Evaluation of the effects of tongue tie and lip tie on breastfeeding with ultrasound measurements and latch breastfeeding assessment tool: A pilot study

Variations in the maxillary labial frenulum and lingual frenulum in newborns are associated with sucking difficulties and early cessation of breastfeeding. The aim of this study was to compare the breastfeeding criteria of newborns with tongue ties, newborns with lip ties, and newborns without tongue and lip ties using ultrasound imaging and various breastfeeding assessment tools. This prospective cohort-type observational clinical pilot study included newborns with tongue tie, newborns with lip tie, and newborns without tongue tie and lip tie, as well as their mothers, who were born at Ankara Yıldırım Beyazıt University Faculty of Medicine, Internal Medicine Sciences, Department of Child Health and Diseases, Neonatology Clinic. The lip tie group consisted of newborns with grade 3 and 4 maxillary labial frenulum according to Kotlow classification, and the tongue tie group consisted of newborns with a score of 5 and below according to the Tongue-tie and Breastfed Babies (TABBY) assessment tool. The sucking functions of newborns were assessed between postnatal days 5 and 15 using the ultrasound measurement protocol of McClellan et al. (2010). Breastfeeding was evaluated using the LATCH measurement tool, and breast pain in the mother was graded using a numerical rating scale. At 1 month postpartum, mothers were interviewed by telephone to learn about newborn feeding, maternal breast pain and whether any intervention was provided for newborns with tongue ties. IBM SPSS 22.0 package program was used for data analysis. Statistical significance level p˂0.05 was accepted. A total of 67 newborns (33 males, 34 females; mean gestational age 38.73±0.88) and their mothers (mean age 28.40±4.87 years), 25 with tongue tie, 21 with lip tie, 21 without tongue tie and lip tie, were included in the study. It was found that there was no statistically significant difference between the tongue tie, lip tie and control groups in terms of mean LATCH scores and mean maternal breast pain scores. In addition, when the USG measurements of the newborns with their tongues up and down during sucking were examined, no significant difference was observed between the groups in terms of the mean distance between the nipple and hard-soft palate, nipple diameters measured at 2, 5, 10, 15 mm from the nipple, mid-tongue height and intra-oral space depth with the tongue down. Anterior tongue height was found to be statistically significantly lower in tongue-up measurements in the tongue tie group compared to the lip tie and control groups. Also, there was a significant and negative correlation between anterior tongue height measured with the tongue up and nipple pain scores in the tongue tie group. According to the results of our study, it is possible to say that not all tongue and lip ties cause breastfeeding difficulties. In future ultrasonography studies to determine the effect of tongue and lip tie on breastfeeding and frenotomy success, it would be beneficial to investigate newborns with sucking difficulties with a larger sample size and a longer follow-up period.