SpeechPathology.com Phone: 800-242-5183


Every Special Child - July 2024

What is the consensus on the effects of ankyloglossia on neonatal feeding?

Ann W. Kummer, PhD, CCC-SLP, ASHA Fellow

October 1, 2024

Share:

Question

What is the consensus on the effects of ankyloglossia on neonatal feeding?

Answer

Ankyloglossia, a very common congenital condition usually identified at birth, is characterized by an anterior attachment of the lingual frenulum to the tongue tip (also commonly referred to as “tongue-tie”). The association between ankyloglossia and breastfeeding has been debated among medical professionals for decades (Messner et al, 2020; Rowan-Legg, 2011; Ruffoli et al., 2005). In a survey of relevant practitioners, more than half of lactation consultants (69%) felt that ankyloglossia frequently causes breastfeeding problems. They argue that infants with restrictive ankyloglossia have difficulty breastfeeding because they cannot extend their tongues over their lower gum line to form a proper seal against the nipple. Consequently, they are unable to sufficiently latch onto the breast and keep it within their mouth (Brookes & Bowley, 2014; Francis, Krishnaswami et al., 2015). More recently, lactation specialists believe that posterior tongue-tie can also cause neonatal feeding disorders (Ghaheri et al., 2022; O’Callahan et al., 2013; Pransky et al., 2015), while others don’t agree that posterior tongue-tie even exists as an anomaly (Messner et al., 2020; Talmor & Caloway, 2022). In contrast, a minority of physicians (10% of pediatricians and 30% of otolaryngologists) agreed that ankyloglossia commonly affects neonatal feeding (Messner & Lalakea, 2000). The controversy regarding the effect of ankyloglossia on infant feeding could be due, at least in part, to the fact that not all affected infants experience breastfeeding difficulty.

One study estimated that only 25% of infants with ankyloglossia have difficulty latching on to the nipple during breastfeeding (Messner et al., 2000; Flinck et al., 1994). This means that most infants with ankyloglossia can breastfeed without surgical intervention (Emond et al., 2014; Power & Murphy, 2015; Caloway et al., 2019). In addition, affected infants can be bottle-fed without difficulty (Ricke et al., 2005). Despite these reports, the overall evidence for an association between ankyloglossia and breastfeeding difficulties remains equivocal.

This Ask the Expert is an edited excerpt from the course 20Q: Ankyloglossia - Myths and Evidence Regarding Its Effects on Function authored by Ann W. Kummer, PhD, CCC-SLP, FASHA, 2017 ASHA Honors.


ann w kummer

Ann W. Kummer, PhD, CCC-SLP, ASHA Fellow

Ann Kummer, PhD, CCC-SLP retired as Senior Director of the Division of Speech-Language Pathology at Cincinnati Children’s and as Professor of Clinical Pediatrics and Otolaryngology at the University of Cincinnati College of Medicine. She is currently a Professor Emeritus. Dr. Kummer has done hundreds of national and international lectures on cleft palate and velopharyngeal insufficiency. She is the author of numerous journal articles, 31 book chapters, and the book entitled Cleft Palate and Craniofacial Conditions: A Comprehensive Guide to Clinical Management, now in the 4th Edition. She taught the craniofacial course at 5 universities for many years. She is the co-developer of the Simplified Nasometric Assessment Procedures (SNAP) test (1996) and author of the SNAP-R (2005) which is incorporated in the Nasometer software (PENTAX Medical). She holds a patent on the nasoscope, which is marketed as the Oral & Nasal Listener (Super Duper, Inc.). She was one of the main developers of workflow software that won the 1995 International Beacon Award through IBM/Lotus. (Derivative software is marketed by Chart Links). Dr. Kummer has received numerous state and national honors and awards, including Fellow and later Honors of the American Speech-Language-Hearing Association (ASHA).


Related Courses

20Q: Ankyloglossia - Myths and Evidence Regarding Its Effects on Function
Presented by Ann W. Kummer, PhD, CCC-SLP, ASHA Fellow
Text

Presenter

Ann W. Kummer, PhD, CCC-SLP, ASHA Fellow
Course: #10990Level: Intermediate1 Hour
  'The information was provided in a clear format'   Read Reviews
There is much controversy about the diagnosis of ankyloglossia and its potential effects on neonatal feeding and speech. Guidance regarding the diagnosis of ankyloglossia and a summary of current research regarding its potential effects on function are provided in this course.

20Q: Evaluation and Treatment of Speech/Resonance Disorders and Velopharyngeal Dysfunction
Presented by Ann W. Kummer, PhD, CCC-SLP
Text

Presenter

Ann W. Kummer, PhD, CCC-SLP
Course: #8729Level: Intermediate1 Hour
  'Good information on therapy for VPI after surgery is performed and motor learning'   Read Reviews
Children with speech and resonance disorders (hypernasality, hyponasality, and cul-de-sac resonance) and/or nasal emission present challenges for speech-language pathologists (SLPs) in all settings. This article will help participants to recognize resonance disorders and the characteristics of velopharyngeal dysfunction, and provide appropriate management.

Sound Judgment: Speech Prerequisites, Therapy Techniques, and Use of Motor Learning Principles
Presented by Ann W. Kummer, PhD, CCC-SLP, ASHA Fellow
Video

Presenter

Ann W. Kummer, PhD, CCC-SLP, ASHA Fellow
Course: #10447Level: Intermediate1.5 Hours
  'I loved this, but I wish it had been offered as two seperate courses'   Read Reviews
Differentiating obligatory distortions from compensatory productions, sensory feedback techniques, and effective placement strategies for correction of speech sound errors (e.g., lateral lisp and distortion of /ɚ/ and /r/) are described in this course. Motor learning and motor memory principles are discussed as a framework for achieving carryover after sound acquisition has occurred.

Causes and Characteristics of Resonance Disorders and Velopharyngeal Dysfunction, presented in partnership with Cincinnati Children's
Presented by Ann W. Kummer, PhD, CCC-SLP
Video

Presenter

Ann W. Kummer, PhD, CCC-SLP
Course: #7915Level: Intermediate1.5 Hours
  'This course was absolutely amazing and extremely helpful'   Read Reviews
This is Part 1 of a two-part series. Children with resonance disorders (hypernasality, hyponasality and cul-de-sac resonance) or suspected velopharyngeal dysfunction present challenges for SLPs in all settings. This course is designed to provide information about the causes and characteristics of resonance disorders and velopharyngeal dysfunction so that these disorders can be recognized and appropriate treatment can be recommended.

Evaluation of Speech/Resonance Disorders Secondary to Velopharyngeal Dysfunction, presented in partnership with Cincinnati Children's
Presented by Ann W. Kummer, PhD, CCC-SLP
Video

Presenter

Ann W. Kummer, PhD, CCC-SLP
Course: #7916Level: Intermediate1.5 Hours
  'This course was absolutely excellent with so much great clinical application- I am evaluating a child with hx of a submucous cleft in an outpatient clinic and this increased my confidence 10 fold with how to evaluate this child appropriately, what to evaluate, and appropriate recommendations'   Read Reviews
This is Part 2 of a two-part series. Children with resonance disorders (hypernasality, hyponasality and cul-de-sac resonance) present challenges for speech-language pathologists (SLPs) in all settings. This course is designed to provide simple, yet very reliable low-tech evaluation techniques for practicing SLPs who frequently or occasionally see clients with cleft palate, hypernasality, or suspected velopharyngeal dysfunction. (Part 1: Course 7915)

Our site uses cookies to improve your experience. By using our site, you agree to our Privacy Policy.