Objective Sucking Metrics in Infants with Ankyloglossia: Preliminary nFant® Feeding Solution Data with Novel Correlations with Comprehensive Clinical and Parent-Reported Assessments

Background: Ankyloglossia affects around 10% of newborns and is commonly associated with feeding difficulties. Clinical decision-making typically draws on assessments of tongue structure and function. Less frequently, this also includes clinician-observed feeding behaviours, oral reflex screening, and parent-reported feeding concerns, and these tools are rarely benchmarked against objective, device-derived measures of sucking performance. The nFant® Feeding Solution is a sensor-based bottle system that quantifies sucking mechanics in real time. To date, the only published application of this technology to infants with tongue-tie is a randomised controlled trial restricted to posterior tongue-tie (PTT) and reporting objective metrics alongside maternal symptoms and confidence scales, without correlation to tongue structure/function, feeding skill, or reflex assessment (Ghaheri et al, 2021).

Aim: To explore objective sucking metrics captured by the nFant® Feeding Solution in infants with ankyloglossia, before and after frenotomy and at 4–6 week follow-up; and examine how these metrics relate to five established clinical assessment tools (ATLFF, EFS, IORA, NeoEat, and LFP); profile this cohort's tongue-tie classification (Kotlow, Coryllos, Todd & Hogan, BTAT).
Methods: Twenty-one infants under six months (18 male, 3 female; mean gestational age 38.8 weeks) with a clinical diagnosis of ankyloglossia who had five clinical assessments at three timepoints: within 48 hours before frenotomy (Pre), within 48 hours after surgery (Post), and at 4–6 week follow-up (Follow-up). nFant® metrics (peak amplitude, duration, frequency, smoothness) were compared with a published full-term reference cohort. Pearson correlations were computed between nFant® metrics and each of the five clinical tools, and baseline tongue-tie classification (Kotlow, Coryllos, Todd & Hogan, BTAT) was tabulated for the full cohort.

Results: Infants with ankyloglossia showed significantly shorter suck duration and reduced suck smoothness compared with full-term reference values at every timepoint (all p<.05), alongside elevated peak amplitude and frequency. ATLFF, EFS, LFP, and several NeoEat subscales showed significant improvement from Pre to Follow-up (p<.05), while IORA scores remained stable. The LFP showed the largest relative change of any tool, with the proportion of infants scoring ≥9 (suggesting an altered lingual frenulum) falling from 85.7% (18/21) Pre-surgery to 5.3% (1/19) at both Post and Follow-up. In this study's novel cross-tool correlation analysis, correlations between nFant® metrics and clinical tools were generally weak, with two significant associations: ATLFF appearance subscore with suck frequency (r=0.33, p=.047), and NeoEat subscales with peak amplitude and frequency (both p<.05); LFP subscales showed no significant correlation with any objective metric (all p>.1). 

Conclusion: This study is, to our knowledge, the first to apply nFant® objective sucking metrics to infants with ankyloglossia beyond the posterior tongue-tie subtype, and the first to correlate these metrics against a comprehensive, multi-domain clinical assessment battery including the LFP. Findings suggest that objective sucking metrics capture a dimension of feeding function that is distinct from, and only weakly related to, existing clinical and parent-reported tools, including the LFP, which showed the largest clinical change of any tool but no correlation with objective sucking metrics, a gap that Ghaheri et al. (2021) did not have the data to examine. These results support continued investigation of the objective feeding measures as a complementary component of a multimodal assessment.