Ankyloglossia (or tongue-tie) is a relatively uncommon congenital anomaly defined by an abnormally short lingual frenulum. Associations between tongue-tie and breastfeeding problems in infants have been inconsistent, and are a longstanding source of controversy in the medical community. Definitions of ankyloglossia vary, and management suggestions are not based on randomized controlled trials. Surgical correction involves cutting the lingual frenulum (frenotomy). Based on current available evidence, frenotomy cannot be recommended. If, however, the association between significant tongue-tie and major breastfeeding problems is clearly identified and surgical intervention is deemed necessary, frenotomy should be performed by a clinician experienced with the procedure and with appropriate analgesia. More definitive recommendations regarding the management of tongue-tie in infants await appropriately designed trials.

aybe 20 seconds to do, the baby is put on the breast immediately afterwards and most parents find a significant difference because now the baby can have a deeper latch.” Even so, it can be difficult to find a physician to perform the procedure, as both diagnosis and treatment of tongue-tie remain a longstanding source of controversy in the medical community. The Canadian Paediatric Society hedges that the procedure “cannot be recommended,” except in cases where “the association between significant tongue-tie and major breastfeeding problems is clearly identified and surgical intervention is deemed necessary.” A recent CMAJ Practice article suggests reserving the procedure for feeding difficulties caused by “severe” tongue-tie. A systematic review of 17 studies suggested that “frenotomy is a safe procedure that may facilitate breastfeeding in women who may otherwise have given up,” but acknowledged that most studies were not randomized and therefore not a good indication of “any true benefit” ( Arch Dis Child 2011;96:A62-3). One such trial recently showed that frenotomy for infants with mild or moderate tongue-tie “did not result in an objective improvement in breastfeeding” at the end of a five-day period. However, the study’s authors noted that 17% of those randomized to “usual care” did not last five days before demanding a frenotomy and 15% switched to bottle feeding. After the five days, most women in the comparison group opted for a frenotomy for their infants. In the absence of clear-cut evidence, few doctors outside of specialty breastfeeding clinics even assess for tongue-tie, says Dr. Howard Mitnick, a breastfeeding management expert at the Goldfarb Breastfeeding Clinic at Jewish General Hospital in Montréal, Quebec. His clinic is “overwhelmed” with frenotomy referrals from across the province. “There are major chunks of Canada where no one’s doing them … because you don’t look for something you can’t deal with.” Open in a new tab Is this baby tongue-tied?