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Pediatrics. 2013 Nov;132(5):e1413-7. doi: 10.1542/peds.2012-2651. Epub 2013 Oct 7.

Evidence of improved milk intake after frenotomy: a case report.

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CNM, IBCLC, School of Chemistry and Biochemistry, Faculty of Life and Physical Sciences, M310, The University of Western Australia, 35 Stirling Hwy, Crawley, Western Australia 6009.


Ankyloglossia (tongue tie) is a well-recognized cause of breastfeeding difficulties and, if untreated, can cause maternal nipple pain and trauma, ineffective feeding, and poor infant weight gain. In some cases, this condition will result in a downregulation of the maternal milk supply. Milk-production measurements (24-hour) for a breastfeeding infant with ankyloglossia revealed the ineffective feeding of the infant (78 mL/24 hours), and a low milk supply (350 mL/24 hours) was diagnosed. Appropriate management increased milk supply (1254 mL/24 hours) but not infant milk intake (190 mL/24 hours). Test weighing convincingly revealed the efficacy of frenotomy, increasing breastfeeding milk transfer from 190 to 810 mL/24 hours. Postfrenotomy, breastfeeding almost completely replaced bottle-feeding of expressed breast milk. This case study confirms that ankyloglossia may reduce maternal milk supply and that frenotomy can improve milk removal by the infant. Milk-production measurements (24-hour) provided the evidence to confirm these findings.


ankyloglossia; breastfeeding; frenotomy; frenulotomy; lactation; milk production; nipple confusion; tongue tie

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