Tongue tie division in infants with breast feeding difficulties

Tongue tie is a congenital oral abnormality characterised by an abnormally short lingual frenulum. The majority of current medical and surgical opinion is that tongue tie rarely, if ever, causes feeding difficulties and therefore, should not be divided. With increased popularity of breast feeding in the last decade there has been renewed interest in tongue tie and its effect on breast feeding. We present a case series of infants who underwent tongue tie division for feeding difficulties and assess the indications for and outcomes of the procedure.

Eleven infants with breast feeding difficulties associated with tongue tie underwent tongue tie division using a standard technique in the outpatient clinic. No anaesthetic or analgesia was used and there was little or no bleeding or infant distress. Parents were subsequently contacted by phone at least 4 months after the procedure to inquire about the effect of the procedure on feeding and any complications encountered.

The age at tongue tie division ranged from 2 to 31 days (median=10 days). 10/11 of these infants were followed up. The age at follow up was 4-20 months (median=10 months). Prior to division, all mothers had attempted breast feeding and were keen to continue. 9/10 had experienced difficulties due to poor latch (8/10), sore nipples (6/10) and continual feeding cycle (5/10). Only 3/10 mothers were breast feeding exclusively. Following tongue tie division, an improvement in breast feeding was noticed immediately by 4/10 mothers. Three mothers did not notice any improvement. 6/10 mothers successfully breast fed for at least 4 months. There were no reported complications of the procedure.

The benefits of breast feeding are well known and lactation consultants are becoming more aware of tongue tie as a treatable cause of breast feeding difficulty. The procedure is quick and simple, not requiring any analgesia or anaesthesia and can be performed in the outpatient clinic. Although not conclusive, this case series suggests a possible benefit of tongue tie division in symptomatic infants.