Ankyloglossia and infant feeding — branching viva

Opening — the two-week-old with a failing, painful breastfeed

Examiner: A two-week-old exclusively breastfed infant feeds for over an hour, clicks and pulls off, and has regained none of his birth weight. His mother has cracked bleeding nipples and an engorged tender breast. Talk me through your assessment and immediate actions. ^[2]

Candidate should cover: the principle that this is feeding failure first — secure the infant's intake with supplemental expressed breast milk or formula by an appropriate method, correct any dehydration, and arrange urgent lactation and paediatric review; the focused feeding history and the observation of a full feed; the oral examination of the frenulum and the functional tests of protrusion, elevation, cupping and lateralisation, looking for a compression stripe on the nipple; and the explicit exclusion of a submucous cleft palate by inspecting the uvula and hard palate before any thought of division. ^{[10] [12]}