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<html lang="en" class="hexml-course s2e"><!--[if lt IE 8]> <html class="oldie"> <![endif]--><!--Generated at Wed, 12 Oct 2022 23:23:13 +0000--><head><meta name="author" content='["Carole Dobrich"]'><meta name="course" content="MA03"><meta name="topic" content="5.2"><meta http-equiv="content-type" content="text/html; charset=utf-8"><meta name="copyright" content="2022 Health e-Learning"><meta name="robots" content="NONE,NOARCHIVE"><meta name="viewport" content="width=device-width, initial-scale=1, maximum-scale=1, user-scalable=0"><link rel="stylesheet" href="//static.health-e-learning.com/jigsaw/design/hexml.pack.css?v=1665616993" type="text/css"><script type="text/javascript" charset="utf-8" src="//static.health-e-learning.com/jigsaw/design/hexml.pack.js?v=1665616993"></script><title>MA03: Ankyloglossia</title></head><body class="loading"><div class="ajax-modal Fixed"></div><div class="watermark"><span>Health e-Learning</span></div><div id="access"><a href="#access" accesskey="a">Access Keys</a><a href="#menu" accesskey="m">Skip to Menu</a><a href="#content" accesskey="c">Skip to Content</a><a href="#footer" accesskey="f">Skip to Footer</a></div><div id="nav"><span class="nav-menu">Maintaining BFHI Education for Nurses and Midwives - Series 2</span><a id="hamburger" href="#"><span class="hamburger hamburger--collapse"><span class="hamburger-box"><span class="hamburger-inner"></span></span></span></a><div class="progress-container"><div id="myBar" class="progress-bar"></div></div></div><nav id="menu"><ol><li><a href="topic_1-0.html"><span class="menu-item-icon">1.0 </span><span class="menu-item-title">Introduction</span></a></li><li><a href="topic_2-0.html"><span class="menu-item-icon">2.0 </span><span class="menu-item-title">Protection of Breastfeeding [Domain 1]</span></a><ol><li><a href="topic_2-1.html"><span class="menu-item-icon">2.1 </span><span class="menu-item-title">A Code History Timeline</span></a></li><li><a href="topic_2-2.html"><span class="menu-item-icon">2.2 </span><span class="menu-item-title">Marketing - the role of the International Code</span></a></li></ol></li><li><a href="topic_3-0.html"><span class="menu-item-icon">3.0 </span><span class="menu-item-title">Understanding the importance of skin-to-skin</span></a><ol><li><a href="topic_3-1.html"><span class="menu-item-icon">3.1 </span><span class="menu-item-title">Infant innate behaviours</span></a></li><li><a href="topic_3-2.html"><span class="menu-item-icon">3.2 </span><span class="menu-item-title">Skin-to-skin and the role of the Health Worker</span></a></li><li><a href="topic_3-3.html"><span class="menu-item-icon">3.3 </span><span class="menu-item-title">Addressing barriers to skin-to-skin</span></a></li><li><a href="topic_3-4.html"><span class="menu-item-icon">3.4 </span><span class="menu-item-title">The loving relationship</span></a></li></ol></li><li><a href="topic_4-0.html"><span class="menu-item-icon">4.0 </span><span class="menu-item-title">Postnatal Interventions</span></a><ol><li><a href="topic_4-1.html"><span class="menu-item-icon">4.1 </span><span class="menu-item-title">The chemistry of feeding</span></a></li></ol></li><li><a href="topic_5-0.html"><span class="menu-item-icon">5.0 </span><span class="menu-item-title">Special needs and infant challenges [Domain 6]</span></a><ol><li><a href="topic_5-1.html"><span class="menu-item-icon">5.1 </span><span class="menu-item-title">The 'late preterm' 'early term' baby</span></a></li><li class="current mm-selected"><a href="topic_5-2.html"><span class="menu-item-icon">5.2 <i class="fa fa-caret-right" aria-hidden="true"></i></span><span class="menu-item-title">Ankyloglossia</span></a></li></ol></li><li><a href="topic_6-0.html"><span class="menu-item-icon">6.0 </span><span class="menu-item-title">Managing common difficulties</span></a><ol><li><a href="topic_6-1.html"><span class="menu-item-icon">6.1 </span><span class="menu-item-title">Engorgement</span></a></li><li><a href="topic_6-2.html"><span class="menu-item-icon">6.2 </span><span class="menu-item-title">Hyperlactation</span></a></li></ol></li><li><a href="topic_7-0.html"><span class="menu-item-icon">7.0 </span><span class="menu-item-title">Supplementation</span></a><ol><li><a href="topic_7-1.html"><span class="menu-item-icon">7.1 </span><span class="menu-item-title">Feeding-line device at the breast or chest</span></a></li><li><a href="topic_7-2.html"><span class="menu-item-icon">7.2 </span><span class="menu-item-title">Cup feeding</span></a></li><li><a href="topic_7-3.html"><span class="menu-item-icon">7.3 </span><span class="menu-item-title">Finger Feeding</span></a></li></ol></li><li><a href="topic_8-0.html"><span class="menu-item-icon">8.0 </span><span class="menu-item-title">Closing session</span></a><hr></li><li class="appendix"><a href="references.html"><span class="menu-item-icon no-topic"><i aria-hidden="true" class="fa fa-book i-topic"></i></span><span class="menu-item-title">List of references</span></a></li><li class="appendix"><a href="contents.html"><span class="menu-item-icon no-topic"><i aria-hidden="true" class="fa fa-file-text-o i-topic"></i></span><span class="menu-item-title">Course contents</span></a></li><li class="appendix"><a href="full.html"><span class="menu-item-icon no-topic"><i aria-hidden="true" class="fa fa-print i-topic"></i></span><span class="menu-item-title">Print version</span></a></li></ol></nav><div id="content"><h1 id="top">5.2 Ankyloglossia</h1><section class="section" id="Ankyloglossia_tongue_tie_"><h2>Ankyloglossia (tongue tie)</h2> <div class="content-node"> <p>The lingual frenulum is a mucous membrane that attaches to the floor of the mouth under the tongue and stabilizes it. Ankyloglossia is a congenital anomaly characterized by an abnormally short lingual frenulum due to an excess of residual embryonic tissue. During fetal development, the tongue is fused to the floor of the mouth. During the process of apoptosis, the tongue detaches and becomes mobile. If there is incomplete detachment, this is called ankyloglossia. Since there is no consensus on diagnostic criteria across studies and the definition is not standardized, the incidence of ankyloglossia can vary from 4% to 11%.</p> </div> <div class="captionBox"><img width="1677" height="1166" data-src="images/6-15_Tongie_tie.jpg" src="//static.health-e-learning.com/jigsaw/design/lazy_image.gif" alt="Note the short, thick lingual frenulum restricting the degree the infant can lift his tongue."><p>Note the short, thick lingual frenulum restricting the degree the infant can lift his tongue. <br>&copy; Carole Dobrich</p></div> </section><section class="section" id=""> <section class="section" id=""> <div class="content-node"> <p>A short or tight lingual frenulum can restrict tongue mobility to varying degrees and may prevent the infant from extending the tongue fully over the bottom gum line or elevating the tongue (both essential actions for breastfeeding).</p> <p>Ultrasound imagery has demonstrated that in order to breastfeed effectively and comfortably, the tongue must use complex movements to create the necessary movement to extract milk without causing friction on the nipple and breast. In addition to discomfort and/or pain at the breast, other problems can be associated with tongue tie:</p> <ul> <li>inadequate latching</li> <li>incomplete drainage of the breast, which can lead to ductal blockages or mastitis</li> <li>long and ineffective feedings, irritability of the baby at the breast, dissatisfaction of the baby after feedings</li> <li>nipple injuries or infections, a feeling that the baby is biting during feeding</li> <li>decreased milk production, and inadequate weight gain in the baby </li> <li>early weaning from breastfeeding in the mother</li> </ul> <p>While tongue tie can sometimes be assessed visually (as in the photo above), the point of attachment is not necessarily indicative of the degree to which breastfeeding is affected.</p> </div> <div class="box"><div class="box-title"><h3>Recommendations</h3></div> <div class="content-node"> <p>According to the Canadian Paediatric Society recommendations, a frenotomy is not routinely recommended in all cases of ankyloglossia. A frenotomy may be recommended when there is a clear association between a restrictive tongue-tie and major breastfeeding problems.<font color="#0000ff"><span style="font-size:12.32px"> </span></font>The Academy of Breastfeeding Medicine suggests that a frenotomy should be considered when there are persistent breastfeeding problems (such as nipple pain or inadequate latch) that are not resolved with timely conservative management. Frenotomy should always be a shared decision between the health care professional and the parents.</p> </div> </div> </section> </section><div class="captionBox"><img width="1200" height="900" data-src="images/Tongue_Tie_1.jpg" src="//static.health-e-learning.com/jigsaw/design/lazy_image.gif" alt=""><p> <br>&copy; Carole Dobrich</p></div><div class="captionBox"><img width="4032" height="2268" data-src="images/6-15.1_Tongue_tie_DH-2016-09-22_14.36.59.jpg" src="//static.health-e-learning.com/jigsaw/design/lazy_image.gif" alt=""><p> <br>&copy; Dale Hansson</p></div><div class="captionBox"><img width="1200" height="931" data-src="images/6-15.2_Tongue_tie1.jpg" src="//static.health-e-learning.com/jigsaw/design/lazy_image.gif" alt=""><p> <br>&copy; Carole Dobrich</p></div><div class="captionBox"><img width="1600" height="1067" data-src="images/6-15.3_Tongue_tie.jpg" src="//static.health-e-learning.com/jigsaw/design/lazy_image.gif" alt=""><p> <br>&copy; Carole Dobrich</p></div><section class="section" id=""> <section class="section" id=""> <div class="content-node"> <p>As you can see in the photos above, tongue tie can present in multiple ways and assessment must always include an oral exam and a full observation of feeding (preferably by an experienced practitioner) before making any recommendations. </p> </div> <section class="section" id="Treatment"><h4>Treatment</h4> <section class="section" id="Frenotomy"><h5>Frenotomy</h5> <div class="content-node"> <p>Even though frenotomy is a simple surgical procedure to release the restriction, providing greater tongue movement and an improved breastfeeding outcome, parents need to be provided with evidence-based information to be able to make that informed decision. This is part of the informed consent.</p> <p>The following outcomes of frenotomy have been described:</p> <ul> <li>Reduced maternal nipple pain</li> <li>Improved milk transfer</li> <li>Reduced length of feeding times</li> <li>Improved infant weight gain</li> <li>Improved maternal breastfeeding self‐efficacy</li> <li>Improved breastfeeding outcomes</li> </ul> </div> </section> <section class="section" id="Supportive_team_care"><h5>Supportive team care</h5> <div class="content-node"> <p>While frenotomy will correct the anatomy, breastfeeding difficulties associated with tongue tie also involve behavioural and physical adaptations that the infant (and parent) have developed while the tongue tie was restricted. Offering a team approach of trained IBCLCS, physiotherapists, and other bodyworkers will help the dyad return to a state of full functionality and comfort.</p> </div> </section> </section> </section> <section class="section" id=""> <section class="section" id="When_tongue-tie_is_noted_..."><h4>When tongue-tie is noted ...</h4> <div class="content-node"> <p>And in the presence of breastfeeding difficulties</p> <ul> <li>Refer the mother/lactating parent and their infant to a health professional who has experience assessing tongue ties and performing frenotomy.</li> </ul> <p>Unfortunately, even when obvious breastfeeding difficulties are affecting both mother/lactating parent and baby related to tongue tie, some health professionals may still refuse to treat ankyloglossia.</p> </div> </section> </section> <div class="box"><div class="box-title"><img src="//static.health-e-learning.com/jigsaw/design/remember.png" class="icon" alt=""><h3>What should I remember?</h3></div> <div class="content-node"> <ul> <li>Not always necessary to treat</li> <li>Many infants with tongue-tie will not need an intervention</li> <li>It is important to fully assess the infant and observe and evaluate a complete feeding</li> <li>Look at the tongue function and not just at the anatomy</li> <li>Always start with good basic breastfeeding guidance (skin-to-skin and self-latching)</li> <li>Provide positive lactation support</li> <li>Try conservative methods first</li> <li>It is still controversial</li> <li>It is an intervention</li> <li>Further education is needed</li> <li>More research is needed</li> <li>Ask the following questions “Is it causing a breastfeeding problem?”, "have other possible reasons for a breastfeeding problem been ruled out?"<ul><li>If yes...what are the risks of not doing the procedure for the breastfeeding dyad?</li><li>Informed consent is essential</li></ul></li> </ul> </div> </div> </section><div id="footer"><a href="topic_5-1.html" rel="prev" class="prev">&laquo; Prev</a><a href="topic_6-0.html" rel="next" class="next">Next &raquo;</a><br style="clear: both"><div class="floating-menu"><button class="theme-toggle" title="Toggle colors (dark or light)"><i class="fa fa-moon-o"></i></button><button class="gotoTop" title="Back to top"><i class="fa fa-chevron-up"></i></button></div><a href="javascript:%20window.print()" id="printLink">Print this page</a><span class="noPrint"> | </span>&copy; 2022 Health e-Learning<p class="printOnly">COPYRIGHT: You are permitted to print ONE (1) copy for your personal use only. No graphics, tables, quizzes, videos, etc, may be used in any form without express written consent. Author: ["Carole Dobrich"]</p><p class="dateUpdated">Updated on Wed, 12 Oct 2022 23:23:13 +0000</p></div></div></body></html>
