Ankyloglossia refers to a tethered frenulum that restricts the movement of the tongue or lips. When too restrictive, the newborn may ineffectively suckle at the breast. Breastfeeding difficulties such as long periods nursing or damaged nipples may indicate treatment, and referrals can be made to pediatricians and surgeons. Historically, formula gained popularity in the United States due to cultural influences. Frenulectomy was not needed to enable sucking on a bottle. The procedure was viewed as unnecessary trauma for the newborn. However, for many infants, breastfeeding can be preserved only with timely treatment of ankyloglossia. Parents should be educated about their options and have their decisions supported. A team approach with lactation consultants can empower nurses to champion for the necessary medical evaluation and possible intervention.
In one case, a second time mother concerned over her newborn's tongue-tie status informed the maternity nurse that despite intending to fully breastfeed her first child, she did not reach her goal. The first child had difficulty latching, was not satisfied with a feed, and lost excessive weight. A painful latch resulted in bleeding nipples. The nurse suspected ankyloglossia, however, the pediatrician opted for delay in surgical intervention hoping the tongue “would come out on its own.” The doctor recommended formula bottles to rest the nipples initially. During breastfeeding attempts several times over the next 2 months, the first infant lost weight. Finally, she was referred to an oral surgeon, but by this time, the disappointed mother had given up hopes of breastfeeding and ceased her efforts.
In contrast, with her second child, the mother's concerns were acknowledged by the maternity nurse who had gained knowledge of ankyloglossia from the hospital-based lactation consultant. The nurse instructed the mother on breast pumping and ordered an early lactation consult. Upon confirming ankyloglossia with a digital exam, the consultant collaborated with the nurse for early intervention. This time, the pediatrician ordered an immediate, in-hospital evaluation by an oral surgeon. A frenulectomy was performed within 24 hours of the newborn's birth. The mother breastfed immediately after the bedside procedure and continued successfully breastfeeding her son.
Recognizing that a tight frenulum affects breastfeeding allows nurses to collaborate for timely breastfeeding interventions. Involving an interdisciplinary team can maximize breastfeeding success. Nurses can ensure that all mothers reach their breastfeeding goals by championing newborns whose ankyloglossia prevents them from effectively nursing.