Introduction
The number of infants undergoing surgery for ankyloglossia, or tongue-tie, has increased substantially in recent years. This rise may be partly influenced by misinformation parents encounter on social media. However, breastfeeding difficulties are multifactorial. When infants or breastfeeding parents experience painful or ineffective feeding, they should receive a comprehensive breastfeeding assessment before surgery is considered. A multidisciplinary evaluation involving paediatricians, lactation specialists, feeding therapists, and surgeons is therefore recommended before determining whether surgical intervention is appropriate for a breastfeeding infant with ankyloglossia.
Most infants with ankyloglossia are asymptomatic and do not have feeding difficulties. The evidence also does not show a clear association between ankyloglossia and speech disorders. Assessment of tongue-tie severity, using tools such as the tongue assessment tool for tongue-tie in breastfed babies, together with a breastfeeding assessment, can help inform surgical decision-making. A parent decision-aid may support shared decision-making by helping parents understand the potential benefits (if any) and risks of surgery for infants with breastfeeding difficulties. Such a decision-aid should provide evidence-based information on whether surgery improves infant breastfeeding, reduces maternal nipple pain, and what complications may occur following the procedure.
Objective
This article briefly reviews these three areas and presents a simplified parent decision-aid to support parents in making informed decisions about surgery for ankyloglossia in breastfeeding infants.
Discussion
Based on the available evidence, the parent decision-aid was developed for use in physician-guided shared decision-making. The aid incorporates behavioural economics principles, including framing, a default option, and traffic-light colour coding. Information is presented in a way that discourages parents from choosing frenotomy as the initial treatment for improving infant feeding; the default option is not to proceed with frenotomy. The decision-aid also outlines potential complications associated with the procedure.
Traffic-light colour coding was included in the article to draw on familiar associations between colours and actions, such as stopping, proceeding with caution, or proceeding:
- Increasing awareness of potential complications following frenotomy (red signal)
- Encouraging caution before undertaking frenotomy (yellow signal)
- Highlighting the possible benefit of frenotomy in reducing nipple pain for breastfeeding parents (green signal)
Conclusion
A simplified parent decision-aid may support more informed, evidence-based decision-making and help reduce surgical overtreatment for ankyloglossia in breastfeeding infants, thereby minimizing avoidable procedure-related morbidity.
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