Diagnosis and management of ankyloglossia in infants and children

ABSTRACT: The diagnosis and management of ankyloglossia, commonly referred to as tongue-tie, has become a controversial topic spanning multiple subspecialties within pediatrics, dentistry, and rehabilitation medicine. Changing perspectives on clinical significance, increased awareness of breastfeeding challenges, and a stronger emphasis on a multidisciplinary approach have contributed to a dramatic rise in both diagnosis and intervention in this condition. Between 1997 and 2012, inpatient diagnoses of ankyloglossia in the United States increased nearly 10-fold, from 3,934 to 32,837 cases, with a similar increase in lingual frenotomy procedures, from 1,279 to 12,406. Providers may encounter tongue-tie in diverse settings, ranging from the newborn nursery to outpatient pediatric primary care to otolaryngology clinics. In the absence of a validated standalone threshold for surgical intervention, clinical decision-making can be challenging. This article provides clinically relevant, evidence-based recommendations to guide the diagnosis and management of ankyloglossia. Current guidance emphasizes direct assessment of the breastfeeding dyad, skilled lactation support, close monitoring of milk transfer and growth, and treatment of competing causes before frenotomy is considered.