Tongue-tie in the newborn: early diagnosis and division prevents poor breastfeeding outcomes.

Background: In 2011, the Centenary Hospital Neonatal Department guidelines were modified and recommended delaying the division of infant tongue-tie (TT) until after 7 days of life. This paper looks at the effect of these guidelines in practice by comparing patient characteristics and breastfeeding practices before and after the change.

Methods: We used prospective data from mothers and babies who had TT division to compare breastfeeding practices in 2008 and 2011. Data included: gestational age (GA), birth-weight (BWt), gender, age at TT division, degrees of TT and maternal feeding pre/post TT division.

Results: There were no significant differences between the 2 years in the rate of TT division, 115/2471 (4.7%) vs 144/2891 (5.0%) (TT divided/birth number) or GA 39.6 ± 1.2 vs 39.5 ± 1.2 (weeks); BWt 3.48 ± 0.45 vs 3.52 ± 0.50 (kg); and Male:Female 77:38 (2.0:1.0) vs 91:53 (1.7:1.0). There was, however, an increase in the age the TT was divided 6.5 ± 4.5 vs 9.7 ± 6.2 (days) p < 0.0001; and an increased number of mothers unable to continue breastfeeding and providing expressed breastmilk: 4/115 (3.5%) vs 25/144 (17.4%) p = 0.0004 (expressing/divided). A majority (> 90%) of mothers noted an immediate improvement in feeding and decreased nipple pain. No significant complications occurred.

Conclusion: The rate of TT division did not change after the implementation of new guidelines post 2011. However, there has been a significant increase in the age at TT division and the number of mothers unable to breastfeed, primarily due to nipple pain and poor attachment. If feeding is problematic, the TT should be divided as early as possible to reduce breastfeeding cessation and improve breastfeeding satisfaction.