Houston Area Pediatric Specialists

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Thursday, March 27, 2014

Tongue tied infant? Nursing? Randomized controlled trial of early frenotomy in breastfed infants.

Tongue tied? Nursing? Considering clipping procedure known as "frenotomy"?
Who is getting treatment? It appears that the babies all work out nursing. Early frenotomy results in a better "self-efficacy" and less bottle feeding in the first 5 days. "...over 80% of both groups were still feeding at the breast at 8 weeks."
Hmm. Tough one. JR

 2013 Nov 18. doi: 10.1136/archdischild-2013-305031. [Epub ahead of print]

Randomised controlled trial of early frenotomy in breastfed infants with mild-moderate tongue-tie.


Trial design A randomised, parallel group, pragmatic trial.
Setting A large UK maternity hospital.
Participants Term infants <2 a="" and="" breastfeeding.="" degree="" difficulties="" having="" mild="" moderate="" mothers="" of="" old="" or="" p="" their="" tongue-tie="" weeks="" were="" who="" with="">
Objectives To determine if immediate frenotomy was better than standard breastfeeding support.
Interventions Participants were randomised to an early frenotomy intervention group or a ‘standard care’ comparison group.
Outcomes Primary outcome was breastfeeding at 5 days, with secondary outcomes of breastfeeding self-efficacy and pain on feeding. Final assessment was at 8 weeks; 20 also had qualitative interviews. Researchers assessing outcomes, but not participants, were blinded to group assignment.
Results 107 infants were randomised, 55 to the intervention group and 52 to the comparison group. 
Five-day outcome measures were available for 53 (96%) of the intervention group and 52 (100%) of the comparison group, and intention-to-treat analysis showed no difference in the primary outcome—Latch, Audible swallowing, nipple Type, Comfort, Hold score. 
Frenotomy did improve the tongue-tie and increased maternal breastfeeding self-efficacy. 
At 5 days, there was a 15.5% increase in bottle feeding in the comparison group compared with a 7.5% increase in the intervention group.
After the 5-day clinic, 44 of the comparison group had requested a frenotomy; 
by 8 weeks only 6 (12%) were breastfeeding without a frenotomy. 
At 8 weeks, there were no differences between groups in the breastfeeding measures or in the infant weight. No adverse events were observed.
Conclusions Early frenotomy did not result in an objective improvement in breastfeeding but was associated with improved self-efficacy. The majority in the comparison arm opted for the intervention after 5 days.

Infant Feeding, Neonatology, Nutrition

What is known on this topic

  • Tongue-tie (ankyloglossia) is a common congenital condition which can interfere with breastfeeding.
  • Tongue-tie release (frenotomy) is a well-tolerated procedure that can provide objective and subjective benefits in breast feeding.
  • Evidence from randomised trials supports early frenotomy in severe cases of tongue-tie, but debate continues about management of mild–moderate degrees of tongue-tie resulting in wide variations in clinical practice.

What this study adds

  • A randomised, parallel group, pragmatic trial comparing early frenotomy with usual care in mild–moderate tongue-tie showed that mothers could sustain breastfeeding of infants with tongue-tie for 5 days without a frenotomy.
  • Early frenotomy did not result in an objective improvement in breastfeeding at 5 days.
  • Early frenotomy did improve maternal breastfeeding self-efficacy and resulted in fewer mothers switching to bottle feeding before 5 days.

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