Australia report in the July issue of Pediatrics.

Restricted tongue movement in infants with ankyloglossia often causes persistent difficulties with breastfeeding, researchers in Australia report in the July issue of Pediatrics. Frenulotomy in such cases usually resolves the problem, leading to better milk intake and less nipple pain for the mother.

Dr. Donna T. Geddes, at the University of Western Australia in Perth, and her associates evaluated 24 breastfeeding mothers and their infants (ages four to 131 days) with persistent breastfeeding difficulties after receiving professional lactation advice.

Submental ultrasound scans of the infants' oral cavity while feeding showed that the infants pinched the tip or the base of nipple. By weighing infants before and after feeding, 24-hour milk production was found to be below normal (< 500 g) in six of eight cases.

Frenulotomy was performed after the parents had been advised about its pros and cons. "Using sterile iris scissors, a small cut was made at the anterior portion of the frenulum extending just past the genioglossus muscle," after which infants were encouraged to breastfeed. There were no complications, the authors report.

When assessed seven to 29 days after frenulotomy, average milk production had increased significantly (from 455 g to 615 g, p = 0.035), "inferring that infants were able to remove more milk from the breast after the release of the frenulum."

Ultrasound showed better attachment to the breast, with less nipple compression in all cases but one, and maternal pain decreased significantly. The mothers continued to breastfeed for up to 24 months (mean 11.3 months).

In conclusion, Dr. Geddes' team writes, "This study provides evidence in support of frenulotomy for infants experiencing persistent breastfeeding difficulties despite professional advice and demonstrates that ultrasound imaging may successfully identify sucking anomalies in infants with ankyloglossia."

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