Lactation Support and Recovery After Frenectomy: A Multidomain Outcomes Study Using InfantEAT and MIF assessment tools

Objectives: Frenectomy outcomes research has relied on breastfeeding specific instruments that cannot characterize the full feeding dysfunction burden in infants with tethered oral tissues (TOT). This study applies the validated Infant Eating Assessment Tool (InfantEAT) and the Matrix of Infant Feeding (MIF) to a cohort of infants undergoing CO2 laser frenectomy, to establish baseline multidomain feeding dysfunction profiles, characterize postoperative recovery, and examine the role of lactation consultant (LC) support during recovery.

Methods: Infants aged six months or younger referred for CO2 laser frenectomy underwent preoperative (T0), one week postoperative (T1), and four week postoperative (T4) InfantEAT and MIF assessment. Descriptive statistics characterized baseline severity and domain level concern rates across the nine InfantEAT domains. Tissue site groups (lingual only versus lingual and labial) were compared using Mann Whitney U tests. Coherence between InfantEAT domain totals and individual MIF items was assessed using Spearman correlation. Resolution at T1 and T4 was compared between infants receiving surgery alone and infants with active LC support during recovery, examining both complete item level resolution and the number of domains remaining at concern. The relationship between baseline severity and resolution was examined within each group.

Results: Among 111 infants with complete baseline data, median InfantEAT total score was 71.0 (interquartile range 57 to 87), with 47 percent in the moderately severe or severe range. Domains beyond breastfeeding, including gastroesophageal, gastrointestinal, sensory, and bottle feeding dysfunction, were flagged at concern in 35 to 74 percent of infants. InfantEAT and MIF showed moderate, significant coherence (rs equals 0.48, p less than 0.001). Two site involvement was associated with significantly greater baseline impairment than lingual only involvement (median 75.0 versus 54.0; p equals 0.021), concentrated in gastroesophageal dysfunction, gastrointestinal dysfunction, and infant dysregulation. Resolution gains were steepest from T0 to T1. By T4, both groups cleared most domains at concern, with surgery alone reducing from approximately six of nine domains to one, and active LC support reducing to zero. By complete item level resolution at T4, infants with active LC support reached this threshold more often than surgery alone (59 percent versus 36 percent, p equals 0.024), an effect strongest among infants with higher baseline severity.

Conclusions: Multidomain assessment using InfantEAT and MIF reveals feeding dysfunction extending well beyond breastfeeding focused outcome measures, with recovery patterns that depend in part on adjunct lactation support. These findings may help clinicians set expectations for recovery and identify infants who could benefit from proactive lactation support postoperatively.