Does frenotomy improve breastfeeding problems in neonates with ankyloglossia?

Abstract

Background There are global and national initiatives to improve breastfeeding rates and ankyloglossia appears to be contributing to breastfeeding cessation, despite significant controversy regarding the need for frenotomy and the success of the intervention on breastfeeding outcomes. Aims To critically appraise contemporary literature regarding the effectiveness of frenotomy on reducing breastfeeding problems. Methods An electronic literature search was systematically performed using CINAHL, PubMed and Cochrane databases. Back-chaining and a hand search of bibliographies were also used. Findings Four key themes were identified from the literature; challenges diagnosing ankyloglossia including lack of a universally recognised assessment tool, apparent maternal breastfeeding improvements, breastfeeding improvements for the neonate, and issues with determining the longevity of breastfeeding. Conclusion Overall the literature was of differing validity and applicability, therefore further longer-term RCTs are required with larger sample sizes to be able to account for cross-over of participants from comparison to frenotomy group. The evidence has shown that frenotomy may improve breastfeeding outcomes but since breastfeeding is a complex interaction between mother and baby, releasing ankyloglossia does not universally remove all breastfeeding problems.