Question
What is the consensus on the effects of ankyloglossia on neonatal feeding?
Answer
Ankyloglossia, a very common congenital condition usually identified at birth, is characterized by an anterior attachment of the lingual frenulum to the tongue tip (also commonly referred to as “tongue-tie”). The association between ankyloglossia and breastfeeding has been debated among medical professionals for decades (Messner et al, 2020; Rowan-Legg, 2011; Ruffoli et al., 2005). In a survey of relevant practitioners, more than half of lactation consultants (69%) felt that ankyloglossia frequently causes breastfeeding problems. They argue that infants with restrictive ankyloglossia have difficulty breastfeeding because they cannot extend their tongues over their lower gum line to form a proper seal against the nipple. Consequently, they are unable to sufficiently latch onto the breast and keep it within their mouth (Brookes & Bowley, 2014; Francis, Krishnaswami et al., 2015). More recently, lactation specialists believe that posterior tongue-tie can also cause neonatal feeding disorders (Ghaheri et al., 2022; O’Callahan et al., 2013; Pransky et al., 2015), while others don’t agree that posterior tongue-tie even exists as an anomaly (Messner et al., 2020; Talmor & Caloway, 2022). In contrast, a minority of physicians (10% of pediatricians and 30% of otolaryngologists) agreed that ankyloglossia commonly affects neonatal feeding (Messner & Lalakea, 2000). The controversy regarding the effect of ankyloglossia on infant feeding could be due, at least in part, to the fact that not all affected infants experience breastfeeding difficulty.
One study estimated that only 25% of infants with ankyloglossia have difficulty latching on to the nipple during breastfeeding (Messner et al., 2000; Flinck et al., 1994). This means that most infants with ankyloglossia can breastfeed without surgical intervention (Emond et al., 2014; Power & Murphy, 2015; Caloway et al., 2019). In addition, affected infants can be bottle-fed without difficulty (Ricke et al., 2005). Despite these reports, the overall evidence for an association between ankyloglossia and breastfeeding difficulties remains equivocal.
This Ask the Expert is an edited excerpt from the course 20Q: Ankyloglossia - Myths and Evidence Regarding Its Effects on Function authored by Ann W. Kummer, PhD, CCC-SLP, FASHA, 2017 ASHA Honors.
