{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T07:52:54Z","timestamp":1793173974137,"version":"4.5.0"},"reference-count":29,"publisher":"American Academy of Pediatrics (AAP)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2008,7,1]]},"abstract":"<jats:p>OBJECTIVE. There is evidence that infants with ankyloglossia can experience breastfeeding difficulties including poor attachment to the breast, suboptimal weight gain, and maternal nipple pain, which may lead to early weaning of the infant. No studies have investigated the cause of these breastfeeding difficulties. The objective of this study was to determine the effectiveness of frenulotomy in infants experiencing persistent breastfeeding difficulties despite professional assistance by measuring changes in milk transfer and tongue movement during breastfeeding before and after frenulotomy.<\/jats:p>\n               <jats:p>PATIENTS AND METHODS. Twenty-four mother-infant dyads (infant age: 33 \u00b1 28 days) that were experiencing persistent breastfeeding difficulties despite receiving professional advice were recruited. Submental ultrasound scans (Acuson XP10) of the oral cavity were performed both before and \u22657 days after frenulotomy. Milk transfer, pain, and LATCH (latch, audible swallowing, type of nipple, comfort, and hold) scores were recorded before and after frenulotomy. Infant milk intake was measured by using the test-weigh method.<\/jats:p>\n               <jats:p>RESULTS. For all of the infants, milk intake, milk-transfer rate, LATCH score, and maternal pain scores improved significantly postfrenulotomy. Two groups of infants were identified on ultrasound. One group compressed the tip of the nipple, and the other compressed the base of the nipple with the tongue. These features either resolved or lessened in all except 1 infant after frenulotomy.<\/jats:p>\n               <jats:p>CONCLUSIONS. Infants with ankyloglossia experiencing persistent breastfeeding difficulties showed less compression of the nipple by the tongue postfrenulotomy, which was associated with improved breastfeeding defined as better attachment, increased milk transfer, and less maternal pain. In the assessment of breastfeeding difficulties, ankyloglossia should be considered as a potential cause.<\/jats:p>","DOI":"10.1542\/peds.2007-2553","type":"journal-article","created":{"date-parts":[[2008,6,24]],"date-time":"2008-06-24T00:44:51Z","timestamp":1214268291000},"page":"e188-e194","source":"Crossref","is-referenced-by-count":156,"title":["Frenulotomy for Breastfeeding Infants With Ankyloglossia: Effect on Milk Removal and Sucking Mechanism as Imaged by Ultrasound"],"prefix":"10.1542","volume":"122","author":[{"given":"Donna T.","family":"Geddes","sequence":"first","affiliation":[{"name":"School of Biomedical, Biomolecular, and Chemical Sciences, University of Western Australia, Perth, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diana B.","family":"Langton","sequence":"additional","affiliation":[{"name":"Breastfeeding Centre, King Edward Memorial Hospital, Subiaco, Western Australia, Perth, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ian","family":"Gollow","sequence":"additional","affiliation":[{"name":"School of Pediatrics and Child Health, Princess Margaret Hospital, Perth, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorili A.","family":"Jacobs","sequence":"additional","affiliation":[{"name":"Ultrasound Department"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter E.","family":"Hartmann","sequence":"additional","affiliation":[{"name":"School of Biomedical, Biomolecular, and Chemical Sciences, University of Western Australia, Perth, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen","family":"Simmer","sequence":"additional","affiliation":[{"name":"Neonatal Clinical Care Unit, King Edward Memorial Hospital, Perth, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2008,7,1]]},"reference":[{"key":"2021120905545618000_R1","unstructured":"Academy of Breastfeeding Medicine. ABM clinical protocol #11: guidelines for the evaluation and management of neonatal ankyloglossia and its complications in the breastfeeding dyad. 2004. Available at: www.bfmed.org\/ace-files\/protocol\/ankyloglossiafinal_11.pdf. Accessed May 7,2008"},{"key":"2021120905545618000_R2","doi-asserted-by":"crossref","unstructured":"Hogan M, Westcott C, Griffiths M. Randomised controlled division of tongue tie infants with breastfeeding problems. J Paediatric Child Health.2005;41(5\u20136):246\u2013250","DOI":"10.1111\/j.1440-1754.2005.00604.x"},{"key":"2021120905545618000_R3","doi-asserted-by":"crossref","unstructured":"Ballard JL, Auer CE, Khoury JC. Ankyloglossia: assessment, incidence, and effect of frenuloplasty on the breastfeeding dyad. Pediatrics.2002;110(5). Available at: www.pediatrics.org\/cgi\/content\/full\/110\/5\/e63","DOI":"10.1542\/peds.110.5.e63"},{"key":"2021120905545618000_R4","doi-asserted-by":"crossref","unstructured":"Messner AH, Lalakea MH, Aby J, MacMahon J, Bair E. Ankyloglossia incidence and associated feeding difficulties. Arch Otolaryngol Head Neck Surg.2000;126(1):36\u201339","DOI":"10.1001\/archotol.126.1.36"},{"key":"2021120905545618000_R5","doi-asserted-by":"crossref","unstructured":"Lalakea ML, Messner AH. Ankyloglossia: the adolescent and adult perspective. Otolaryngol Head Neck Surg.2003;128(5):746\u2013752","DOI":"10.1016\/S0194-5998(03)00258-4"},{"key":"2021120905545618000_R6","doi-asserted-by":"crossref","unstructured":"Messner AH, Lalakea MH. Ankyloglossia: controversies in management. Int J Pediatr Otorhinolaryngol.2000;54(2\u20133):123\u2013131","DOI":"10.1016\/S0165-5876(00)00359-1"},{"key":"2021120905545618000_R7","doi-asserted-by":"crossref","unstructured":"Cunningham AS, Jelliffe DB, Jelliffe EF. Breastfeeding and health in the 1980s: a global epidemiological review. J Pediatr.1991;118(5):659\u2013666","DOI":"10.1016\/S0022-3476(05)80023-X"},{"key":"2021120905545618000_R8","doi-asserted-by":"crossref","unstructured":"Singhal A, Cole TJ, Lucas A. Early nutrition in pre-term infants and later blood pressure: 2 cohorts after randomised trials. Lancet.2001;357(9254):431\u2013419","DOI":"10.1016\/S0140-6736(00)04004-6"},{"key":"2021120905545618000_R9","doi-asserted-by":"crossref","unstructured":"American Academy of Pediatrics, Working Group on Breastfeeding. Breastfeeding and the use of human milk. Pediatrics.1997;100(6):1035\u20131039","DOI":"10.1542\/peds.100.6.1035"},{"key":"2021120905545618000_R10","doi-asserted-by":"crossref","unstructured":"Win NN, Binns CW, Zhao Y, Scott JA, Oddy WH. Breastfeeding duration in mothers who express breast milk: a cohort study. Int Breastfeed J.2006;1:28","DOI":"10.1186\/1746-4358-1-28"},{"key":"2021120905545618000_R11","doi-asserted-by":"crossref","unstructured":"Scott JA, Binns CW, Oddy WH, Graham KI. Predictors of breastfeeding duration: evidence from a cohort study. Pediatrics.2006;117(4). Available at: www.pediatrics.org\/cgi\/content\/full\/117\/4\/e646","DOI":"10.1542\/peds.2005-1991"},{"key":"2021120905545618000_R12","doi-asserted-by":"crossref","unstructured":"Griffiths DM. Do tongue ties affect breastfeeding?J Hum Lact.2004;20(4):409\u2013414","DOI":"10.1177\/0890334404266976"},{"key":"2021120905545618000_R13","doi-asserted-by":"crossref","unstructured":"Kent JC, Mitoulas LR, Cregan MD, Ramsay DT, Doherty DA, Hartmann PE. Volume and frequency of breastfeeds and fat content of breastmilk throughout the day. Pediatrics.2006;117(3). Available at: www.pediatrics.org\/cgi\/content\/full\/117\/3\/e387","DOI":"10.1542\/peds.2005-1417"},{"key":"2021120905545618000_R14","doi-asserted-by":"crossref","unstructured":"Jensen D, Wallace S, Kelsay P. LATCH: a breastfeeding charting system and documentation tool. J Obstet Gynecol Neonatal Nurs.1994;23(1):27\u201332","DOI":"10.1111\/j.1552-6909.1994.tb01847.x"},{"key":"2021120905545618000_R15","doi-asserted-by":"crossref","unstructured":"Arthur PG, Hartmann PE, Smith M. Measurement of milk intake of breastfed infants. J Pediatr Gastroenterol Nutr.1987;6(5):758\u2013763","DOI":"10.1097\/00005176-198709000-00017"},{"key":"2021120905545618000_R16","doi-asserted-by":"crossref","unstructured":"Woolridge MW. The anatomy of infant sucking. Midwifery.1986;2(4):164\u2013171","DOI":"10.1016\/S0266-6138(86)80041-9"},{"key":"2021120905545618000_R17","doi-asserted-by":"crossref","unstructured":"Smith WL, Erenberg A, Nowak A. Imaging evaluation of the human nipple during breast-feeding. Am J Dis Child.1988;142(1):76\u201378","DOI":"10.1001\/archpedi.1988.02150010086031"},{"key":"2021120905545618000_R18","doi-asserted-by":"crossref","unstructured":"Jacobs LA, Dickinson JE, Hart DP, Doherty DA, Faulkner SJ. Normal nipple position in term infants measured on breastfeeding ultrasound. J Hum Lact.2007;23(1):52\u201359","DOI":"10.1177\/0890334406297184"},{"key":"2021120905545618000_R19","doi-asserted-by":"crossref","unstructured":"Geddes DT, Kent JC, Mitoulas LR, Hartmann PE. Tongue movement and intra-oral vacuum in breastfeeding infants. Early Hum Dev.2008; In press","DOI":"10.1016\/j.earlhumdev.2007.12.008"},{"key":"2021120905545618000_R20","unstructured":"Hazelbaker AK. The Assessment Tool for Lingual Frenulum Function (ATLFF): Use in a Lactation Consultant Private Practice. Los Angeles, CA: Pacific Oaks College;1993"},{"key":"2021120905545618000_R21","doi-asserted-by":"crossref","unstructured":"Amir LH, James JP, Donath SM. Reliability of the hazelbaker assessment tool for lingual frenulum function. Int Breastfeed J.2006;1(1):3","DOI":"10.1186\/1746-4358-1-3"},{"key":"2021120905545618000_R22","doi-asserted-by":"crossref","unstructured":"Madlon-Kay DJ, Ricke LA, Baker NJ, Defor TA. Case series of 148 tongue-tied newborn babies evaluated with the assessment tool for lingual frenulum function. Midwifery.2007; In press","DOI":"10.1016\/j.midw.2006.02.005"},{"key":"2021120905545618000_R23","doi-asserted-by":"crossref","unstructured":"Srinivasan A, Dobrich C, Mitnick H, Feldman P. Ankyloglossia in breastfeeding infants: the effect of frenotomy on maternal nipple pain and latch. Breastfeed Med.2006;1(4):216\u2013224","DOI":"10.1089\/bfm.2006.1.216"},{"key":"2021120905545618000_R24","doi-asserted-by":"crossref","unstructured":"Thomassen P, Johansson VA, Wassberg C, Petrini B. Breast-feeding, pain and infection. Gynecol Obstet Invest.1998;46(2):73\u201374","DOI":"10.1159\/000010004"},{"key":"2021120905545618000_R25","doi-asserted-by":"crossref","unstructured":"Mozingo JN, Davis MW, Droppleman PG, Merideth A. \u201cIt wasn't working\u201d: women's experiences with short-term breastfeeding. MCN Am J Matern Child Nurs.2000;25(3):120\u2013126","DOI":"10.1097\/00005721-200005000-00004"},{"key":"2021120905545618000_R26","unstructured":"Wilson-Clay B, Hoover K. The Breastfeeding Atlas. 3rd ed. Manchaca, TX: LactNews Press;2005"},{"key":"2021120905545618000_R27","doi-asserted-by":"crossref","unstructured":"Newton M, Newton N. The let-down reflex in human lactation. J Pediatrics.1948;33(6):698\u2013704","DOI":"10.1016\/S0022-3476(48)80075-2"},{"key":"2021120905545618000_R28","doi-asserted-by":"crossref","unstructured":"Dollberg S, Botzer E, Grunis E, Mimouni FB. Immediate nipple pain relief after frenotomy in breast-fed infants with ankyloglossia: a randomised, prospective study. J Pediatr Surg.2006;41(9):1598\u20131600","DOI":"10.1016\/j.jpedsurg.2006.05.024"},{"key":"2021120905545618000_R29","doi-asserted-by":"crossref","unstructured":"Marmet C, Marmet R. Neonatal frenotomy may be necessary to correct breastfeeding problems. J Hum Lact.1990;6(3):117\u2013121","DOI":"10.1177\/089033449000600318"}],"container-title":["Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/122\/1\/e188\/1068782\/zpe0070800e188.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/122\/1\/e188\/1068782\/zpe0070800e188.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,12,9]],"date-time":"2021-12-09T23:51:44Z","timestamp":1639093904000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.aap.org\/pediatrics\/article\/122\/1\/e188\/72964\/Frenulotomy-for-Breastfeeding-Infants-With"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2008,7,1]]},"references-count":29,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2008,7,1]]},"published-print":{"date-parts":[[2008,7,1]]}},"URL":"https:\/\/doi.org\/10.1542\/peds.2007-2553","relation":{},"ISSN":["0031-4005","1098-4275"],"issn-type":[{"value":"0031-4005","type":"print"},{"value":"1098-4275","type":"electronic"}],"subject":[],"published":{"date-parts":[[2008,7,1]]}}}