Evidence-Based Clinical Practice Guideline for Assessment and Management of Ankyloglossia in Infants with Breastfeeding Difficulties

Abstract

Purpose: To provide evidence-based recommendations for managing infants with restrictive lingual frenum and breastfeeding difficulties.
Methods: Recommendations were informed by 2 recent systematic reviews regarding outcomes such as the diagnostic criteria for ankyloglossia, association of ankyloglossia with feeding difficulties, and evidence for surgical release of the lingual frenum. The Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach guided consensus on problem prioritization, certainty of evidence, benefit-risk balance, patient values, acceptability, and feasibility.
Results: Twelve conditional recommendations were developed addressing the diagnosis and management of symptomatic ankyloglossia. Both anatomical and functional assessments were advised for a comprehensive assessment of the tongue. Evidence suggested an association between restrictive lingual frenum and feeding difficulties and potential benefits of frenotomy on feeding in carefully selected cases. This document provides guidance on preferred surgical techniques, postoperative care, and counseling regarding possible adverse events, aiming to support clinical decision making for dental professionals.
Conclusions: All recommendations were conditional and grounded in very low-certainty evidence, underscoring the need for high-quality research. Clinicians should engage in multidisciplinary, shared decision making with parents to determine the most appropriate intervention from available options, incorporating the family’s values and preferences.

_{KEYWORDS:  RESTRICTIVE LINGUAL FRENUM; FRENOTOMY; FRENECTOMY; FEEDING DIFFICULTIES; LACTATION}

Plain language summary

Purpose. To offer clear and practical guidance for clinicians who treat babies with tongue-tie when breastfeeding problems are present.
Background. Tongue-tie can limit a baby’s tongue movement and may contribute to breastfeeding difficulties, poor latch, and nipple pain for the mother. There is ongoing debate about how best to diagnose and treat this condition.
Study characteristics. A group of experts reviewed 2 recent high-quality systematic reviews summarizing all available scientific research on tongue-tie in infants and its effect on feeding. The group used a structured process (called GRADE) to evaluate the strength of the evidence and develop recommendations.
Key results. The proposed recommendations emphasize the following:

• Using a combination of methods to check how tongue looks or how well it moves to see if a baby is truly tonguetied.
• Understanding that tongue-tie might be 1 of the reasons a baby is having trouble breastfeeding.
• Thinking of tongue-tie release as an option only when feeding issues persist after getting help from experts like lactation consultants.
• Having a clear conversation with the parents about the possible benefits and risks of the procedure.
• Recognizing medical scissors, laser, or electrosurgery as acceptable ways to release tongue-tie.
• Not using numbing gels or creams before the procedure in babies.
• Talking about concerns with follow-up stretching exercises, since there is not enough proof that they help, and they might cause discomfort or harm.
• Explaining that while problems are rare, tongue-tie release procedure can sometimes lead to minor bleeding, mouth sores, scarring, swelling, or a fussy baby.

Conclusions. Because current scientific evidence is limited, all recommendations are conditional. Dentists and parents should work together, ideally with lactation consultants and pediatric health care providers to decide on the best, individualized plan for each baby based on clinical findings and family preferences. More high-quality research is needed to guide future care.