Primary Care and Outpatient Specialty Care Clinical Pathway for the care of Infants with Ankyloglossia

  • Definition of Ankyloglossia
    • Tongue is limited in range of movement and subsequent function, due to presence of restrictive sublingual frenulum
  • Restrictive lingual frenulum
    • with abnormal assessment
    • and impact on feeding
  • 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