Background Ankyloglossia is a developmental anomaly causing restricted tongue mobility. Posterior types are usually identified latest and least commonly. Currently, there are no standardised national/international guidelines for diagnosis. This case series aims to highlight the importance of early diagnosis to reduce cases identified only following significant morbidity.

Methods Over a 2 year period, consecutive patients diagnosed with posterior ankyloglossia were identified.

Results Of the 15 patients identified, mean age at diagnosis was 24 days (range 4–42). 8(53%) had regained their birthweight however, for 3(38%) of these, weight gain was slow/inadequate. The remaining 7(47%) had lost weight with a mean weight loss of 8.54% (range 2.56–16.06). 13(86%) were exclusively breastfed, 1(7%) both breast- and formula-fed, and 1(7%) formula-fed. Presenting features included poor latch (60%), weight loss (47%), sore nipples (40%), irritability (40%), poor weight gain (20%), increased feed duration (20%), and lethargy (20%). 9(60%) were diagnosed by breastfeeding co-ordinators, 4(26%) by community midwives, and 1(7%) each by a paediatrician and neonatal nurse. All patients underwent a frenotomy following which both weight gain and feeding improved in 11(73%). Behavioural improvements were noted in 8(53%). 11(73%) mothers felt their baby’s symptoms had improved. All of the 6 mothers who initially described symptoms of their own reported improvement.

Conclusion For many infants, posterior ankyloglossia is often detected only once feeding has deteriorated enough to result in significantly poor weight gain or weight loss. To prevent this and other morbidities shown in this small case series, a standardised assessment tool may be a useful method to facilitate earlier diagnosis and improve clinical practice.