Ankyloglossia (tongue-tie) is a relatively common congenital anomaly characterized by an abnormally short and/ or tight lingual frenulum, which may restrict tongue mobility. Prevalence estimates range from 4.2% to 10.7% in newborns (recent studies have shown the incidence to be much higher). There is considerable controversy regarding its diagnosis, clinical significance and management at the moment. Many times, infants with a visible lingual frenulum are asymptomatic and do not exhibit any feeding problems or growth issues. But, there is a large subset of infants with significant breastfeeding challenges too.
Also many studies show that restricted tongue mobility can cause many challenges , like oral breathing, obstructive sleep apnea, crowding of teeth/orthodontic problems, ADHD, facial growth abnormalities, Gastro-esophageal reflux issues and speech issues later in life.
So, in cases where mothers are repeatedly reporting latching issues like painful breastfeeding, sore / injured nipples, very frequent feeds, very long feeds, weight gain challenges, excessive colic issues, reflux etc, clinician must look for oral restrictions due to an abnormal frenulum. These symptomatic dyads may further benefit from a timely intervention by an IBCLC (Lactation Consultant), in the form of special latching assessment and assistance and management .
Frenotomy (i.e. the surgical division of the lingual frenulum) may help in some situations, once other challenges are being addressed appropriately by a Lactation Consultant experienced with such babies. Current evidence does not recommend injudicious frenotomy for all infants with anatomical ankyloglossia without a functional assessment and assistance by a skilled lactation professional.