Secondary Logo

Journal Logo

Institutional members access full text with Ovid®

Implications of Ankyloglossia on Breastfeeding

Hill, Rebecca, DNP, MSN, RN, FNP, CNE

MCN: The American Journal of Maternal/Child Nursing: March/April 2019 - Volume 44 - Issue 2 - p 73–79
doi: 10.1097/NMC.0000000000000501

Objective: The purpose of this integrative review was to synthesize the literature on the relationship between infant breastfeeding and ankyloglossia.

Data Sources: The search terms tongue-tie or ankyloglossia and breastfeeding were used via CINAHL, Ovid MEDLINE, Health Reference Academic, and PsycINFO. Primary research articles and clinical reviews were considered in the search parameters.

Study Selection: Searches yielded 201 articles written in English and published between 1999 and 2018. After screening, 50 full-text articles were assessed for eligibility, 43 of which were omitted for irrelevance. Three qualitative and four quantitative studies remained for inclusion in the review.

Data Extraction: Studies were reviewed for information on the relationship between ankyloglossia and breastfeeding. Studies examining results of ankyloglossia treatment were omitted. Preferred Reporting Items of Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used.

Data Synthesis: Analysis revealed a varied degree of difficulties with breastfeeding when the infant has ankyloglossia. Prevalence is uncertain due to lack of universal screening guidelines, and infrequent use of screening tools. No studies were found that examined psychological ramifications of feeding difficulties with ankyloglossia. There are no validated screening tools for ankyloglossia.

Conclusion: More research is necessary on effects of breastfeeding difficulties of infants with ankyloglossia on the mother–infant relationship. A reliable screening tool needs to be developed and validated. Education for nurses to assess infants with ankyloglossia in a systematic fashion should be explored. Investigation of psychological sequelae, including maternal stress, postpartum depression, and mother–infant bonding is an important next step in the research of infants with ankyloglossia.

Ankyloglossia, also known as tongue tie, is a relatively common congenital anomaly with an overall prevalence of 4.5% to 16% of newborns. It often affects breastfeeding duration and pain. There are no validated screening tools for early detection. An integrated review of the literature on the relationship between ankyloglossia and breastfeeding is provided and important gaps in knowledge identified.

Rebecca Hill is an Assistant Professor, MGH Institute of Health Professions, School of Nursing, and a PhD student at Boston College Connell School of Nursing, Boston, MA. The author can be reached via e-mail at

The author declares no conflicts of interest.

The author would like to acknowledge Dr. Judith Vessey and her PhD cohort colleagues for their support in constructing this integrative review.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved