Ankyloglossia and infant feeding — formative SAQs

SAQ 1 — The two-week-old with poor weight gain and a painful latch (10 marks, 15 minutes)

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. ^[2]

a) Define ankyloglossia and classify this tie by position and function, naming two validated functional assessment tools. (3 marks) ^{[9] [11]}

b) Outline your immediate management of the feeding failure, including how you would secure the infant's intake and protect the mother's milk supply. (3 marks) ^[10]

c) State the conservative-first principle, and give the indication for frenotomy in this infant after a trial of support. Summarise the evidence (Cochrane and at least one randomised trial) for frenotomy. (3 marks) ^{[1] [5]}

d) Name two procedural complications of frenotomy and one mimic that must be excluded before any division. (1 mark) ^[12]