1/9 Ankyloglossia and Other Ties: What is the Evidence? https://cdmcd.co/Zwj5PE  #AAP2020
Ankyloglossia = tongue tie

Diagnosis is exponentially increasing:
US Birth Rate 2000: 4M; 2012: 3.9M
Ankyloglossia dx 2000: 5K; 2012: 33K
Frenotomy 2000: 1,600; 2012: >12K
#AAP2020

2/9 Many symptoms are attributed to tongue tie that have no evidence. Symptoms such as colic, excessive gassiness, reflux and excessive drooling have no evidence to be caused by ankyloglossia.
#AAP2020 #tweetiatrician

3/9 Bristol tongue tie Assessment (see tweet below):
score 1-8
8 = normal
6-7 = borderline
5 = impaired - assess for frenotomy

Scored on:
Tongue appearance
Frenulum attachment
Lift of tongue
Protrusion of tongue
#AAP2020 #tweetiatrician

4/9 Tongue appearance (at tip)
0 = heart shaped
1 = slight cleft
2 = rounded
Frenulum attachment
0 = top of gum ridge
1 = inner aspect of gum
2 = floor of mouth
Lift
0 = minimal
1 = edges only
2 = full tongue
Protrusion
0 = tip behind gum
1 = tip over gum
2 = tip over lower lip

5/9 Provider assessment of latch using mnemonic
L= latch
A = audible swallowing
T = type of nipple
C = comfort
H = hold (cradle hold often causes shallow latch; cross cradle and football hold better for head support and deeper latch)
#AAP2020 #tweetiatrician

6/9 DDx of breastfeeding difficulties is broad.

Biggest challenge is lack of adequate lactation/maternal support for breastfeeding

#AAP2020 #breastfeeding #tweetiatrician

7/9 Classic (anterior) ankyloglossia - 1-11% of infants

Evidence IS sufficient to recommend frenotomy in breastfeeding infants with classic (anterior) ankyloglossia.

#AAP2020 #breastfeeding #tweetiatrician

8/9 There is NO validated assessment tool for "posterior" tongue tie
NO RCTs support frenotomy for "posterior" tongue tie
83% of infants born w/ "upper lip tie"
NO credible studies support treatment of maxillary frenulum (aka "upper lip tie") in infancy

#AAP2020 #breastfeeding

9/9 Take home point:

We need to advocate for more #breastfeeding support for new moms and NOT more frenotomies.

#AAP2020 #tweetiatrician