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Effect of frenotomy for tongue-tie on improving breastfeeding

Introduction: Tongue-tie is a congenital anomaly that may hinder effective breastfeeding. This study aimed to review outcomes of frenotomy on breastfeeding in babies with tongue-tie and their mothers at a lactation clinic. Methods: Since 2016, the lactation clinic of Department of Obstetrics and Gynaecology, Queen Elizabeth Hospital has taken a more active role to help babies with tongue-tie and breastfeeding difficulties. If feeding problems persisted, the babies were referred to a paediatric hospital for treatment. When indicated, frenotomy was suggested and performed upon consents using bipolar diathermy forceps under no anaesthesia. After frenotomy, the selfrated improvement on feeding condition was assessed in a scale of 0 (no improvement at all) to 10 (excellent improvement). At babies’ 4 months of age, mothers were followed up by phone about feeding condition. Results: From July 2016 to June 2018, 49 babies with tongue-tie and persistent breastfeeding problems were referred for consultation for frenotomy. Of them, four were deemed no need for frenotomy and were excluded, 36 underwent frenotomy and were categorised as the frenotomy group, and the remaining 9 who did not attend consultation or refuse surgery were categorised as the non-frenotomy group. In the frenotomy group, the most common breastfeeding difficulties was poor attachment (61.11%), followed by sore nipples (30.56%), ineffective suckling (5.56%), and poor weight gain (2.78%). After frenotomy, sore nipple was the most improved symptom with a mean rating of 8.18 (n=11), followed by poor attachment with a mean rating of 6.91 (n=22). In the nonfrenotomy group, the most common breastfeeding difficulties was poor attachment (55.56%), followed by ineffective suckling (33.33%) and sore nipples (11.11%). At babies’ 4 months of age, the proportion of mothers remaining direct breastfeeding was higher in the frenotomy group than the non-frenotomy group (80.56% vs 44.4%, p=0.028). Direct breastfeeding at 4 months was associated with frenotomy (87.88% vs 58.33%, p=0.028). Conclusions: Frenotomy improved maternal nipple soreness during breastfeeding and the direct breastfeeding rate and duration.