Ankyloglossia, Breastfeeding, and Infant Weight Gain: A Mixed-Methods Study

Ankyloglossia may cause breastfeeding difficulties, potentially leading to early cessation of exclusive breastfeeding (EBF). However, increases in rates of frenotomy have not resulted in increases in EBF rates, and, in some regions, ankyloglossia is not regarded as a major barrier to successful breastfeeding. We sought to elucidate the contribution of untreated ankyloglossia to early cessation of EBF.

We conducted a sequential explanatory mixed-methods study at an urban tertiary care hospital for women and children in Hyderabad, India. We evaluated for ankyloglossia and breastfeeding difficulties in mother-infant dyads recruited within 48 hours after birth. Primary outcomes of EBF and infant weight gain were compared between infants with (tongue-tie [TT]) or without (No-TT) ankyloglossia. Semistructured interviews were conducted to identify reasons contributing to early cessation.

A total of 476 dyads were recruited over 3 months. There was no significant difference in rates of EBF at 6 months (No-TT 81.4% vs TT 78.6%; P = .6) or infant weight gain velocity from 0 to 3 months (No-TT 26.3 g/d vs TT 26 g/d; P = .86) or from 3 to 6 months (19.3 g/d vs 20.4 g/d; P = .49). Maternal concern for inadequate supply was associated with lower EBF odds at 6 months (odds ratio 0.22; P = .003). Mothers with early cessation in either group rarely reported issues with infant breastfeeding skill or nipple pain.

Although ankyloglossia may affect breastfeeding experiences, ankyloglossia alone does not appear to affect breastfeeding maintenance or infant weight gain. Improving breastfeeding outcomes should include multidisciplinary management to focus on all potential causes and not only ankyloglossia.