Ankyloglossia (Tongue Tie) — Infant Physical Assessment — Clinical Pathway: Primary Care, Outpatient Specialty Care

Infants with Ankyloglossia (Tongue-Tie) Clinical Pathway — Outpatient Specialty Care and Primary Care

Infant History and Physical Assessment

  • A restrictive sublingual frenulum may cause significant functional impediment to:
    • Infant latch, suckling
    • Breast milk transfer
    • Lactating parent nipple/areolar discomfort
    • Trauma while breastfeeding
    • Increased risk of discontinuing breastfeeding
  • May result from multifactorial issues
  • Musculoskeletal issues may interfere with successful breastfeeding. In such instances, referral to developmental motor therapist (PT/OT) may be beneficial.
    • e.g., torticollis, head-flattening, increased or decreased tone (particularly of upper body or neck muscles)
General
  • Detailed birth history
    • Gestational age, weight, history of birth trauma affecting feeding
  • Dysmorphic/congenital anomalies
  • Posture/tone
  • Developmental motor skills
  • Developmental delay or underlying conditions
    • e.g., prematurity, genetic or neurologic conditions that impact movement and endurance
Feeding History
ENT
  • Nasal congestion or obstruction
  • Cleft lip or palate
  • Macroglossia
  • Micrognathia
Oral Cavity
  • Hard and soft palate
  • Gingivae
  • Sublingual areas
  • Sublingual frenulum points of insertion into mouth floor
  • Features of Ankyloglossia
    • Tongue Tip
      • Thin, anterior band to tip of tongue
      • Can appear heart-shaped or notched
    • Tongue attachment
      • Fixed more anteriorly towards alveolar ridge
    • Tongue elevation (with wide open mouth)
      • Immobile
      • Poor elevation, lateral movement
    • Tongue extension
      • Difficulty extending beyond
    • 4-way stopcock 1

Growth Assessment

Growth Charts

  • Several growth charts available in EHR
  • For most children, the appropriate growth chart will be the default
  • WHO Child Growth Standards will be most appropriate

Post-natal Weight Gain

  • Lose up to 10% of birth weight
  • Regain birth weight by the first 2-3 wks of life
  • Weight loss should cease by day 7 of life
Age (corrected) Median gm/day
  Females Males
2-4 wks 29 34
4 wks to 2 mos 34 40
2-3 mos 24 27
3-4 mos 20 21
4-5 mos 16 17
2-6 mos 13 14
6-8 mos 11 11
8-10 mos 9 9
10-12 mos 8 8

References