Primary Care and Outpatient Specialty Care Clinical Pathway for the care of Infants with Ankyloglossia
Exclusion: Prominent labial frenulum
- Definition of Ankyloglossia
- Tongue is limited in range of movement and subsequent function, due to presence of restrictive sublingual frenulum
- Primary Care Team Assessment
- History and Physical Exam
- Detailed Feeding History, Observation
- Milk Production Assessment, Interventions
- Physical exam features of tongue restriction
- Band of tissue that tethers tongue to floor of mouth
- Limited tongue mobility (extension, elevation, and lateralization)
- Tongue may be notched or heart-shaped
- Restrictive lingual frenulum
- with abnormal assessment
- and impact on feeding
- Expedited Referral
- ENT or Medical/dental provider skilled in Frenotomy
- Unclear if lingual frenulum is restricted and feeding is impacted
- Continue to monitor growth
- Support breast/chestfeeding
- Re-evaluate feeding at routine visits
Consider Lactation Consult
- Indications for lactation consult
- Inadequate milk production
- Latching difficulties at breast only
- Breast and/or nipple pain/trauma
Consider Speech (SLP)/Feeding consult
- Indications for SLP consultation
- Atypical suck across feeding methods
- Poor suck/swallow/breathe coordination
- Medical diagnosis that may impact feeding
- SLP may refer to interdisciplinary feeding
team if concerns appear more complex
- Restrictive lingual frenulum with impact on feeding identified
- Post Procedure f/u with PCP
- Monitor weight
- Continue lactation and/or SLP referral for resolution of any continued feeding challenges
- If no restrictive lingual frenulum with impact on feeding identified
- Consider other causes
- Monitor feeding and nutrition
- Continue lactation, SLP support as indicated
Posted: February 2022
Authors: M. Devine, RN, IBCLC; M. Kawan, MD, IBCLC; R. Lessen, IBCLC; E. Scott, OTR/L; J. Liberati, CRNP, IBCLC;
M. Brodnik, CRNP; D. Kaminski, MD; S. Galbally, SLP; J. McDonald, MD; S. Daniel, MD; A. Buzi, MD
Authors: M. Devine, RN, IBCLC; M. Kawan, MD, IBCLC; R. Lessen, IBCLC; E. Scott, OTR/L; J. Liberati, CRNP, IBCLC;
M. Brodnik, CRNP; D. Kaminski, MD; S. Galbally, SLP; J. McDonald, MD; S. Daniel, MD; A. Buzi, MD
Evidence
- AAP Section on Breastfeeding. The Breastfeeding-Friendly Pediatric Office Practice
- Treatment of ankyloglossia. A systematic review
- Clinical Consensus Statement. Ankyloglossia in Children
- Frenotomy for tongue-tie in newborn infants
- Academy of Breastfeeding Medicine Position Statement on Ankyloglossia in Breastfeeding Dyads
- Ankyloglossia and Oral Frena Consensus Statement
- Manual Interventions for Musculoskeletal Factors in Infants With Suboptimal Breastfeeding: A Scoping Review
- Lactation Consultants’ Perceptions of Musculoskeletal Disorders Affecting Breastfeeding: A Cross-Sectional Survey
- Policy on Management of the Frenulum in Pediatric Dental Patients
- Ankyloglossia and Other Oral Ties