Ankyloglossia and Frenulotomy by neos in the newborn nursery

[abeluchin]

What is your experience with this condition and performing frenotomy?

Thanks

[Stefan Johansson]

1000-dollar-question!

We do it sometimes (I'd estimate 1 procedure/week among our 7500 inborn babies/year) and almost always after request from the midwife or parents when the return for the maternity care follow-up (typically around 5-7th postnatal day), if breastfeeding is not on track as expected.

However, science tells that there is not much effect on a group level in terms of breastfeeding rate/length, but some proxy outcomes (such as maternal satisfaction and tongue movement measured with ultrasound) improve.

 

We do this procedure ourselves (no ENT referral). Baby head towards the doctor, 30% glucose as "pre-med", left index finger in the baby mouth that pulls the tounge towards the palate exposing the tongue tie, and then, open scissors down to the tongue base, and one cut. My experience is that the babies react little to the cut, if anything.

 

Here is a thorough post on a (very nice!) web site for pediatric residents:

http://dontforgetthebubbles.com/tongue-tie-cut/

[selvanr4]

great stefan!

i can become a surgeon now!

After 25 yrs of practice had on daughter who found out by google search! that her baby has tongue tie and that needs frenotomy!!

Baby had laser surgery and it didn't make any improvement on breastfeeding.

[Stefan Johansson]

@selvanr4 - laser surgery?! Frenotomy seems closer to rocket science than I had thought

 

Related to your case: a speech therapist I met said we (in neonatal care) should also consider that a cut tongue tie lead to pronounciation difficulties later in childhood.

 

Found some good parents info about this condition here:

http://www.entnet.org/content/tongue-tie-ankyloglossia

[JACK]

The way the frenotomy is done ---can it affect speech later on ?

[Stefan Johansson]

The way the frenotomy is done ---can it affect speech later on ?

 

As I understand it: an uncut tongue tie that is still tight over the first years affects vocalisation/pronounciation. But I have not "pubmed'ed" this question... only from the sayings of this speech therapist.

[JACK]

Have a look here:

 

http://www.ncbi.nlm.nih.gov/pubmed/23537928

 

Looks encouraging for breast feeding  but speech benefits are still to be proved

 

Also http://www.ncbi.nlm.nih.gov/pubmed/24937906 shows office frenotomy to be satisfying to the parents...(isn't that the new motto...CUSTOMER SATISFACTION !!!!....but is it all about the parents...how does the baby feel ????)

 

Nice opinion: http://fn.bmj.com/content/99/3/F178.extract