Superior Labial Frenulum Attachment Site and Correlation with Breastfeeding Outcomes

Area of Science:

• Pediatrics
• Lactation
• Oral Surgery

Background:

• Infant oral anatomy, specifically the superior labial frenulum (SLF), is theorized to influence breastfeeding.
• Existing grading systems for SLF attachment may not fully capture functional impact on breastfeeding.

Purpose of the Study:

• To evaluate a modified grading system for superior labial frenulum (SLF) attachment site.
• To investigate the correlation between SLF attachment grade and breastfeeding outcomes in dyads.

Main Methods:

• Recruited 208 dyads and assessed neonates' SLF and lingual frenulum using photo-documentation.
• Utilized blinded reviewers to assess SLF photos with a modified Stanford grade.
• Collected maternal surveys on breastfeeding attitudes and pain at 24 hours, 2 weeks, and 2 months postpartum.

Main Results:

• Breastfeeding rates at 2 weeks and 2 months were 86.8% and 72.8%, respectively.
• A lower breastfeeding rate (50.0%) was observed in SLF grade 1 dyads at 2 months compared to grades 2 (75.3%) and 3 (85.7%) (p=0.0384).
• No significant differences were found in maternal attitudes, pain scores, infant weight, or need for frenulectomy across SLF grades.

Conclusions:

• The study found no correlation between SLF attachment grade and breastfeeding outcomes, including duration, maternal confidence, pain, or infant weight.
• Findings do not support interventions like labial frenulectomy based solely on SLF grade.
• A more comprehensive functional grading system for infant oral anatomy is needed to better assess breastfeeding impact.