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This study assessed indications for and safety and outcome of simple division of tongue tie without an anesthetic. There were 215 infants younger than 3 months (mean 0-19 days) who had major problems breastfeeding, despite professional support. Symptoms, tongue tie details, safety of division, and complications were recorded. Feeding was assessed by the mothers immediately, at 24 hours, and 3 months after division. Prior to division, 88% had difficulty latching, 77% of mothers experienced nipple trauma, and 72% had a continuous feeding cycle. During division, 18% slept throughout; 60% cried more after division (mean 0-15 seconds). There were no significant complications. Within 24 hours, 80% were feeding better. Overall, 64% breastfed for at least 3 months (UK national average is 30%). Initial assessment, diagnosis, and help, followed by division and subsequent support by a qualified lactation consultant, might ensure that even more mothers and infants benefit from breastfeeding.

An informal, retrospective telephone survey of 202 breastfeeding women was conducted over an 8-month period of time, assessing patients’ perceptions regarding use of a silicone nipple shield. Women used the shield most frequently because of flat nipples (62%). Other reasons for shield use included the infant’s disorganized suck (43%), sore nipples (23%), engorgement (15%), prematurity (12%), short frenulum (1%), and other reasons (1%). Fortysix percent of the women gave more than 1 reason for using a shield. Sixty-seven percent of the women continued to breastfeed after transitioning off the nipple shield. Median duration of nipple shield use for this group of women was 2 weeks. Thirty-three percent of the women who used the nipple shield with every breastfeeding breastfed from 1 day to 15 months. Five percent of women used the shield on only one side from 1 day to 9 months. J Hum Lact. 20(3):327-334.

A breastfed baby with impending failure to thrive resisted assuming a wide-mouthed, flanged-lip position at breast. A lingual frenotomy was only partly successful in correcting his breastfeeding problems. Following a labial frenectomy, the baby was better able to flange his upper lip against the breast. He then began breastfeeding with full efficiency.

A review of cases of short frenulum (tongue-tie) seen in a recent year at the Lactation Institute and Breastfeeding Clinic provides data about its relationship to sucking and breastfeeding problems such as insufficient infant weight gain and reduced milk supply, sore nipples and repeat bouts of mastitis in the mother. Frenotomy was recommended for ten of 13 babies who appeared to have a short frenulum. Three mothers chose not to hae the frenulum clipped and either gave up breastfeeding or continued to experience problems. Breastfeeding was successfully established by the five healthy babies whose frenulum was clipped. The two babies for whom frenotomy did not completely correct breastfeeding problems had severe birth defects.

Following the birth of a baby with a short frenulum, the mother experienced pain from the infant's first feeding that was severe and persistent, despite usually effective interventions. The pain forced the mother to pump her breastmilk and use a feeding bottle and rubber nipple despite her determination to breastfeed. Because the baby's tongue could not extend over the lower gumline, suckling injured all tissue the tongue touched--both the mother's nipples and areolae. Nevertheless, even though this baby's frenulum extended to the tip of the tongue, he was able to adapt his suckling movements to provide good areolar stimulation without persistent nipple damage. Infant growth was not compromised and no surgical intervention was necessary.