Evaluation of the lingual frenulum in newborns using two protocols and its association with breastfeeding

Araujo, Maria da C.M.; Freitas, Rebeca L.; Lima, Maria Goretti de Souza; Kozmhinsky, Veronica M. da R.; Guerra, Cândida A.; Lima, Geisy M. de S.; Silva, Amitis V. Costa e; Melo Júnior, Paulo Correia de; Arnaud, Manuela; Albuquerque, Emídio C.; Rosenblatt, Aronita

doi:10.1016/j.jped.2018.12.013

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Original articles • J. Pediatr. (Rio J.) 96 (3) • May-Jun 2020 • https://doi.org/10.1016/j.jped.2018.12.013 copy

Evaluation of the lingual frenulum in newborns using two protocols and its association with breastfeeding^☆ ☆ Please cite this article as: Araujo MC, Freitas RL, Lima MG, Kozmhinsky VM, Guerra CA, Lima GM, et al. Evaluation of the lingual frenulum in newborns using two protocols and its association with breastfeeding. J Pediatr (Rio J). 2020;96:379-85.

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Abstract

Objective:

To characterize the lingual frenulum of full-term newborns using two different protocols and to assess the association of the lingual frenulum with breastfeeding.

Methods:

This non-probabilistic sample consisted of 449 mother/baby binomials. For the anatomo-functional evaluation of the frenulum, the Neonatal Tongue Screening Test and the Bristol Tongue Assessment Tool were used for the evaluation of the lingual frenulum. Breastfeeding was evaluated using the protocol proposed by UNICEF. Scores were created (good, fair, poor) to evaluate every aspect of the breastfeeding to be observed. The results were analyzed through descriptive and inferential statistics and association tests (Pearson's chi-squared and Fisher's exact test).

Results:

The study showed that 14 babies had a lingual frenulum alteration, of whom three had difficulties during suction, requiring frenotomy in the first week of life, whereas 11 had no difficulties during breastfeeding. Regarding the breastfeeding evaluation, 410 mother/baby binomials had good, 36 regular, and three had bad scores. There was a statistically significant association between the tongue-tie test protocol and breastfeeding (p = 0.028) and between the Bristol Tongue Assessment Tool protocol and breastfeeding (p = 0.028).

Conclusion:

Alterations in the lingual frenulum are associated with interferences in the quality of breastfeeding and thus, evaluation of the lingual frenulum in newborns is important.

KEYWORDS
Lingual frenulum; Ankyloglossia; Breastfeeding; Clinical protocols

Evaluated aspects	Number of negative behaviors investigated	Negative behaviors observed/classification of scores
Evaluated aspects	Number of negative behaviors investigated	Good	Fair	Poor
Mother/child position	5	0-1	2-3	4-5
Responses of the mother/child pairs	6	0-1	2-3	4-6
Suction adequacy	6	0-1	2-3	4-6
Breast anatomy	4	0	1	2-4
Affectiveness	3	0	1	2-3

Anatomical aspects	n	%
Lip posture
Closed	392	87.3
Semi-open	54	12
Open	3	0.7

Tendency of tongue positioning during crying
Midline	282	62.8
Elevated	153	34.1
Midline position with lateral elevation	6	1.3
Low	8	1.8

Tongue shape when elevated
Rounded	429	95.5
Slight slit at the apex	8	1.8
Heart-shaped	12	2.7

Thickness
Thin	446	99.3
Thick	3	0.7

Frenulum fixation in the sublingual (ventral) aspect of the tongue
In the middle third	403	89.8
Between the middle third and the apex	32	7.1
Apex	14	3.1

Frenulum fixation in the roof of the mouth
Visible from the sublingual caruncles	423	94.2
Visible from the lower alveolar ridge	26	5.8

Anatomical aspects and characteristics of the lingual frenulum	n	%
Appearance of the tip of the tongue
Heart-shaped	12	2.7
Slit/notched tongue	8	1.8
Round	429	95.5

Fixation of the frenulum in the lower alveolus
Attached to the upper part/top of the gingiva	1	0.2
Attached to the inner side of the gingiva/back	25	5.5
Attached in the middle of the mouth floor	423	94.2

Tongue elevation during crying with mouth open
Minimal elevation	8	1.8
Elevation only of the borders of the tongue toward the hard palate	6	1.3
Complete elevation of the tongue toward the hard palate	435	96.8

Protrusion of the tongue over the gingiva
Tongue tip behind the gingiva	4	0.8
Tongue tip over the gingiva	10	2.2
Tongue tip may extend over the lower lip	435	96.8

Variables	Breastfeeding						Statistical analysis^a a Chi-squared.
	Good		Fair		Poor		p-value
	n	%	n	%	n	%
Anatomo-functional (TL)
Frenulum interferes with tongue movements	11	71.4	3	28.6	0	0.0	0.028^b b Fisher's exact test.
Frenulum does not interfere with tongue movements	400	92	32	7.4	3	0.6

BTAT
Normal frenulum	400	92	32	7.4	3	0.6	0.02^b b Fisher's exact test.
Severe ankyloglossia	11	71.4	3	28.6	0	0.0

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[1] * Corresponding author. E-mail:goretti_odonto@yahoo.com.br (M.G. Lima).