Beyond Tongue-Tie: The 2027 ABM Clinical Protocol for Evidence-Based Assessment and Management of Ankyloglossia

Background:
The diagnosis and treatment of ankyloglossia have increased substantially over the past two decades, accompanied by growing controversy regarding indications for frenotomy, diagnostic criteria, surgical techniques, and postoperative care. While ankyloglossia may contribute to breastfeeding difficulties in some dyads, overdiagnosis and unnecessary intervention may expose infants to avoidable risks and divert attention from other causes of breastfeeding dysfunction. The Academy of Breastfeeding Medicine (ABM) undertook a comprehensive revision of Clinical Protocol #11 to provide contemporary, evidence based guidance for clinicians caring for breastfeeding infants with suspected ankyloglossia.

Methods:
A multidisciplinary international panel conducted a structured review of the literature from 2004 through 2025 using PubMed/MEDLINE, EMBASE, Web of Science, and CINAHL databases. Publications addressing infant ankyloglossia and breastfeeding outcomes were reviewed and graded using the Strength of Recommendation Taxonomy (SORT) framework. Evidence was synthesized to develop clinical recommendations addressing diagnosis, evaluation, procedural considerations, postoperative care, complications, and ethical issues.

Results:
The revised protocol emphasizes that ankyloglossia is fundamentally a functional diagnosis requiring three essential elements: a shortened lingual frenulum, demonstrable restriction of tongue mobility, and persistent breastfeeding symptoms despite skilled lactation support. During this presentation, the protocol’s key recommendations will be presented in detail, including approaches to diagnosis, assessment, conservative management, procedural considerations, postoperative care, complications, and ethical decision-making. The evidence supporting each recommendation, including areas of consensus, controversy, and knowledge gaps, will be reviewed and referenced. This presentation will represent the first formal conference presentation of the updated 2027 Academy of Breastfeeding Medicine Clinical Protocol #11.

Conclusions:
This updated protocol provides a comprehensive framework for the diagnosis and management of ankyloglossia in breastfeeding infants, emphasizing functional assessment, multidisciplinary lactation support, procedural safety, and evidence based decision making. By promoting appropriate patient selection and discouraging unsupported practices, the protocol seeks to reduce unnecessary procedures while ensuring timely access to treatment for infants and families most likely to benefit. The conference presentation will provide attendees with the first opportunity to review and discuss the recommendations of the newly revised protocol and their implications for clinical practice.

Representative clinical cases will be used to illustrate the protocol recommendations, supported by high quality clinical photographs and videos that demonstrate the spectrum of ankyloglossia presentations, breastfeeding assessment, procedural techniques, postoperative findings, and complications.