The American Academy of Pediatrics Clinical Report on Ankyloglossia
by Anne Eglash MD, IBCLC, FABM
Ankyloglossia is a medical term for tongue-tie. Lingual frenula are common, and only a fraction of frenula tether sufficiently to cause nipple pain and reduced milk transfer. According to the AAP, there has been a nearly 10-fold increase in the diagnosis of ankyloglossia and rate of frenotomy between 1997 and 2012, with another doubling of these rates from 2012 to 2014. It is unclear how much of this is a true increased incidence, improved diagnostics, or overdiagnosis.
The American Academy of Pediatrics’ Clinical Report addresses the lack of criteria for diagnosing ankyloglossia and the limited research on breastfeeding outcomes after frenotomy. The report reviews the anatomy of ankyloglossia, the physiology of lactation, and provides an algorithm for ankyloglossia evaluation and treatment decision making.
Of note, the report casts doubt on indications for upper lip and buccal frenotomies.
Check out the question to learn more about the AAP Clinical Report’s findings and recommendations!
- The report recommends using local anesthesia before performing a frenotomy.
- None of the formal scoring systems for ankyloglossia have been validated.
- Laser treatment is considered superior to scissors, especially for posterior tongue ties.
- Frenotomy to prevent problems with speech or obstructive sleep apnea is not evidence based.
- Frenotomy providers should document the receipt of intramuscular vitamin K before the procedure.
- Post-op stretches are recommended after a frenotomy.
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Abstract
No abstract is available.
The AAP Clinical Report on ankyloglossia does not recommend routine local anesthesia for frenotomy. Frenotomy is not indicated to prevent speech problems or obstructive sleep apnea. Further, the report does not recommend routine post-op stretches.
While I appreciate the AAP’s attempt to provide a comprehensive algorithm to diagnose and manage ankyloglossia, their Clinical Report on ankyloglossia overlooks a critical component of care: the breastfeeding medicine physician/provider. Breastfeeding medicine physicians/providers possess specialized training to assess the entire dyad. This includes infant oral anatomy and function, maternal breast exam, milk culture, feeding evaluation and differential diagnosis. Many if not most are skilled in frenotomy.
The average pediatrician, family physician, obstetrician, or midwife caring for lactating dyads lacks the expertise to do such a comprehensive evaluation. Non-provider lactation consultants, while valuable, cannot diagnose medical conditions. Consequently, direct referrals to frenotomy providers without comprehensive evaluations risk overlooking maternal/infant health issues and may lead to unnecessary infant oral surgery.
Breastfeeding infants and parents deserve a comprehensive evaluation and treatment plan for lactation-related issues, akin to the care provided for other non-lactation health concerns.