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J Hum Lact. 2018 Dec 13:890334418816973. doi: 10.1177/0890334418816973. [Epub ahead of print]

Frenotomy in Infants with Tongue-Tie and Breastfeeding Problems.

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1 Department of Family Medicine, McGill University, Montreal, Canada.
2 Herzl-Goldfarb Breastfeeding Clinic, Herzl Family Practice Centre, Jewish General Hospital, Montreal, Canada.



Infant tongue-tie can cause breastfeeding problems, which may be improved by frenotomy. However, controversy exists among the medical community.


To examine the influence of frenotomy on infants with posterior ankyloglossia, by quantifying the changes in breastfeeding and maternal nipple pain using standardized tools.


Newborns ( N=30) below 12 weeks of age were recruited from the Herzl-Goldfarb Breastfeeding Clinic between April 2014 and April 2015. Diagnosis of posterior ankyloglossia was made clinically. Frenotomy was performed. Mothers received breastfeeding counseling before and after the procedure. Pain and breastfeeding were assessed before the procedure, immediately after the procedure, and after two days, seven days and 14 days. Breastfeeding was assessed using the LATCH Tool and by subjective questioning. Maternal nipple pain was assessed using the Numeric Rating System.


No complications were reported with frenotomy. There was a significant improvement in LATCH score immediately post-frenotomy, with an increase in median scores from 7.5 to 8.5 ( p < 0.0001, Wilcoxon signed rank test). There was a significant decrease in median pain score immediately post-frenotomy, from 3.0 on the left nipple and 3.25 on the right nipple, to 0 bilaterally ( p < 0.0001, Wilcoxon signed rank test). Subjective improvement in breastfeeding was reported by 90% of mothers immediately after frenotomy and 83% of mothers at day 14.


Frenotomy for posterior ankyloglossia may improve breastfeeding and nipple pain.


LATCH assessment tool; ankyloglossia; breast pain; breastfeeding difficulties; tongue-tie


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