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MCN. the American Journal of Maternal... 2019The purpose of this integrative review was to synthesize the literature on the relationship between infant breastfeeding and ankyloglossia. (Review)
Review
OBJECTIVE
The purpose of this integrative review was to synthesize the literature on the relationship between infant breastfeeding and ankyloglossia.
DATA SOURCES
The search terms tongue-tie or ankyloglossia and breastfeeding were used via CINAHL, Ovid MEDLINE, Health Reference Academic, and PsycINFO. Primary research articles and clinical reviews were considered in the search parameters.
STUDY SELECTION
Searches yielded 201 articles written in English and published between 1999 and 2018. After screening, 50 full-text articles were assessed for eligibility, 43 of which were omitted for irrelevance. Three qualitative and four quantitative studies remained for inclusion in the review.
DATA EXTRACTION
Studies were reviewed for information on the relationship between ankyloglossia and breastfeeding. Studies examining results of ankyloglossia treatment were omitted. Preferred Reporting Items of Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used.
DATA SYNTHESIS
Analysis revealed a varied degree of difficulties with breastfeeding when the infant has ankyloglossia. Prevalence is uncertain due to lack of universal screening guidelines, and infrequent use of screening tools. No studies were found that examined psychological ramifications of feeding difficulties with ankyloglossia. There are no validated screening tools for ankyloglossia.
CONCLUSION
More research is necessary on effects of breastfeeding difficulties of infants with ankyloglossia on the mother-infant relationship. A reliable screening tool needs to be developed and validated. Education for nurses to assess infants with ankyloglossia in a systematic fashion should be explored. Investigation of psychological sequelae, including maternal stress, postpartum depression, and mother-infant bonding is an important next step in the research of infants with ankyloglossia.
Topics: Adult; Ankyloglossia; Breast Feeding; Female; Humans; Infant; Interviews as Topic; Male; Mass Screening; Qualitative Research; Treatment Outcome
PubMed: 30807325
DOI: 10.1097/NMC.0000000000000501 -
Clinical Pediatrics Sep 2020Recent studies suggest that speech, solid feeding, and sleep difficulties may be linked to restricted tongue function. Children with tongue restrictions and speech,... (Clinical Trial)
Clinical Trial
Recent studies suggest that speech, solid feeding, and sleep difficulties may be linked to restricted tongue function. Children with tongue restrictions and speech, feeding, and sleep issues underwent lingual frenectomies with a CO laser, paired with myofunctional exercises. Questionnaires were completed before, 1 week after, and 1 month following treatment. Thirty-seven patients participated in the study (mean age 4.2 years [range 13 months to 12 years]). Overall, speech improved in 89%, solid feeding improved in 83%, and sleep improved in 83% of patients as reported by parents. Fifty percent (8/16) of speech-delayed children said new words after the procedure ( = .008), 76% (16/21) of slow eaters ate more rapidly ( < .001), and 72% (23/32) of restless sleepers slept less restlessly ( < .001). After tongue-tie releases paired with exercises, most children experience functional improvements in speech, feeding, and sleep. Providers should screen for oral restrictions in children and refer for treatment when functions are impaired.
Topics: Ankyloglossia; Child; Child, Preschool; Combined Modality Therapy; Feeding and Eating Disorders of Childhood; Female; Follow-Up Studies; Humans; Infant; Lingual Frenum; Male; Myofunctional Therapy; Prospective Studies; Sleep Wake Disorders; Speech Disorders; Treatment Outcome
PubMed: 32462918
DOI: 10.1177/0009922820928055 -
International Journal of Pediatric... Sep 2022To evaluate the efficiency of maternal breastfeeding and maternal pain pre- and post-lingual frenulum release procedures in infants with ankyloglossia.
OBJECTIVE
To evaluate the efficiency of maternal breastfeeding and maternal pain pre- and post-lingual frenulum release procedures in infants with ankyloglossia.
METHODS
Infants under 4 months of age with tongue-tie who were actively breastfeeding, and their mothers (mother-infant dyads) were recruited. Infants' ankyloglossia severity was evaluated using the Coryllos® ankyloglossia tongue-tie grading scale. Each mother completed a pre-procedure questionnaire where breastfeeding efficiency was evaluated using the LATCH® criteria. Each mother also reported a numeric score of pain with feeding, breastfeeding time, and a perceived feeding efficiency score. After the tongue-tie release procedure, each mother completed a post-procedure questionnaire within a 1-week to 1-month window to assess the change in breastfeeding efficiency using the LATCH® criteria, breastfeeding pain, breastfeeding time, and perceived breastfeeding efficiency.
RESULTS
41 mother-infant dyads participated in the study. No surgical complications occurred during or post-procedure. All dyads reported improved (40) or equal (1) LATCH® scores: with a mean improved LATCH® score of 3.2 points (p < 4^10, 95% CI 2.6, 3.7.). The mean improved maternal perception of feeding was 3.3 points (p < 6^10,95% CI 2.6, 4.0.), the mean decreased maternal pain was 4.0 points (p < 1^10, 95% CI 3.3, 4.8), and the mean decreased maternal feeding time was 0.80 points (p = 0.002, 95% CI 0.5, 1.1.).
CONCLUSION
Lingual frenulum release procedures appear to consistently improve breastfeeding efficiency and decrease maternal pain.
Topics: Ankyloglossia; Breast Feeding; Female; Humans; Infant; Lingual Frenum; Pain; Treatment Outcome
PubMed: 35930834
DOI: 10.1016/j.ijporl.2022.111242 -
International Journal of Environmental... Jun 2021This randomized, double-blind and controlled clinical trial investigates how a diode laser lingual frenectomy can improve obstructive sleep apnea syndrome (OSAS) in... (Randomized Controlled Trial)
Randomized Controlled Trial
UNLABELLED
This randomized, double-blind and controlled clinical trial investigates how a diode laser lingual frenectomy can improve obstructive sleep apnea syndrome (OSAS) in pediatric patients.
BACKGROUND
Several authors have shown that a short lingual frenulum causes a reduction in incoming air flow and the relationship between OSAS and a short lingual frenulum.
METHODS
Thirty-two pediatric patients were equally randomly divided into a Study Group (SG) and a Control Group (CG). On each SG patient a polysomnography 1 (PSG1) and a lingual frenectomy were performed using a diode laser via Doctor Smile Wiser technology, power 7 W. After three months, a new polysomnography (PSG2) was performed to evaluate the lingual frenectomy efficacy in pediatric patients. The pain was assessed by a numerical rating scale (NRS) before and after surgery. The CG followed the same protocol without a lingual frenectomy but myofunctional and speech therapy were conducted to qualitatively and quantitatively improve the lingual functionality. In the SG, eight subjects (50%) had severe OSAS and eight had moderate (50%) while in the CG, three subjects had severe OSAS (18.8%) and thirteen had moderate (81.2%).
RESULTS
In the SG, 93.8% were classified as mild OSAS and 6.2% as moderate. In contrast, in the CG, 18.75% were classified as mild OSAS, 62.5% as moderate and 18.75% as severe.
CONCLUSION
The study demonstrates how a lingual laser frenectomy can improve OSAS in pediatric patients.
Topics: Child; Control Groups; Double-Blind Method; Humans; Lasers, Semiconductor; Lingual Frenum; Sleep Apnea, Obstructive
PubMed: 34204017
DOI: 10.3390/ijerph18116112 -
Facial Plastic Surgery Clinics of North... Nov 2014Most speech disorders of childhood are treated with speech therapy. However, two conditions, ankyloglossia and velopharyngeal dysfunction, may be amenable to surgical... (Review)
Review
Most speech disorders of childhood are treated with speech therapy. However, two conditions, ankyloglossia and velopharyngeal dysfunction, may be amenable to surgical intervention. It is important for surgeons to work with experienced speech language pathologists to diagnose the speech disorder. Children with articulation disorders related to ankyloglossia may benefit from frenuloplasty. Children with velopharyngeal dysfunction should have standardized clinical evaluation and instrumental asseessment of velopharyngeal function. Surgeons should develop a treatment protocol to optimize speech outcomes while minimizing morbidity.
Topics: Ankyloglossia; Child; Child, Preschool; Humans; Infant; Lingual Frenum; Mouth Abnormalities; Palate; Pharynx; Plastic Surgery Procedures; Speech Disorders; Treatment Outcome; Velopharyngeal Insufficiency
PubMed: 25444731
DOI: 10.1016/j.fsc.2014.07.010 -
Otolaryngologic Clinics of North America Aug 2024Oral causes of dysphagia in infancy may involve the lips, the tongue, or the palate. Whereas ankyloglossia is commonly diagnosed in infants with dysphagia, assessment of... (Review)
Review
Oral causes of dysphagia in infancy may involve the lips, the tongue, or the palate. Whereas ankyloglossia is commonly diagnosed in infants with dysphagia, assessment of the need for surgical intervention may be less straightforward. Tongue size (macroglossia) may be associated with dysphagia as it may cause limitation of movement of the food or milk bolus by the lips or cheeks. Congenital conditions such as cleft lip and palate, micrognathia, or craniofacial microsomia may also be associated with dysphagia. Diagnosis and treatment of these conditions can be improved with the engagement of lactation and feeding experts as well as multidisciplinary craniofacial teams.
Topics: Humans; Deglutition Disorders; Infant; Tongue; Child; Ankyloglossia; Cleft Palate; Cleft Lip; Lip; Mouth Abnormalities; Micrognathism
PubMed: 38503668
DOI: 10.1016/j.otc.2024.02.012 -
Jornal de Pediatria 2020To characterize the lingual frenulum of full-term newborns using two different protocols and to assess the association of the lingual frenulum with breastfeeding.
OBJECTIVE
To characterize the lingual frenulum of full-term newborns using two different protocols and to assess the association of the lingual frenulum with breastfeeding.
METHODS
This non-probabilistic sample consisted of 449 mother/baby binomials. For the anatomo-functional evaluation of the frenulum, the Neonatal Tongue Screening Test and the Bristol Tongue Assessment Tool were used for the evaluation of the lingual frenulum. Breastfeeding was evaluated using the protocol proposed by UNICEF. Scores were created (good, fair, poor) to evaluate every aspect of the breastfeeding to be observed. The results were analyzed through descriptive and inferential statistics and association tests (Pearson's chi-squared and Fisher's exact test).
RESULTS
The study showed that 14 babies had a lingual frenulum alteration, of whom three had difficulties during suction, requiring frenotomy in the first week of life, whereas 11 had no difficulties during breastfeeding. Regarding the breastfeeding evaluation, 410mother/baby binomials had good, 36 regular, and three had bad scores. There was a statistically significant association between the tongue-tie test protocol and breastfeeding (p=0.028) and between the Bristol Tongue Assessment Tool protocol and breastfeeding (p=0.028).
CONCLUSION
Alterations in the lingual frenulum are associated with interferences in the quality of breastfeeding and thus, evaluation of the lingual frenulum in newborns is important.
Topics: Ankyloglossia; Breast Feeding; Female; Humans; Infant, Newborn; Lingual Frenum; Mothers
PubMed: 31029684
DOI: 10.1016/j.jped.2018.12.013 -
Pediatric Research Jan 2024Symptoms related to infant ankyloglossia/tongue-tie may deter mothers from breastfeeding, yet frenotomy is controversial. (Meta-Analysis)
Meta-Analysis
BACKGROUND
Symptoms related to infant ankyloglossia/tongue-tie may deter mothers from breastfeeding, yet frenotomy is controversial.
METHODS
Databases included PubMed, Embase, CINAHL, PsycINFO, Web of Science, and Google Scholar from 1961-2023. Controlled trials and cohort studies with validated measures of surgical efficacy for breastfeeding outcomes were eligible. Meta-analyses synthesized data with inverse-variance weighting to determine standardized mean differences (SMD) between pre-/postoperative scores.
RESULTS
Twenty-one of 1568 screened studies were included. Breastfeeding self-efficacy improved significantly post-frenotomy: medium effect after 5-10 days (SMD 0.60 [95% CI: 0.48, 0.71; P < 0.001]), large effect after 1 month (SMD 0.91 [CI: 0.79, 1.04; P < 0.001]). Nipple pain decreased significantly post-frenotomy: large effect after 5-15 days (SMD -1.10 [CI: -1.49, -0.70; P < 0.001]) and 1 month (SMD -1.23 [CI: -1.79, -0.67; P = 0.002]). Frenotomy had a medium effect on infant gastroesophageal reflux severity at 1-week follow-up (SMD -0.63 [CI: -0.95, -0.31; P = 0.008]), with continued improvement at 1 month (SMD -0.41 [CI: -0.78, -0.05; P = 0.04]). From LATCH scores, breastfeeding quality improved after 5-7 days by a large SMD of 1.28 (CI: 0.56, 2.00; P = 0.01).
CONCLUSIONS
Providers should offer frenotomy to improve outcomes in dyads with ankyloglossia-associated breastfeeding difficulties.
PROTOCOL REGISTRATION
PROSPERO identifier CRD42022303838 .
IMPACT
This systematic review and meta-analysis showed that breastfeeding self-efficacy, maternal pain, infant latch, and infant gastroesophageal reflux significantly improve after frenotomy in mother-infant dyads with breastfeeding difficulties and ankyloglossia. Providers should offer frenotomy to improve breastfeeding outcomes in symptomatic mother-infant dyads who face challenges associated with ankyloglossia.
Topics: Female; Humans; Infant; Ankyloglossia; Breast Feeding; Gastroesophageal Reflux; Lingual Frenum; Pain; Treatment Outcome
PubMed: 37608056
DOI: 10.1038/s41390-023-02784-y -
Seminars in Speech and Language Aug 2023The purpose of this article is to (1) define the diagnostic characteristics of ankyloglossia, (2) identify potential problems associated with ankyloglossia, and (3)... (Review)
Review
The purpose of this article is to (1) define the diagnostic characteristics of ankyloglossia, (2) identify potential problems associated with ankyloglossia, and (3) discuss treatment options, when treatment is appropriate. This article is based on a review of the literature, including recent systematic reviews, and the author's experience as a cleft and orofacial specialist. Ankyloglossia is a common congenital condition characterized by an anterior attachment of the lingual frenulum on the tongue. This causes difficulty elevating and/or protruding the tongue tip. As such, ankyloglossia has been thought to affect neonatal feeding, speech, and other functions. Although systematic reviews have concluded that most infants with ankyloglossia can be fed normally, a small percentage of affected infants will show improved efficiency of feeding post-frenotomy. They also concluded that frenotomy may relieve nipple pain in the breastfeeding mothers of affected infants. Regarding speech, the systematic reviews concluded that there is no evidence that ankyloglossia causes speech disorders. This may be because simple compensations will result in normal acoustics of the sounds. Therefore, frenotomy should be recommended sparingly for newborn infants, and it should rarely, if ever, be recommended for speech disorders.
Topics: Infant; Infant, Newborn; Humans; Ankyloglossia; Tongue; Speech; Speech Disorders
PubMed: 37748489
DOI: 10.1055/s-0043-1772598