{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,4]],"date-time":"2025-10-04T12:27:11Z","timestamp":1759580831601,"version":"3.41.2"},"reference-count":35,"publisher":"Danish Medical Association","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Dan Med J"],"abstract":"<jats:p>INTRODUCTION. Ankyloglossia in breastfeeding infants has been proposed to cause maternal nipple pain. Lingual frenotomy has been cited to reduce maternal nipple pain. The aim of this systematic review was to investigate if frenotomy in infants with ankyloglossia and breastfeeding problems reduces maternal nipple pain.\n\nMETHODS. We conducted a systematic literature search for RCTs comparing frenotomy to a sham procedure or usual care in mother-infant dyads with ankyloglossia and maternal nipple pain. Maternal nipple pain was registered as the main outcome. We conducted a meta-analysis and assessed the risk of bias using Rob 2.0 and the quality of evidence, adopting the GRADE approach.\n\nRESULTS. Five RCTs were included in the review. Three RCTs were used for the meta-analysis. The meta-analysis showed a significant pre-post intervention reduction in maternal nipple pain in the frenotomy group compared with the comparison group: mean difference = \u22121.23; 95% confidence interval: \u22121.88 to \u22120.57. The overall bias was assessed to range from \u201csome concerns\u201d to \u201chigh\u201d. The quality of evidence for the assessed outcome, maternal nipple pain, was classified as \u201clow\u201d to \u201cvery low\u201d.\n\nCONCLUSIONS. We found that frenotomy reduced maternal nipple pain in the short term. Despite being statistically significant, the clinical relevance of a 1.2-point reduction on a ten-point VAS must be questioned. Due to a considerable risk of bias along with a low study quality, the definitive benefit of frenotomy on maternal nipple pain remains unproven. Hence, quality large-scale RCTs are warranted.<\/jats:p>","DOI":"10.61409\/a06240378","type":"journal-article","created":{"date-parts":[[2025,2,4]],"date-time":"2025-02-04T06:09:45Z","timestamp":1738649385000},"page":"1-11","source":"Crossref","is-referenced-by-count":1,"title":["The effect of frenotomy in infants with ankyloglossia on maternal nipple pain \u2013 a systematic review"],"prefix":"10.61409","author":[{"given":"L\u00e6rke N\u00f8rgaard","family":"Albertsen","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Therese","family":"Ovesen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"40208","published-online":{"date-parts":[[2025,1,1]]},"reference":[{"key":"ref0","doi-asserted-by":"publisher","unstructured":"Ricke LA, Baker NJ, Madlon-Kay DJ, DeFor TA. Newborn tongue-tie: prevalence and effect on breast-feeding. J Am Board Fam Pract. 2005;18(1):1-7. https:\/\/doi.org\/10.3122\/jabfm.18.1.1","DOI":"10.3122\/jabfm.18.1.1"},{"key":"ref1","doi-asserted-by":"publisher","unstructured":"Hogan M, Westcott C, Griffiths M. Randomized, controlled trial of division of tongue-tie in infants with feeding problems. J Paediatr Child Health. 2005;41(5-6):246-50. https:\/\/doi.org\/10.1111\/j.1440-1754.2005.00604.x","DOI":"10.1111\/j.1440-1754.2005.00604.x"},{"key":"ref2","unstructured":"Coryllos E, Genna CW, Salloum AC. Breastfeeing: best for mother and baby. Congenital tongue-tie and its impact on breastfeeding. American Academy of Pediatrics, 2004:1-6. https:\/\/breastfeedingmadesimple.com\/wp-content\/uploads\/2016\/02\/tonguetie.pdg_.pdf (Oct 2024)"},{"key":"ref3","unstructured":"Hazelbaker AK. The Assessment Tool for Lingual Frenulum Function (ATLFF): use in a lactation consultant private practise. Thesis, 1993."},{"key":"ref4","doi-asserted-by":"publisher","unstructured":"Ingram J, Johnson D, Copeland M et al. The development of a tongue assessment tool to assist with tongue-tie identification. Arch Dis Child Fetal Neonatal Ed. 2015;100(4):F344-F348. https:\/\/doi.org\/10.1136\/archdischild-2014-307503","DOI":"10.1136\/archdischild-2014-307503"},{"key":"ref5","doi-asserted-by":"publisher","unstructured":"Ingram J, Copeland M, Johnson D, et al. The development and evaluation of a picture tongue assessment tool for tongue-tie in breastfed babies (TABBY). Int Breastfeed J. 2019;14:31. https:\/\/doi.org\/10.1186\/s13006-019-0224-y","DOI":"10.1186\/s13006-019-0224-y"},{"key":"ref6","unstructured":"Ellehauge E, Jensen JS, Gr\u00f8nh\u00f8j C, et al. Trends of ankyloglossia and lingual frenotomy in hospital settings among children in Denmark. Dan Med J. 2020;67(5):A01200051"},{"key":"ref7","doi-asserted-by":"publisher","unstructured":"Walsh J, Links A, Boss E et al. Ankyloglossia and lingual frenotomy: national trends in inpatient diagnosis and management in the United States, 1997-2012. Otolaryngol Head Neck Surg. 2017;156(4):735-40. https:\/\/doi.org\/10.1177\/0194599817690135","DOI":"10.1177\/0194599817690135"},{"key":"ref8","doi-asserted-by":"publisher","unstructured":"Carnino JM, Walia AS, Lara FR et al. The effect of frenectomy for tongue-tie, lip-tie, or cheek-tie on breastfeeding outcomes: a systematic review of articles over time and suggestions for management. Int J Pediatr Otorhinolaryngol. 2023;171:111638. https:\/\/doi.org\/10.1016\/j.ijporl.2023.111638","DOI":"10.1016\/j.ijporl.2023.111638"},{"key":"ref9","doi-asserted-by":"publisher","unstructured":"Cordray H, Mahendran GN, Tey CS et al. Severity and prevalence of ankyloglossia-associated breastfeeding symptoms: a systematic review and meta-analysis. Acta Paediatr. 2023;112(3):347-57. https:\/\/doi.org\/10.1111\/apa.16609","DOI":"10.1111\/apa.16609"},{"key":"ref10","doi-asserted-by":"publisher","unstructured":"Ito Y. Does frenotomy improve breast-feeding difficulties in infants with ankyloglossia? Pediatr Int. 2014;56(4):497-505. https:\/\/doi.org\/10.1111\/ped.12429","DOI":"10.1111\/ped.12429"},{"key":"ref11","doi-asserted-by":"publisher","unstructured":"Victora CG, Bahl R, Barros AJ et al. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet. 2016;387(10017):475-90. https:\/\/doi.org\/10.1016\/S0140-6736(15)01024-7","DOI":"10.1016\/S0140-6736(15)01024-7"},{"key":"ref12","unstructured":"WHO. Breastfeeding. www.who.int\/health-topics\/breastfeeding#tab=tab_1 (7 May 2024)"},{"key":"ref13","unstructured":"CDC. Breastfeeding report card. CDC, 2022. www.cdc.gov\/breastfeeding\/data\/reportcard.htm (14 May 2024)"},{"key":"ref14","unstructured":"Sundhedsdatastyrelsen. Den Nationale B\u00f8rnedatabase: amning og uds\u00e6ttelse for tobaksr\u00f8g i f\u00f8rste leve\u00e5r. 2024."},{"key":"ref15","doi-asserted-by":"publisher","unstructured":"O'Shea JE, Foster JP, O'Donnell CP et al. Frenotomy for tongue-tie in newborn infants. Cochrane Database Syst Rev. 2017;3:CD011065. https:\/\/doi.org\/10.1002\/14651858.CD011065.pub2","DOI":"10.1002\/14651858.CD011065.pub2"},{"key":"ref16","doi-asserted-by":"publisher","unstructured":"Page MJ, McKenzie JE, Bossuyt PM et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71. https:\/\/doi.org\/10.1136\/bmj.n71","DOI":"10.1136\/bmj.n71"},{"key":"ref17","doi-asserted-by":"publisher","unstructured":"Guyatt GH, Oxman AD, Kunz R et al. GRADE guidelines: 2. Framing the question and deciding on important outcomes. J Clin Epidemiol. 2011;64(4):395-400. https:\/\/doi.org\/10.1016\/j.jclinepi.2010.09.012","DOI":"10.1016\/j.jclinepi.2010.09.012"},{"key":"ref18","doi-asserted-by":"publisher","unstructured":"Sterne JAC, Savovi\u0107 J, Page MJ et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ. 2019;366:l4898. https:\/\/doi.org\/10.1136\/bmj.l4898","DOI":"10.1136\/bmj.l4898"},{"key":"ref19","doi-asserted-by":"publisher","unstructured":"Balshem H, Helfand M, Sch\u00fcnemann HJ et al. GRADE guidelines: 3. Rating the quality of evidence. J Clin Epidemiol. 2011;64(4):401-6. https:\/\/doi.org\/10.1016\/j.jclinepi.2010.07.015","DOI":"10.1016\/j.jclinepi.2010.07.015"},{"key":"ref20","doi-asserted-by":"publisher","unstructured":"Ghaheri BA, Lincoln D, Mai TNT, Mace JC. Objective improvement after frenotomy for posterior tongue-tie: a prospective randomized trial. Otolaryngol Head Neck Surg. 2022;166(5):976-84. https:\/\/doi.org\/10.1177\/01945998211039784","DOI":"10.1177\/01945998211039784"},{"key":"ref21","doi-asserted-by":"publisher","unstructured":"Emond A, Ingram J, Johnson D et al. Randomised controlled trial of early frenotomy in breastfed infants with mild-moderate tongue-tie. Arch Dis Child Fetal Neonatal Ed. 2014;99(3):F189-F195. https:\/\/doi.org\/10.1136\/archdischild-2013-305031","DOI":"10.1136\/archdischild-2013-305031"},{"key":"ref22","doi-asserted-by":"publisher","unstructured":"Berry J, Griffiths M, Westcott C. A double-blind, randomized, controlled trial of tongue-tie division and its immediate effect on breastfeeding. Breastfeed Med. 2012;7(3):189-93. https:\/\/doi.org\/10.1089\/bfm.2011.0030","DOI":"10.1089\/bfm.2011.0030"},{"key":"ref23","doi-asserted-by":"publisher","unstructured":"Buryk M, Bloom D, Shope T. Efficacy of neonatal release of ankyloglossia: a randomized trial. Pediatrics. 2011;128(2):280-8. https:\/\/doi.org\/10.1542\/peds.2011-0077","DOI":"10.1542\/peds.2011-0077"},{"key":"ref24","doi-asserted-by":"publisher","unstructured":"Dollberg S, Botzer E, Grunis E, Mimouni FB. Immediate nipple pain relief after frenotomy in breast-fed infants with ankyloglossia: a randomized, prospective study. J Pediatr Surg. 2006;41(9):1598-600. https:\/\/doi.org\/10.1016\/j.jpedsurg.2006.05.024","DOI":"10.1016\/j.jpedsurg.2006.05.024"},{"key":"ref25","doi-asserted-by":"publisher","unstructured":"Knight M, Ramakrishnan R, Ratushnyak S et al. Frenotomy with breastfeeding support versus breastfeeding support alone for infants with tongue-tie and breastfeeding difficulties: the FROSTTIE RCT. Health Technol Assess. 2023;27(11):1-73. https:\/\/doi.org\/10.3310\/wbbw2302","DOI":"10.3310\/WBBW2302"},{"key":"ref26","doi-asserted-by":"publisher","unstructured":"Cordray H, Raol N, Mahendran GN et al. Quantitative impact of frenotomy on breastfeeding: a systematic review and meta-analysis. Pediatr Res. 2024;95(1):34-42. https:\/\/doi.org\/10.1038\/s41390-023-02784-y","DOI":"10.1038\/s41390-023-02784-y"},{"key":"ref27","doi-asserted-by":"publisher","unstructured":"Bruney TL, Scime NV, Madubueze A, Chaput KH. Systematic review of the evidence for resolution of common breastfeeding problems-ankyloglossia (tongue tie). Acta Paediatr. 2022;111(5):940-7. https:\/\/doi.org\/10.1111\/apa.16289","DOI":"10.1111\/apa.16289"},{"key":"ref28","doi-asserted-by":"publisher","unstructured":"Hill RR, Pados BF. Symptoms of problematic feeding in infants under 1 year of age undergoing frenotomy: a review article. Acta Paediatr. 2020;109(12):2502-14. https:\/\/doi.org\/10.1111\/apa.15473","DOI":"10.1111\/apa.15473"},{"key":"ref29","doi-asserted-by":"publisher","unstructured":"Francis DO, Krishnaswami S, McPheeters M. Treatment of ankyloglossia and breastfeeding outcomes: a systematic review. Pediatrics. 2015;135(6):e1458-66. https:\/\/doi.org\/10.1542\/peds.2015-0658","DOI":"10.1542\/peds.2015-0658"},{"key":"ref30","doi-asserted-by":"publisher","unstructured":"Hale M, Mills N, Edmonds L et al. Complications following frenotomy for ankyloglossia: a 24-month prospective New Zealand Paediatric Surveillance Unit study. J Paediatr Child Health. 2020;56(4):557-62. https:\/\/doi.org\/10.1111\/jpc.14682","DOI":"10.1111\/jpc.14682"},{"key":"ref31","doi-asserted-by":"publisher","unstructured":"Solis-Pazmino P, Kim GS, Lincango-Naranjo E et al. Major complications after tongue-tie release: a case report and systematic review. Int J Pediatr Otorhinolaryngol. 2020;138:110356. https:\/\/doi.org\/10.1016\/j.ijporl.2020.110356","DOI":"10.1016\/j.ijporl.2020.110356"},{"key":"ref32","doi-asserted-by":"publisher","unstructured":"Feldens CA, Heck ABdS, Rodrigues PH et al. Ankyloglossia and breastfeeding duration: a multicenter birth cohort study. Breastfeed Med. 2024;19(1):17-25. https:\/\/doi.org\/10.1089\/bfm.2023.0182","DOI":"10.1089\/bfm.2023.0182"},{"key":"ref33","doi-asserted-by":"publisher","unstructured":"Ngerncham S, Laohapensang M, Wongvisutdhi T et al. Lingual frenulum and effect on breastfeeding in Thai newborn infants. Paediatr Int Child Health. 2013;33(2):86-90. https:\/\/doi.org\/10.1179\/2046905512Y.0000000023","DOI":"10.1179\/2046905512Y.0000000023"},{"key":"ref34","unstructured":"Busck-Rasmussen M, Nilsson I, Hjuler T et al. National klinisk retningslinje for unders\u00f8gelse og behandling af ankyloglossi hos ammende sp\u00e6db\u00f8rn. 2020. www.sst.dk\/-\/media\/Viden\/Sundhedsv\u00e6sen\/NKR\/Puljefinansierede-NKR\/Stramt-tungeb\u00e5nd\/20200806_Quick-guide_Stramt-tungebaand.ashx?sc_lang=da&hash=11D1C8E8A970EE6D1896839894594451 (2 Aug 2024)"}],"container-title":["Danish Medical Journal"],"original-title":[],"deposited":{"date-parts":[[2025,7,28]],"date-time":"2025-07-28T13:13:47Z","timestamp":1753708427000},"score":1,"resource":{"primary":{"URL":"https:\/\/ugeskriftet.dk\/dmj\/A06240378"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,1]]},"references-count":35,"URL":"https:\/\/doi.org\/10.61409\/a06240378","relation":{},"ISSN":["2245-1919"],"issn-type":[{"type":"electronic","value":"2245-1919"}],"subject":[],"published":{"date-parts":[[2025,1,1]]}}}