Based on NICE IPG 149
INTRODUCTION
- Breastfeeding is a complex interaction between mother and baby. Many factors can affect the ability to breastfeed
- Skilled breastfeeding support is an integral part of the management of breastfeeding difficulties
- Current evidence suggests that there are no major safety concerns about division of tongue-tie, and limited evidence suggests that it can improve breastfeeding
DEFINITION
- A congenital anomaly of variable severity characterised by an abnormally short lingual frenulum, which may restrict movement of the tongue. In severe cases the tongue is joined to the bottom of the mouth
INDICATIONS
- Many tongue-ties are asymptomatic and cause no problem
- Breastfeeding difficulties; conservative management includes breastfeeding advice
- enhanced breastfeeding support may reduce the need for frenotomy
- Assess carefully to determine if frenulum is interfering with feeding, and if division is appropriate
- Symptoms may include:
- difficulties with latching on
- sore nipples
- poor weight gain
- Cochrane review 2017, updated 2020
- frenotomy reduces breastfeeding mothers’ nipple pain in the short-term
- no consistent positive effect on baby breastfeeding
- researchers reported no serious complications, but total number of babies studied was small
PROCEDURE
- Division to be performed by properly trained registered healthcare professional only
- Division in early infancy is usually performed without anaesthetic (although local anaesthetic is sometimes used)
- Little or no blood loss
- Feeding may be resumed immediately
COMPLICATIONS OF PROCEDURE
- Infrequent, but may include:
- bleeding
- infection
- ulceration
- pain
- damage to tongue and surrounding area
- recurrence of tongue-tie
KEY RESULTS
- In a baby with tongue-tie and feeding difficulties, surgical release of the tongue-tie does not consistently improve baby’s feeding but is likely to improve maternal nipple pain
- further research required to clarify and confirm this effect
Date updated: