Table 1

Randomised trials of frenotomy

CitationStudy groupStudy typePrimary outcomeKey resultComments
Hogan et al3857 babies randomised:
28 immediate division,
29 controls (lactation support)
RCTImprovement in feedingDivision improved feeding (maternal gauge) in 96.42% (27/28) babies compared with lactation support alone (p<0.001)All 28 of control group requested division at 48 h.
Lack of objective measure of improvement
Dollberg et al3925 mother/baby dyads
Two sequences:
  1. frenotomy, breast feeding, sham, breast feeding (n=14)

  2. sham, breast feeding, frenotomy, breast feeding (n=11)

Randomised prospective cohortStandardised LATCH score
Standardised pain score
Non-significant improvement in LATCH score (p=0.06)
Significant reduction in pain score (p=0.001)
All babies had frenotomy procedure as part of sequence
Buryk et al4058 mother/infant dyads with maternal nipple pain or difficulty breastfeeding with significant ankyloglossia as judged by HATLFF:
30 frenotomy
28 sham
Single-blind RCTSF-MPQ score
IBFAT score
SF-MPQ scores reduced from 16.77 (SD1.88) before, to 4.9 (SD1.46) after intervention in frenotomy group. (p<0.001)
IBFAT scores improved in the frenotomy group and were unchanged in sham group (p=0.29)
All but one parent in the sham group elected to have frenotomy at or before 2-week follow-up
Berry et al4160 breastfed babies:
27 division group
30 non-division group
Double-blind RCTMaternal improvement in feeding
Observer improvement in feeding
Significant immediate improvement in maternal gauge in 21 (78%) of division group compared with 14 (47%) of comparison group (p<0.02; 95% CI 6% to 51%)
The results were reported in the study as follows: 78% (21 of 27) of mothers in Group A reported an immediate improvement in feeding following the intervention, compared with 47% (14 of 30) in Group B (two-tailed χ(2) p<0.02; 95% confidence interval, 6−51%).
Only objective observed change was better latch
After the intervention, those infants allocated to non-division had their tongue-tie divided
Emond et al17107 infants with mild to moderate tongue-tie diagnosed by HATLFF-short form tool:
55 intervention group
52 comparison group
Randomised parallel group single-centre feasibility trialLATCH score at 5 daysNo difference in primary outcome (ie, LATCH score) between intervention and control groups at 5  days (0.52)Severe tongue-tie was not included.
Long-term follow-up not possible as only 8 (15%) of comparison group had not had a frenotomy at 8 weeks
  • HATLFF, Hazelbaker Assessment Tool for Lingual Frenulum Function; IBFAT, Infant Breastfeeding Assessment Tool; RCT, randomised controlled trial; SF-MPQ, short-form McGill Pain Questionnaire.