Despite the low level of evidence supporting the correction of tongue-tie for breastfeeding problems, recognition and treatment has increased substantially over the past 15 years. Prevalence reporting of tongue-tie is variable. The purpose of this study was to quantitatively synthesize the prevalence of tongue-tie in children aged <1 year and to examine the psychometric properties of the assessment tools used for diagnosing tongue-tie in these studies.
PRISMA and MOOSE guidelines were followed, with selection of studies and data extraction verified by two authors. Random-effects meta-analyses were performed to determine an overall prevalence rate, prevalence by infant sex, and prevalence by diagnostic method.
There were 15 studies that met inclusion criteria. Overall prevalence of tongue-tie (N = 24,536) was 8% (95% CI 6–10%, p < 0.01). Prevalence was 7% in males and 4% in females. Prevalence was 10% when using a standardized assessment tool compared to 7% when using visual examination alone (p = 0.16). Available assessment tools for diagnosis of tongue-tie do not have adequate psychometric properties.
Tongue-tie is a common anomaly, which has the potential to impact infant feeding. Development of a psychometrically sound assessment of tongue-tie is needed.
The overall prevalence of tongue-tie in infants aged <1 year is 8%.
Available diagnostic tools for tongue-tie do not have adequate psychometric testing.
Prevalence data can assist health care providers in the recognition of tongue-tie as a potential barrier to infant feeding to promote maternal breastfeeding success.
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Messner, A. H. et al. Clinical consensus statement: ankyloglossia in children. Otolaryngol. Head Neck Surg. 162, 597–611 (2020).
Mills, N., Pransky, S. M., Geddes, D. T. & Mirajalili, S. A. What is tongue tie? Defining the anatomy of the in-situ lingual frenulum. Clin. Anat. 32, 749–761 (2019).
Geddes, D. T. et al. Frenulotomy for breastfeeding infants with ankyloglossia: effect on milk removal and sucking mechanism as imaged by ultrasound. Pediatrics 122, e188–e194 (2008).
Ricke, L. A., Baker, N. J., Madlon-Kay, D. J. & DeFor, T. A. Newborn tongue-tie: prevalence and effect on breast-feeding. J. Am. Board Fam. Pract. 18, 1–7 (2005).
Çetinkaya, M. et al. Prevalence of oral abnormalities in a Turkish newborn population. Int. Dent. J. 61, 90–100 (2011).
Ngerncham, S. et al. Lingual frenulum and effect on breastfeeding in Thai newborn infants. Paediatr. Int. Child Health 33, 86–90 (2013).
Messner, A. H. & Lalakea, M. L. Ankyloglossia: controversies in management. Int. J. Pediatr. Otorhinolaryngol. 54, 123–131 (2000).
O’Shea, J. et al. Frenotomy for tongue-tie in newborn infants. Cochrane Database Syst. Rev. 3, CD011065 (2017).
Walsh, J. & Tunkel, D. Diagnosis and treatment of ankyloglossia in newborns and infants: a review. JAMA Otolaryngol. Neck Surg. 143, 1032–1039 (2017).
Moher, D., Liberati, A., Tetzlaff, J. & Altman, D. G. Preferred Reporting for Items for Systematic Reviews and Meta-Analyses: the PRISMA statement. Ann. Intern. Med. 151, 264–269 (2009).
Stroup, D. F. et al. Meta-analysis of obervational studies in epidemiology: a proposal for reporting. J. Am. Med. Assoc. 283, 2008–2012 (2000).
Hoy, D. et al. Assessing risk of bias in prevalence studies: modification of an existing tool and evidence of interrater agreement. J. Clin. Epidemiol. 65, 934–939 (2012).
de Oliveira, A. J., Duarte, D. A. & Diniz, M. B. Oral anomalies in newborns: an observational cross-sectional study. J. Dent. Child 86, 75–80 (2019).
Flinck, A., Paludan, A., Matsson, L., Holm, A. K. & Axelsson, I. Oral findings in a group of newborn Swedish children. Int. J. Paediatr. Dent. 4, 67–73 (1994).
Freudenberger, S., Santos Díaz, M. Á. A., Bravo, J. M. & Sedano, H. O. Intraoral findings and other developmental conditions in Mexican neonates. J. Dent. Child 75, 280–286 (2008).
Friend, G. W., Harris, E. F., Mincer, H. H., Fong, T. L. & Carruth, K. R. Oral anomalies in the neonate, by race and gender, in an urban setting. Pediatr. Dent. 12, 157–161 (1990).
Harris, E. F., Friend, G. W. & Tolley, E. A. Enhanced prevalence of ankyloglossia with maternal cocaine use. Cleft Palate Craniofac J. 29, 72–76 (1992).
Perez-Aguirre, B. et al. Oral findings and its association with prenatal and perinatal factors in newborns. Korean J. Pediatr. 61, 279–284 (2018).
Hogan, M., Westcott, C. & Griffiths, M. Randomized, controlled trial of division of tongue-tie in infants with feeding problems. J. Paediatr. Child Health 41, 246–250 (2005).
Puapornpong, P., Paritakul, P., Suksamarnwong, M., Srisuwan, S. & Ketsuwan, S. Nipple pain incidence, the predisposing factors, the recovery period after care management, and the exclusive breastfeeding outcome. Breastfeed. Med. 12, 169–173 (2017).
Puapornpong, P., Raungrongmorakot, K., Mahasitthiwat, V. & Ketsuwan, S. Comparisons of the latching on between newborns with tongue-tie and normal newborns. J. Med. Assoc. Thai. 97, 255–259 (2014).
Ferrés-Amat, E., Pastor-Vera, T., Rodriguez-Alessi, P., Ferrés-Amat, E., Mareque-Bueno, J. & Ferrés-Padró, E. The prevalence of ankyloglossia in 302 newborns with breastfeeding problems and sucking difficulties in Barcelona: a descriptive study. Eur. J. Paediatr. Dent. 18, 319–325 (2017).
Messner, A. H., Lalakea, M. L. & Aby, J. et al. Ankyloglossia: incidence and associated feeding difficulties. Arch. Otolaryngol. Head Neck Surg. 126, 36–39 (2000).
Hazelbaker, A. K. The Assessment Tool for Lingual Frenulum Function (ATLFF): Use in a Lactation Consultant Private Practice (Pacific Oaks College, 1993).
Kotlow, L. A. Ankyloglossia (tongue-tie): a diagnostic and treatment quandary. Quintessence Int. 30, 259–262 (1999).
Coryllos, E., Watson Genna, C. & Salloum, A. In Breastfeeding: Best for Mother and Baby 1–6 (AAP, 2004).
Amir, L. H., James, J. P. & Donath, S. M. Reliability of the Hazelbaker Assessment Tool for Lingual Frenulum Function. Int. Breastfeed. J. 1, 1–6 (2006).
Madlon-Kay, D. J., Ricke, L. A., Baker, N. J. & Defor, T. A. Case series of 148 tongue-tied newborn babies evaluated with the assessment tool for lingual frenulum function. Midwifery 24, 353–357 (2008).
Ingram, J., Johnson, D., Copeland, M., Churchill, C. & Taylor, H. The development of a new breast feeding assessment tool and the relationship with breast feeding self-efficacy. Midwifery 31, 132–137 (2015).
Hazelbaker, A. K. Tongue-Tie Morphogenesis, Impact, Assessment and Treatment (Aidan and Eva Press, Columbus, 2010).
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Hill, R.R., Lee, C.S. & Pados, B.F. The prevalence of ankyloglossia in children aged <1 year: a systematic review and meta-analysis. Pediatr Res 90, 259–266 (2021). https://doi.org/10.1038/s41390-020-01239-y