Systematic review of the evidence for resolution of common breastfeeding problems—Ankyloglossia (Tongue Tie)

Aim Tongue tie is a common problem affecting breastfeeding due to poor infant latch and/or maternal pain. Evidence of whether treatment improves breastfeeding outcomes is conflicting. We conducted a systematic review and meta‐analysis to examine the effectiveness of tongue‐tie treatment on breastfeeding difficulties. Methods We searched peer‐reviewed and grey literature in MEDLINE (OVID), PubMed, CINAHL Plus, EMBASE and PsycINFO, from 01/1970 to 09/2019. Inclusion: randomised and non‐randomised clinical trials, and quasi‐experimental study designs, involving breastfeeding interventions for full‐term singleton infants, using standardised measure of breastfeeding difficulty. Exclusion: qualitative and purely observational studies, lacked operational definition of breastfeeding difficulty, lacked control/comparison group. We assessed risk of bias, summarised study quality and results and conducted meta‐analysis using random effects modelling. Results Six studies on tongue‐tie division were included (4 randomised and 2 non‐randomised). Meta‐analysis of standardised mean differences in breastfeeding difficulty scores in four studies showed statistically significant differences in favour of frenotomy (Pooled SMD +2.12, CI:(0.17–4.08)p = 0.03). Similarly, a statistically significant difference in favour of frenotomy was observed for pain (Pooled SMD −1.68, 95% CI: (−2.87‐ −0.48). Conclusion Results support that infant frenotomy is effective for improving standardised scores on breastfeeding difficulty and maternal pain scales and could improve breastfeeding outcomes.