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  • Systematic Review
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Quantitative impact of frenotomy on breastfeeding: a systematic review and meta-analysis

Pediatric Research volume 95, pages 34–42 (2024)Cite this article

Abstract

Background

Symptoms related to infant ankyloglossia/tongue-tie may deter mothers from breastfeeding, yet frenotomy is controversial.

Methods

Databases included PubMed, Embase, CINAHL, PsycINFO, Web of Science, and Google Scholar from 1961-2023. Controlled trials and cohort studies with validated measures of surgical efficacy for breastfeeding outcomes were eligible. Meta-analyses synthesized data with inverse-variance weighting to determine standardized mean differences (SMD) between pre-/postoperative scores.

Results

Twenty-one of 1568 screened studies were included. Breastfeeding self-efficacy improved significantly post-frenotomy: medium effect after 5–10 days (SMD 0.60 [95% CI: 0.48, 0.71; P < 0.001]), large effect after 1 month (SMD 0.91 [CI: 0.79, 1.04; P < 0.001]). Nipple pain decreased significantly post-frenotomy: large effect after 5–15 days (SMD −1.10 [CI: −1.49, −0.70; P < 0.001]) and 1 month (SMD −1.23 [CI: −1.79, −0.67; P = 0.002]). Frenotomy had a medium effect on infant gastroesophageal reflux severity at 1-week follow-up (SMD −0.63 [CI: −0.95, −0.31; P = 0.008]), with continued improvement at 1 month (SMD −0.41 [CI: −0.78, −0.05; P = 0.04]). From LATCH scores, breastfeeding quality improved after 5–7 days by a large SMD of 1.28 (CI: 0.56, 2.00; P = 0.01).

Conclusions

Providers should offer frenotomy to improve outcomes in dyads with ankyloglossia-associated breastfeeding difficulties.

Protocol registration

PROSPERO identifier CRD42022303838.

Impact

  • This systematic review and meta-analysis showed that breastfeeding self-efficacy, maternal pain, infant latch, and infant gastroesophageal reflux significantly improve after frenotomy in mother-infant dyads with breastfeeding difficulties and ankyloglossia.

  • Providers should offer frenotomy to improve breastfeeding outcomes in symptomatic mother-infant dyads who face challenges associated with ankyloglossia.

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Fig. 1: PRISMA flow diagram of study inclusion and exclusion.
Fig. 2: Short-term and long-term impact of frenotomy on breastfeeding self-efficacy.
Fig. 3: Immediate, Short-term, and long-term impact of frenotomy on maternal nipple pain.
Fig. 4: Short-term and intermediate-term impact of frenotomy on infant gastrointestinal reflux symptoms.
Fig. 5: Random-effects meta-analysis of increases in LATCH scores from baseline to 1 week post-frenotomy.

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Acknowledgements

The authors would like to thank Dr Bobak Ghaheri and Dr Elvira Ferrés-Amat for providing additional information from their studies to support our meta-analyses.

Funding

This work benefitted from a science infrastructure grant provided by the Marcus Foundation.

Author information

Author notes

  1. These authors contributed equally: Holly Cordray, Nikhila Raol.

Authors and Affiliations

  1. Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA

    Holly Cordray

  2. Children’s Healthcare of Atlanta, Atlanta, GA, USA

    Holly Cordray, Nikhila Raol & Ching Siong Tey

  3. Department of Otolaryngology–Head and Neck Surgery, Emory University School of Medicine, Atlanta, GA, USA

    Holly Cordray & Nikhila Raol

  4. Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA

    Nikhila Raol, Ching Siong Tey & William G. Sharp

  5. Department of Otolaryngology–Head and Neck Surgery, Massachusetts Eye and Ear, Boston, MA, USA

    Geethanjeli N. Mahendran

  6. Department of Psychology, University of Georgia, Athens, GA, USA

    Ching Siong Tey

  7. Emory University Woodruff Health Sciences Center Library, Atlanta, GA, USA

    John Nemeth

  8. Population, Policy, and Practice Department, Institute of Child Health, University College London, London, UK

    Alastair Sutcliffe

  9. University of Bristol, Bristol, UK

    Jenny Ingram

  10. Marcus Autism Center, Atlanta, GA, USA

    William G. Sharp

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Contributions

H.C., N.R., and G.N.M. had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Concept and design: H.C., G.N.M., C.S.T., N.R. Acquisition, analysis, or interpretation of data: All authors. Drafting of the manuscript: H.C. and N.R. Critical revision of the manuscript for important intellectual content: H.C. and N.R. Statistical analysis: H.C. Administrative, technical, or material support: J.N., A.S. Supervision: C.S.T. and N.R.

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Correspondence to Nikhila Raol.

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Cordray, H., Raol, N., Mahendran, G.N. et al. Quantitative impact of frenotomy on breastfeeding: a systematic review and meta-analysis. Pediatr Res 95, 34–42 (2024). https://doi.org/10.1038/s41390-023-02784-y

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