Search

Ankyloglossia ('tongue-tie') is a relatively common congenital anomaly characterized by an abnormally short lingual frenulum, which may restrict tongue tip mobility. There is considerable controversy regarding its diagnosis, clinical significance and management, and there is wide variation in practice in this regard. Most infants with ankyloglossia are asymptomatic and do not exhibit feeding problems. Based on available evidence, frenotomy cannot be recommended for all infants with ankyloglossia. There may be an association between ankyloglossia and significant breastfeeding difficulties in some infants. This subset of infants may benefit from frenotomy (the surgical division of the lingual frenulum). When an association between significant tongue-tie and major breastfeeding problems is clearly identified and surgical intervention is deemed to be necessary, frenotomy should be performed by a clinician experienced with the procedure and using appropriate analgesia. More definitive recommendations regarding the management of tongue-tie in infants await clear diagnostic criteria and appropriately designed trials.L’ankyloglossie est une anomalie congénitale relativement courante caractérisée par un frein lingual anormalement court, qui peut restreindre la mobilité de la langue. Une énorme controverse en entoure le diagnostic, la signification clinique et la prise en charge, et les pratiques varient considérablement à cet égard. La plupart des nourrissons ayant une ankyloglossie sont asymptomatiques et n’ont pas de problèmes pour se nourrir. D’après les données probantes, on ne peut pas recommander la frénotomie pour tous les nourrissons ayant une ankyloglossie. Chez certains nourrissons, on peut constater une association entre l’ankyloglossie et certains problèmes d’allaitement. Ce sous-groupe de nourrissons peut tirer profit de la frénotomie (la division chirurgicale du frein de la langue). Lorsqu’une association entre une ankyloglossie marquée et de graves troubles d’allaitement est clairement établie et qu’une intervention chirurgicale est jugée nécessaire, un clinicien habitué à la frénotomie doit effectuer l’intervention et utiliser l’analgésie convenable. Pour faire des recommandations plus définitives sur la prise en charge de l’ankyloglossie chez les nourrissons, il faudra attendre des critères diagnostiques clairs et des essais cliniques bien conçus.

Allergic conditions in children are a prevalent health concern in Canada. The burden of disease and the societal costs of proper diagnosis and management are considerable, making the primary prevention of allergic conditions a desirable health care objective. This position statement reviews current evidence on dietary exposures and allergy prevention in infants at high risk for developing allergic conditions. It revisits previous dietary recommendations for pregnancy, breastfeeding and formula feeding, and provides an approach for introducing solid foods to high-risk infants. While there is no evidence that delaying the introduction of any specific food beyond six months of age helps to prevent allergy, the protective effect of early introduction of potentially allergenic foods (at four to six months of age) remains under investigation. Recent research appears to suggest that regularly ingesting a new, potentially allergenic food may be as important as when that food is first introduced. © Canadian Paediatric Society 2013.