Ankyloglossia and its impact on breastfeeding: a prospective observational study


  • Rahul R. Holkar Department of Pediatrics, TNMC, B.Y.L. Nair Hospital, Mumbai, Maharashtra, India
  • Charusheela S. Korday Department of Pediatrics, TNMC, B.Y.L. Nair Hospital, Mumbai, Maharashtra, India
  • Sushma Malik Department of Pediatrics, TNMC, B.Y.L. Nair Hospital, Mumbai, Maharashtra, India



Ankyloglossia, Breastfeeding, Hazelbacker tool, Kotlow classification


Background: Ankyloglossia is due to the short lingual frenulum. It has been associated with an increased incidence of breastfeeding difficulties. The aim of our study was to determine the association between ankyloglossia and breastfeeding difficulties in healthy full term newborns.

Methods: We assessed 504 full term newborns admitted in post-natal care ward for presence of ankyloglossia, severity and associated breast feeding difficulties using the Hazelbacker‘s tool, Kotlow classification and breastfeeding observation form respectively. Mother and baby were observed in postnatal ward for breastfeeding problems during their hospital stay for at-least 48 hours and thereafter till day seven of life in admitted babies and by telephonic contact if discharged earlier. All mothers were counselled regarding breastfeeding.

Results: The incidence of AG was found to be 11.71% (59/504) with male predominance (Male: Female- 1.57:1). Breastfeeding difficulties were encountered in 13 (22.03%) neonates with AG. Majority of babies with breastfeeding difficulties had mild (Class I) ankyloglossia (69.2%) and rest had moderate AG. Breastfeeding difficulty was related to mother's position in 38.5%, baby's position in 30.8%, latching difficulty in 100%, suckling difficulty in 84.6% and associated with mother's breast problems in 23.1%. All these feeding problems were observed during 24-48hours, which persisted in 92.3% for 48-72 hours and 76.9% during 72-96 hours of life but were not observed on day of life seven on follow up.

Conclusions: Breastfeeding problems associated with mild or moderate ankyloglossia are usually transient and it can be resolved with prompt and appropriate counseling, unless AG is complete or severe type. 


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Original Research Articles