Elsevier

Journal of Pediatric Surgery

Volume 41, Issue 9, September 2006, Pages 1598-1600
Journal of Pediatric Surgery

Original article
Immediate nipple pain relief after frenotomy in breast-fed infants with ankyloglossia: a randomized, prospective study

https://doi.org/10.1016/j.jpedsurg.2006.05.024Get rights and content

Abstract

Purpose

Ankyloglossia (“tongue-tie”) occurs in nearly 5% of neonates, but its clinical significance relating to breast-feeding difficulties is controversial. We tested the hypothesis that in infants with ankyloglossia referred because of breast-feeding difficulties, frenotomy alleviates the symptoms.

Methods

Twenty-five mothers of healthy infants with ankyloglossia were recruited because of sore nipples. Infants were randomized to either of 2 sequences: (1) frenotomy, breast-feeding, sham, breast-feeding (n = 14) or (2) sham, breast-feeding, frenotomy, breast-feeding (n = 11). The mothers as well as all personnel taking care of the child after each sham or frenotomy procedure were masked as to the study sequence. In every sequence, and after each sham or frenotomy procedure, a standardized latch score and pain score were obtained from the mother.

Results

There was a significant decrease in pain score after frenotomy than after sham (P = .001). There was also a nearly significant improvement in latch after the frenotomy in these mothers (P = .06).

Conclusion

Frenotomy appears to alleviate nipple pain immediately after frenotomy. We speculate that ankyloglossia plays a significant role in early breast-feeding difficulties, and that frenotomy is an effective therapy for these difficulties.

Section snippets

Methods

Institutional review board permission for conducting the study was granted, and written informed parental consent was obtained for each of the participants. We recruited 25 full-term healthy, appropriate-for-gestational age infants aged 1 to 21 days. This number of patients was initially designed as a pilot that would help to calculate sample size of a larger study. All patients had been referred to the lactation clinic at the Lis Maternity Hospital because of nipple pain. On physical

Results

The study was successfully completed in 25 infants between December 1, 2001, and September 30, 2004. An additional infant had been excluded because upon breast-feeding, a few drops of blood were seen by the mother at the corner of his mouth, which cancelled blinding. The 25 remaining infants had a mean ± SD gestational age of 39.8 ± 1.2 weeks and birth weight of 3205 ± 830 g. In only 3 of the infants did the tongue protruded beyond the alveolar ridge, whereas in 22 it did not. Fifteen of the

Discussion

In this prospective randomized masked study, we studied frenotomy or sham in infants with ankyloglossia and maternal nipple pain. We found that after frenotomy, there was an immediate and significant nipple pain relief as judged by a significant decrease in pain score after frenotomy than after sham. We also found a concomitant improvement in infant's latch to the breast in this group.

The design of our study allowed overcoming several biases. As stated in a recent, nonrandomized study, maternal

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