Nipple Pain at Presentation Predicts Success of Tongue-Tie Division for Breastfeeding Problems

Abstract

Introduction: In mother-infant pairs experiencing breastfeeding difficulties, frenulotomy for tongue-tie may improve breastfeeding. We tested the hypothesis that those experiencing nipple pain are most likely to benefit from the procedure in a prospective cohort study.

Materials and Methods: Mother-infant pairs attending a dedicated clinic for the assessment and treatment of tongue-tie completed a standardised, structured symptom questionnaire. Three months later outcome was assessed by questionnaire. Multivariate logistic regression analysis was used to determine preoperative predictors of successful outcome.

Results: Sixty-two infants <90 days old underwent frenulotomy and completed follow-up. At presentation, 52 mothers (84%) reported nipple pain, and 32 mothers (52%) nipple trauma. Three months after frenulotomy, 78% of respondents were still breastfeeding. Feed lengths (mean reduction: 17 mins; p<0.001) and time between feeds (mean increase: 38 mins; p<0.001) had significantly improved, as had difficulty of feeding (mean improvement in self-rated difficulty score: 42%; p<0.001). Those having difficulty breastfeeding due to nipple pain showed a significant long-term benefit from frenulotomy; pre-frenulotomy nipple pain was associated with an increased likelihood of breastfeeding at 3 months in adjusted multivariate analysis (OR 5.8 [95% CI 1.1–31.6]).

Conclusion: Mother-infant pairs with tongue-tie and breastfeeding difficulties due to nipple pain are most likely to benefit from frenulotomy.

Key words

tongue-tie - ankyloglossia - breastfeeding - nipple pain

References

• 1 Flinck A, Paludan A, Matsson L. et al . Oral findings in a group of newborn Swedish children.  Int J Paediatr Dent. 1994;  4 67-73
• 2 Freudenberger S, Santos Diaz M, Bravo J. et al . Intraoral findings and other developmental conditions in Mexican neonates.  J Dent Child (Chic). 2008;  75 280-286
• 3 Messner A, Lalkea M. Ankyloglossia: incidence and associated feeding difficulties.  Arch Otolaryngol Head Neck Surg. 2002;  126;  36-39
• 4 Griffith D. Do tongue-ties affect breastfeeding?.  J Hum Lact. 2004;  20 409-414
• 5 Dollberg S, Botzer E, Grunis E. et al . Immediate nipple pain relief after frenotomy in breast-fed infants with ankyloglossia: a randomized prospective study.  J Pediatr Surg. 2006;  41 1598-1600
• 6 Hogan M, Westcott C, Griffiths M. Randomized, controlled trial of division of tongue-tie in infants with feeding problems.  J Paediatr Child Health. 2005;  41 246-250
• 7 National Institute for Health and Clinical Excellence . IPG149 Division of ankyloglossia (tongue-tie) for breastfeeding – guidance. NICE December 2005. , ISBN 1-84629-121
• 8 Madlon-Kay D, Ricke L, Baker J. et al . Case series of 148 tongue-tied newborn babies evaluated with the assessment tool for lingual frenulum function.  Midwifery. 2008;  24 353-357
• 9 Geddes D, Langton D, Gollow I. et al . Frenulotomy for breastfeeding infants with ankyloglossia: effect on milk removal and sucking mechanism as imaged by ultrasound.  Pediatrics. 2008;  122 188-194
• 10 Segal L, Stephenson R, Dawes M. et al . Prevalence, diagnosis and treatment of ankyloglossia, methodologic review.  Can Fam Physician. 2007;  53 1027-1033
• 11 Ricke LA, Baker NJ, Madlon-Kay DJ. et al . Newborn tongue-tie: prevalence and effect on breast-feeding.  J Am Board Fam Pract. 2005;  18 1-7
• 12 Ballard J, Auer C, Khoury J. Ankyloglossia: assessment, incidence and effect of frenuloplasty on the breastfeeding dyad.  Paediatrics. 2002;  110 1-6
• 13 Kramer MS, Kakuma R. Optimal duration of exclusive breastfeeding: a systematic Review.  Cochrane Database Systematic Review 1: CD003517. 2002; 
• 14 WHO/UNICEF . Global Strategy for Infant and Young Child Feeding. Geneva, World Health Organization 2003
• 15 Scientific Advisory Committee on Nutrition. Infant Feeding Survey 2005 . A commentary on infant feeding practices in the UK. The Stationary Office 2008 ISBN 978-0-11-243118-3
• 16 World Health Organization . Protecting, promoting and supporting breastfeeding: the special role of maternity services. A joint WHO/UNICEF statement. Geneva, World Health Organization 1989 ISBN 92-4-156130-0
• 17 Morland-Schultz K, Hill PD. Prevention of and therapies for nipple pain: a systematic review.  J Obstet Gynecol Neonatal Nurs. 2005;  34 428-437

Correspondence