Paeds · ent-hearing-and-oral-health

Ankyloglossia and infant feeding

Also known as Tongue-tie · Lingual frenulum restriction · Tongue-tie and breastfeeding · Posterior tongue-tie · Frenotomy for tongue-tie · Lingual frenectomy · Tongue-tie division · Tethered oral tissues and infant feeding

Fellowship topic on ankyloglossia (tongue-tie) and infant feeding — a congenital short, thick or tight lingual frenulum that tethers the underside of the tongue to the floor of the mouth and restricts tongue mobility. Covers the anterior-versus-posterior and structural-versus-functional classification (Coryllos type one to four, Kotlow free-tongue length, the Hazelbaker Assessment Tool for Lingual Frenulum Function and the TABBY picture tool); the biomechanics of the breastfeeding latch and how a restricted tongue fails to cup, elevate and form a peristaltic wave, causing nipple trauma, poor milk transfer, engorgement and mastitis; the estimated four to eleven percent prevalence with male predominance; the bedside and lactation assessment including observing a feed and testing protrusion, elevation, cupping and lateralisation; the principle of skilled lactation support before any decision to divide; the stepwise move through conservative support, validated assessment and frenotomy (sterile scissors or laser division) for the infant whose feeding difficulty persists; the randomised and systematic-review evidence on frenotomy and its limits; the complications of bleeding, oral ulceration and reattachment and the overdiagnosis and underdiagnosis pitfalls; and the regional guidance from NICE interventional procedures guidance one four nine, the AAO-HNS consensus and the Royal Children's Hospital Melbourne.