Frenotomy for Tongue-Tie: Seeking an Evidence-Based Approach

Cornelius W. Van Niel, MD

The procedure should be reserved for babies with ankyloglossia-related breast-feeding difficulties.

Frenotomy has gained renewed popularity as a way to help breast-feeding problems. However, pediatric societies in many countries do not recommend frenotomy because of lack of evidence (the American Academy of Pediatrics does support it as an early intervention when tongue-tie is symptomatic). To evaluate its effectiveness, researchers conducted a comprehensive literature review.

Among the findings:

• Frenulum function is more important than observed anatomy, but clinical assessment tools vary in reliability for determining tongue function and breast-feeding success. The difficulty in identifying clinically significant tongue-tie is reflected in the wide range of reported prevalence: 0.02% to 10.7%.
• Prior systematic reviews show that quality of evidence for frenotomy's effectiveness is moderate and that frenotomy can improve long-term breast-feeding success in >50% of cases.
• Data from randomized trials (5 trials comprising 316 babies) are difficult to interpret, because objective improvement measures weren't always used; use of “sham” procedures may constitute inadequate blinding and therefore negate a potentially significant placebo effect; and most “control” babies underwent frenotomy, so long-term breast-feeding differences couldn't be evaluated.
• Frenotomy can be performed using acetaminophen or sucrose for analgesia.
• Complications, such as sublingual hematoma or ulceration, are rare when frenotomy is performed by a trained professional.

Citation(s):

Power RF and Murphy JF.Tongue-tie and frenotomy in infants with breastfeeding difficulties: Achieving a balance. Arch Dis Child 2014 Nov 7; [e-pub ahead of print].