Tethered Oral Tissue Release Among Breastfed Infants: Maternal Sources of Information and Treatment

Abstract

Background:

Despite limited clinical consensus regarding surgery for tethered oral tissues (“tongue-tie”) for resolving breastfeeding-related issues, the procedure has been increasing in the United States. Greater understanding of maternal experiences with obtaining surgical release may help to improve breastfeeding outcomes.

Research Aim:

To explore experiences of breastfeeding mothers with infants having undergone “tongue-tie” surgery.

Method:

This online, cross-sectional, observational survey occurred between August and September 2020. Eligibility included being ≥ 18 years of age and previously or currently breastfeeding an infant with ≥ 1 tissue surgically released. Of 463 screens, 318 mothers were eligible and 115 consented. The final sample was 90.

Results:

The sample was predominantly white (n = 86; 95%), non-Hispanic (n = 84; 93%), married/cohabitating (n = 85; 94%), and currently providing their own milk (n = 81; 89%).

Difficult latch was the primary reason for seeking help. Participants reported lingual (n = 84; 93%), labial (n = 79; 88%), and buccal (n = 16; 17%) tissue-release, with 80% (n = 73) reporting > 1 released. For each tissue released, > 80% (n = 72) of participants felt “very confident” in their ability to correctly identify it and 97% (n = 87) felt “very involved” and “strongly agreed” with surgical release. International Board Certified Lactation Consultants^® were the most frequently identified source of information (n = 45; 50%) and referrals (n = 38; 42%), while pediatric dentists most frequently performed interventions (n = 60; 67%).

Conclusions:

Participants reported being confident, involved, and in agreement with surgical release and lactation support professionals were frequent information and referral sources.

Keywords

ankyloglossia breastfeeding breastfeeding difficulties breastfeeding experience cross-sectional online survey maternal behavior southeastern United States tongue-tie

Get full access to this article

View all access options for this article.

References

Aaronson

N. L.

Castaño

J. E.

Simons

J. P.

Jabbour

(2018). Quality, readability, and trends for websites on ankyloglossia. Annals of Otology, Rhinology & Laryngology, 127(7), 439–444. https://doi.org/10.1177/0003489418776343

Brooks

(2017). IBCLC scope of practice for tongue-tie assessment. Clinical Lactation, 8(3), 121–125. https://doi.org/10.1891/2158-0782.8.3.121

Brown

Shenker

(2021). Experiences of breastfeeding during COVID-19: Lessons for future practical and emotional support. Maternal & Child Nutrition, 17(1), Article 313088. https://doi.org/10.1111/mcn.13088

Bundogji

Zamora

Brigger

Jiang

(2020). Modest benefit of frenotomy for infants with ankyloglossia and breastfeeding difficulties. International Journal of Pediatric Otorhinolaryngology, 133, Article 109985. https://doi.org/10.1016/j.ijporl.2020.109985

Caloway

Hersh

C. J.

Baars

Sally

Diercks

Hartnick

C. J.

(2019). Association of feeding evaluation with frenotomy rates in infants with breastfeeding difficulties. Otolaryngology–Head and Neck Surgery, 145(9), 817–822. https://doi.org/10.1001/jamaoto.2019.1696

Cash

Isaksson

Maier

Summers

(2022). Sampling in design research: Eight key considerations. Design Studies, 78, Article 101077. https://doi.org/10.1016/j.destud.2021.101077

Centers for Disease Control and Prevention. (2022.) Breastfeeding report card, United States, 2022. https://www.cdc.gov/breastfeeding/data/reportcard.htm

Costa-Romero

Espinola-Docio

Paricio-Talayero

J. M.

Diaz-Gomez

N. M.

(2021). Ankyloglossia in breastfeeding infants. An update. Archivos Argentinos De Pediatria, 119(6), e600–e609. https://doi.org/10.5546/aap.2021.eng.e600

Darko

E. M.

Kleib

Olson

(2022). Social media use for research participant recruitment: Integrative literature review. Journal of Medical Internet Research, 24(8), e38015. https://doi.org/

10.

Dixon

Gray

Elliot

Shand

Lynn

(2018). A multifaceted programme to reduce the rate of tongue-tie release surgery in newborn infants: Observational study. International Journal of Pediatric Otorhinolaryngology, 113, 156–163. https://doi.org/10.1016/j.ijporl.2018.07.045

11.

Douglas

Geddes

(2018). Practice-based interpretation of ultrasound studies leads the way to more effective clinical support and less pharmaceutical and surgical intervention for breastfeeding infants. Midwifery, 58, 145–155. https://doi.org/10.1016/j.midw.2017.12.007

12.

Feenstra

M. M.

Jørgine Kirkeby

Thygesen

Danbjørg

D. B.

Kronborg

(2018). Early breastfeeding problems: A mixed method study of mothers’ experiences. Sexual & Reproductive Healthcare, 16, 167–174. https://doi.org/10.1016/j.srhc.2018.04.003

13.

Gianni

M. L.

Bettinelli

M. E.

Manfra

Sorrentino

Bezze

Plevani

Cavallaro

Raffaeli

Crippa

B. L.

Colombo

Morniroli

Liotto

Roggero

Villamore

Marchisio

Mosca

(2019). Breastfeeding difficulties and risk for early breastfeeding cessation. Nutrients, 11(10), Article 2266. https://doi.org/10.3390/nu11102266

14.

Grond

S. E.

Kallies

McCormick

M. E.

(2021). Parental and provider perspectives on social media about ankyloglossia. International Journal of Pediatric Otorhinolaryngology, 146, Article 110741. https://doi.org/10.1016/j.ijporl.2021.110741

15.

Hale

Mills

Edmonds

Dawes

Dickson

Barker

Wheeler

B. J.

(2019). Complications following frenotomy for ankyloglossia: A 24-month prospective New Zealand paediatric surveillance unit study. Journal of Paediatrics and Child Health, 56(4), 557–562. https://doi.org/10.1111/jpc.14682

16.

Hamaguchi

Nematollahi

Minter

D. J.

(2020). Picture of a pandemic: Visual aids in the COVID-19 crisis. Journal of Public Health, 42(3), 483–485. https://doi.org/10.1093/pubmed/fdaa080

17.

Hand

Olivi

Lajolo

Gioco

Marigo

Castagnola

(2020). Short lingual frenum in infants, children and adolescents. Part 1: Breastfeeding and gastroesophageal reflux disease improvement after tethered oral tissues release. European Journal of Paediatric Dentistry, 21(4), 309–317. https://doi.org/10.23804/ejpd.2020.21.04.10

18.

Hornsby

P. P.

Gurka

K. K.

Conaway

M. R.

Kellams

A. L.

(2019). Reasons for early cessation of breastfeeding among women with low income. Breastfeeding Medicine, 14(6), 375–381. https://doi.org/10.1089/bfm.2018.0206

19.

Jin

R. R.

Sutcliffe

Vento

Miles

Travadi

Kishore

Suzuki

Todd

Wooderson

Kamar

A. A.

Smyth

Oei

J. L.

(2018). What does the world think of ankyloglossia? Acta Paediatrica, 107(10), 1733–1738. https://doi.org/10.1111/apa.14242

20.

Labbok

Krasovec

(1990). Toward consistency in breast-feeding definitions. Studies in Family Planning, 21(4), 226–230. https://www-jstor-org-443.web.bisu.edu.cn/stable/1966617

21.

Langberg

E. M.

Dyhr

Davidsen

A. S.

(2019). Development of the concept of patient-centredness: A systematic review. Patient Education and Counseling, 102(7), 1228–1236. https://doi.org/10.1016/j.pec.2019.02.023

22.

Larrain

Stevenson

E. G.

(2022). Controversy over tongue-tie: Divisions in the community of healthcare professionals. Medical Anthropology, 41(4), 446–459. https://doi.org/10.1080/01459740.2022.2056843

23.

LeFort

Evans

Livingstone

Douglas

Dahlquist

Donnelly

Leeper

Harley

Lappin

, & Academy of Breastfeeding Medicine. (2021). Academy of Breastfeeding Medicine Position Statement on ankyloglossia in breastfeeding dyads. Breastfeeding Medicine, 16(4), 278–281. https://doi.org/10.1089/bfm.2021.29179.ylf

24.

Litchfield

Shukla

Greenfield

(2021). Impact of COVID-19 on the digital divide: A rapid review. BMJ Open, 11(10), Article e053440. https://doi.org/10.1136/bmjopen-2021-053440

25.

Merritt

L. S.

(2019). The effect of tongue-tie and lip-tie on breastfeeding. The Journal for Nurse Practitioners, 15(5), 356–360. https://doi.org/10.1016/j.nurpra.2019.02.021

26.

Messner

A. H.

Walsh

Rosenfeld

R. M.

Schwartz

S. R.

Ishman

S. L.

Baldassari

Brietzke

S. E.

Darrow

D. H.

Goldstein

Levi

Meyer

A. K.

Parikh

Simons

J. P.

Wohl

D. L.

Lambie

Satterfield

(2020). Clinical consensus statement: Ankyloglossia in children. Otolaryngology–Head and Neck Surgery, 162(2), 597–611. https://doi.org/10.1177/0194599820915457

27.

Morse

Brown

(2021). Accessing local support online: Mothers’ experiences of local breastfeeding support Facebook groups. Maternal & Child Nutrition, 17(4), Article e13227. https://doi.org/10.1111/mcn.13227

28.

Morrison

A. H.

Gentry

Anderson

(2019). Mothers’ reasons for early breastfeeding cessation. MCN, The American Journal of Maternal/Child Nursing, 44(6), 325–330. https://doi.org/10.1097/nmc.0000000000000566

29.

O’Connor

M. E.

Gilliland

A. M.

LeFort

(2022). Complications and misdiagnoses associated with infant frenotomy: Results of a healthcare professional survey. International Breastfeeding Journal, 17(1), 1–9. https://doi.org/10.1186/s13006-022-00481-w

30.

Patel

P. S.

D. B.

Schwartz

Rosenfeld

R. M.

(2019). Upper lip frenotomy for neonatal breastfeeding problems. International Journal of Pediatric Otorhinolaryngology, 124, 190–192. https://doi.org/10.1016/j.ijporl.2019.06.008

31.

Praborini

Setiani

Munandar

Wulandari

R. A.

(2018). A holistic supplementation regimen for tongue-tied babies with slow weight gain and failure to thrive. Clinical Lactation, 9(2), 78–87. https://doi.org/10.1891/2158-0782.9.2.78

32.

Ray

Hairston

T. K.

Giorgi

Links

A. R.

Boss

E. F.

Walsh

(2020). Speaking in tongues: What parents really think about tongue-tie surgery for their infants. Clinical Pediatrics, 59(3), 236–244. https://doi.org/10.1177/0009922819896583

33.

Schindler-Ruwisch

Phillips

K. E.

(2021). Breastfeeding during a pandemic: The influence of COVID-19 on lactation services in the Northeastern United States. Journal of Human Lactation, 37(2), 260–268. https://doi.org/10.1177/08903344211003898

34.

Shah

Allen

Walker

Rosen-Carole

McKenna Benoit

M. K.

(2021). Upper lip tie: Anatomy, effect on breastfeeding, and correlation with ankyloglossia. The Laryngoscope, 131(5), e1701–e1706. https://doi.org/10.1002/lary.29140

35.

Talmor

Caloway

C. L.

(2022). Ankyloglossia and tethered oral tissue: An evidence-based review. Pediatric Clinics, 69(2), 235–245. https://doi.org/10.1016/j.pcl.2021.12.007

36.

United States Census Bureau. (2021). Geographic Levels. https://www.census.gov/programs-surveys/economic-census/guidance-geographies/levels.html

37.

United States Department of Health and Human Services. (2011). Executive summary: The Surgeon General’s call to action to support breastfeeding. Breastfeeding Medicine, 6(1), 3–5. https://doi.org/10.1089/bfm.2011.9996

38.

Unger

Chetwynd

Costello

(2019). Ankyloglossia identification, diagnosis, and frenotomy: A qualitative study of community referral pathways. Journal of Human Lactation, 36(3), 519–527. https://doi.org/10.1177/0890334419887368

39.

Walsh

Tunkel

D. E.

(2018). Tongue-tie and frenotomy: What evidence do we have and what do we need? Medical Journal of Australia, 208(2), 67–68. https://doi.org/10.5694/mja17.00806

40.

Wei

E. X.

Tunkel

Boss

Walsh

(2020). Ankyloglossia: Update on trends in diagnosis and management in the United States, 2012–2016. Otolaryngology—Head and Neck Surgery, 163(5), 1029–1031. https://doi.org/10.1177/0194599820925415

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.06 MB

0.03 MB

0.38 MB