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

Clinical Pathways Home Emergency ICU Inpatient Outpatient Specialty Care Primary Care

Goals and Metrics

Provider Resources

Related Pathways

Malnutrition, Outpatient

Infants < 6 months with Suspected Tongue Tie or Restriction Impacting Feeding, Weight Gain

Exclusion: Prominent labial frenulum

Definition of Ankyloglossia

Tongue is limited in range of movement and subsequent function, due to presence of restrictive sublingual frenulum

Referral Information

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

Evidence

If you have questions about any of the clinical pathways or about the process of creating a clinical pathway please contact us.

©2024 by Children's Hospital of Philadelphia, all rights reserved.
Use of this site is subject to the Terms of Use.

The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

Accordingly, these clinical pathways are not intended to constitute medical advice or treatment, or to create a doctor-patient relationship between/among The Children’s Hospital of Philadelphia (“CHOP”), its physicians and the individual patients in question. CHOP does not represent or warrant that the clinical pathways are in every respect accurate or complete, or that one or more of them apply to a particular patient or medical condition. CHOP is not responsible for any errors or omissions in the clinical pathways, or for any outcomes a patient might experience where a clinician consulted one or more such pathways in connection with providing care for that patient.

Children's Hospital of Philadelphia

Search

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

Evidence