Ankyloglossia and infant feeding — structured clinical encounter

A two-week-old exclusively breastfed infant is reviewed because feeds last over an hour, the baby clicks and repeatedly comes off the breast, and he has regained none of his birth weight. His mother has cracked, bleeding nipples and a tender, engorged right breast. On oral examination there is a short, tight frenulum attaching near the tongue tip, and the tongue cannot elevate past the lower gum or form a cup; the uvula and palate are normal. You are the paediatric registrar working through the assessment, securing feeding, the conservative-first principle, the frenotomy decision and the evidence, with a later scenario of a suspected posterior tongue-tie and an overdiagnosis counselling case.