Table 1

 Tongue tie; review of literature

Author(s)Number and age group studiedHow cases were identifiedType of study and interventionResults
TT, tongue tie; ATLFF, Assessment Tool for Lingual Frenulum Function.
Messner et al3Examined 1041 newborns. Identified 50 TT cases (4.8%). M: F ratio 2.6:1Screened by one doctor, confirmed by one colleagueObservational follow up study but no intervention30/36 TT cases and 33/36 controls breast fed to 2 months (p = 0.29). 9 cases and 1 control experienced breast feeding difficulties
36 cases of TT enrolled and 36 controls without TT
Hogan et al4Examined 1866 babies. Identified 201 TT cases (10.7%). M:F ratio 1.6:1. 44% TT cases had problems feeding. 57 TT babies entered study (40 breast fed and 17 bottle fed)Photos to assist staff in postnatal checksRandomised to immediate frenulotomy or support by lactation counsellor, at mean age 20 days (3–70), median age 14 daysTT cases treated by frenulotomy; 27/28 marked improvement. Counselled cases managed conservatively; 1/29 improved
Ballard et al5Examined 2763 breast fed in-patient babies and 273 attenders at lactation clinic.One observer examining all babies. ATLFF used123 cases underwent frenulotomy at age 1–2 daysLatch improved in all, pain scores fell significantly
M:F ratio 1.5:1. Identified TT in 3.2% in-patients and 12.8% clinic attenders
Ricke et al6Examined 3490 babies, identified 148 TT cases (4.24%). M:F ratio 2.3:1.Nurses assisted by photos, ATLFF by teamObservational study, no interventionMothers of TT babies three times more likely to give up breast feeding by one week; however, 80% TT breast feeding well at one week. TT and non-TT breast feeding in equal numbers at 1 month. Mothers with TT babies reporting more pain at one month but not statistically significant. Small numbers so type II errors possible
Enrolled 49 TT babies for study with 2 matched non-TT breast fed babies as controls
Ramsay7Case seriesReferrals to paediatric surgeonMeasured nipple tip to hard soft palate junction by ultrasound, pre- and post-frenulotomyDistance changed from 7.99 mm to 6.49 mm. Milk transfer increased from 3.3 to 7.2 ml/min. At least 7 day interval between frenulotomy and 2nd measurement
Messner and Lalakea8Case series of speech problems: 30 children age 1–12Measured tongue protrusion and inter-incisal distanceFrenulotomySpeech improved. 25 mothers had tried to breast feed; 21 said no problems
Fernando9Case series, n ⩾200Various; majority presenting with speech disordersFrenulotomyImproved to varying degree. 20% had history of BF problems: 80% did not