Aerophagia Induced Reflux in Breastfeeding Infants With Ankyloglossia and Shortened Maxillary Labial Frenula (Tongue and Lip Tie)

Abstract

Background: Infants with tongue and possible lip tie often have a poor latch in which there is often an inadequate seal around the breast and disorganized swallowing. As a result, many of these infants swallow air during breastfeeding. Many of these infants suffer from symptoms of reflux. Methods: This was a retrospective analysis of questionnaire/intake surveys of 1,000 infants over 5 years in private surgical practice. The inclusion of these infants was determined based on painful breastfeeding, poor lip seal, infant taking H2 blockers or proton pump inhibitors. These infants underwent release of their restrictions with CO 2 laser. Results: This study shows a correlation between aerophagia in infants with short maxillary labial frenula (maxillary lip tie) and ankyloglossia and reflux. A new term has been created to describe this entity: aerophagia induced reflux (AIR). Five hundred twenty (52%) showed improvement or complete reversal of symptoms of reflux to the end point of cessation of reflux medication. Two hundred eighty-three (28.3%) had no change in reflux, and 191 (19.1%) showed post-surgical improvement in post-feed irritability and less reflux symptoms but not successfully weaned off medications. Conclusion: There appears to be a relationship between maxillary lip tie (ankyloglossia and shortened maxillary labial frenula) and AIR. Treatment of these infants with a relatively simple frenotomy procedure may reduce or eliminate reflux. As a result, many of these infants may be spared from invasive testing or medications that have been shown to have potentially significant side effects. This may change diagnostic and treatment algorithms. Int J Clin Pediatr. 2016;5(1):6-8 doi: http://dx.doi.org/10.14740/ijcp246w