Help Wanted: Champions for Breastfeeding Success in Newborns with Ankyloglossia

Background:

Ankyloglossia refers to a tethered frenulum which restricts the movement of the tongue or lips. When too restrictive, the newborn may ineffectively suckle at the breast. Breastfeeding difficulties that manifest such as long nursings or damaged nipples may indicate required treatment. When recognized, referrals can be made to pediatricians and potentially surgeons.  Historically, formula gained popularity in the United States due to cultural influences. Frenulotomy was not needed to enable sucking on a bottle.  The procedure was viewed as unnecessary trauma for the newborn. However, for many babies, breastfeeding can be preserved only with timely treatment of ankyloglossia. Parents should be educated about their options and have their decisions supported.  A team approach with lactation consultants can empower nurses to champion for the necessary medical evaluation and possible intervention

Case:

In one case, a second time mother concerned over her newborn’s “tongue-tie” informed the maternity nurse that despite intending to fully breastfeed her first child, she did not reach her goal.  The first child had difficulty latching, was not satisfied with a feed and lost excessive weight. A painful latch resulted in bleeding nipples. The nurse suspected ankyloglossia, however, the pediatrician opted for delay in surgical intervention hoping the tongue” would come out on its own”. The doctor recommended formula bottles to rest the nipples initially. During breastfeeding attempts several times over the next two months, the first baby lost weight. Finally, she was referred to an oral surgeon. By this time, the disappointed mother had given up hopes of breastfeeding and ceased her efforts.

 In contrast, with her second child, the concerns of the mother were acknowledged by the maternity nurse who had gained knowledge of ankyloglossia from the hospital-based lactation consultant.  The nurse instructed the mother on breast pumping and ordered an early lactation consult. Upon confirming ankyloglossia with a digital exam, the consultant collaborated with the nurse for early intervention. This time, the pediatrician ordered an immediate, in-hospital evaluation by an oral surgeon. A frenulotomy was performed within twenty-four hours of the newborn’s birth. The mother breastfed immediately after the bedside procedure and continued successfully breastfeeding her son.  

Conclusion:

Recognizing that tight frenulums impact effectiveness of breastfeeding allows nurses to collaborate for timely breastfeeding interventions.  Involving an interdisciplinary team can maximize breastfeeding success. Nurses can ensure that all mothers reach their breastfeeding goals by championing for newborns whose ankyloglossia prevents them from effectively nursing.

Keywords: ankyloglossia, frenulotomy, tongue-tie, breastfeeding difficulty, breastfeeding