Frenotomy is increasingly being advocated for ‘tongue tied’ infants struggling to breast feed. Evidence for its efficacy is weak. Objective measures of tongue tie are limited. We aimed to determine if randomisation to day zero or day 5 for mild to moderately tongue tied infants would be acceptable to Mothers. We also wished to assess tongue tie using the LATCH score and the HATLFF short form score.
Our study was set in a large “Baby Friendly” UK maternity hospital between 2011–2013 Term infants <2 weeks with mild to moderate tongue tie were offered randomisation to immediate or delayed frenotomy (with standard care) by the research midwife. Severity was judged by Hazelbaker Tool HATLFF short form score 6–12 and difficulty in breast feeding by LATCH score (<8) Primary outcome was breast feeding at 5 days and secondary outcomes of breast feeding self efficacy and pain scores. Final assessment was at 8 weeks. Researchers assessing outcomes were blinded to intervention status.
Results: 107 infants were randomised 55 to intervention and 52 to comparison group. Five day outcome measures were obtained in 52 (100%) of the comparison and 53 (96%) of the intervention group. ITT analyses showed no difference in the primary outcome LATCH score. Frenotomy improved breast feeding self efficacy assessment. At 5 days there was a 7.5% increase in bottle feeding in the intervention group and 15% in the comparison group. After the day 5 clinic 44 of the comparison group (who were referred origninally with the expectation to have frenotomy) requested frenotomy. By 8 weeks only 6 (12%) were breast feeding without frenotomy. There were no adverse events.
Conclusions: Feasability to sustain breastfeeding for 5 days in tongue tied infants is acheivable. Early frenotomy did NOT result in an objective improvement in breastfeeding at five days. But fewer Mothers switched to bottle feeds. This trial funded by NIHR-RFPB sets the scene for a potential multicentre trial using breast feeding at 8 weeks as the primary outcome. Our trial allowed us to further refine tools for assessing breast feeding and tongue tie (ongoing work.)
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