Implications for Tongue Tie clinical decision making - based on "An evaluation of infant tongue-tie assessment, management and outcomes in a multidisciplinary clinic in Western Australia"

There is a lack of professional consensus regarding the clinical assessment, diagnosis and treatment of what is referred to as ‘tongue-tie’, with both parental anxiety and practitioner motivation driving increasing rates of tongue-tie release (frenotomy). The aim of this audit was to review the current multidisciplinary protocol for assessment and management of tongue-tie at Baby Steps Health Centre, a private early childhood healthcare centre in Perth, Western Australia, and evaluate its role in objectively identifying infants who may benefit from frenotomy.

A retrospective audit of electronic records of consultations for tongue-tie assessment performed between July 2020 and June 2023 was conducted. Extracted data included infant and maternal demographics, referral source, presenting concerns, infant oral characteristics, management approach and parents’ perceived improvement in their presenting concerns 1 week following their appointment. A total of 217 infant–mother dyads presented for tongue-tie assessment.

Lingual frenula attached to the anterior tongue were significantly more likely to require release compared to those attached to the mid- to posterior tongue (40/45 (89%) vs. 39/148 (23%), p<0.001). For the latter group, tongue mobility was a useful predictor of the need for frenotomy. 
Of those families who provided follow-up, 80% reported a subjective improvement in their presenting concerns in both the group selected for frenotomy and for those selected for lactation consultant advice and follow up.

This audit demonstrated the value of a standardised multidisciplinary and collaborative approach to tongue-tie assessment and management in preventing unnecessary frenotomy and improving outcomes for infants and their families. Additionally, the need for formalised education on tongue-tie for healthcare professionals was identified.

Authors : Dr Eloise Wiffen, Jillian Wiffen ( CHN, IBCLC ) and Dr Leon Levitt