Diagnosis, classification and management of ankyloglossia including its influence on breastfeeding

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| 08 abr 2019

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Normal, clinically acceptable range of "free tongue" >16mm
Class 1: mild ankyloglossia	12-16 mm
Class II: moderate ankyloglossia	8-11 mm
Class III: severe ankyloglossia	3-7 mm
Class IV: complete ankyloglossia	<3 mm

Function items	Appearance items
Lateralization	Appearance of tongue when lifted
2 – complete	2– round or square
1 – body of tongue but not tongue tip	1 – slight cleft in tip apparent
0–none	0– heart-shaped
Lift of tongue
2–tip to mid-mouth	Elasticity of frenulum
1 – only edges to mid-mouth	2–very elastic
0 – tip stays at alveolar ridge or tip rises	1 – moderately elastic
to mid-mouth with jaw closure	0 – little or no elasticity
Extension of tongue	Length of lingual frenulum when tongue lifted
2–tip over lower lip	2–>1 cm
1 – tip over lower gum only	1–1 cm
0 – neither of the above or mid-tongue humps	0–<1 cm
Spread of anerior tongue	Attachment of lingua frenulum to tongue
2 – complete	2 – posterior to tip
1 – partial	1 – at tip
0– little or none	0– notched
Cupping of tongue	Attachment of lingual frenulum to inferior alveolar ridge
2 – entire edge, firm cup	2 – attached to floor of mouth or well below ridge
1 – side edges only, moderate cup	1 – attached just below the ridge
0 – poor or no cup	0– attached at ridge
Peristalsis
2 – complete anterior to posterior (originates at tip)
1 – partial (orignates posteriori to tip)
0 – none or reverse peristalsis
Snap-back
2 – none
1 – periodic
0 – frequent or with each suck
Scoring:
14 – perfect score
11 – acceptable if appearance item score is 10
<11 – tongue function impaired (frenotomy should be considered)
Frenotomy is necessary if function score is <11 and appearance score is <8

Type 1	Fine and elastic frenulum; the tongue is anchored from the tip to the alveolar ridge and it is found to be heart-shaped
Type II	Fine and elastic frenulum; the tongue is anchored 2-4 mm from the tip near the alveolar ridge
Type III	Thick, fibrous non-elastic frenulum; the tongue is anchored from its middle to the floor of the mouth
Type IV	The frenulum cannot be seen but palpated; it has a fibrous and/or thick and shiny submucous anchoring from the base of the tongue to the floor of the month

	3	2	1	0
To get the baby to begin this feed, did you have to:	Just place the baby on the breast, as no effort was needed	Use mild stimulation, such as unbundling, patting, burping	Unbundle baby, sit baby back and forward, rub baby's body or limbs at the beginning and during the feed	Could not be aroused
Rooting (at touch of nipple to cheek, baby's head turns toward the nipple, the mouth opens, and baby attempts to fix mouth on the nipple) When the baby was placed at the breast he/she:	Rooted effectively at once.	Needed some coaxing, prompting/ /encouragement to root	Rooted poorly even with coaxing	Did not try to root
How long from placing baby he/she at the latch breast does on and start to feed well?	0–3 minutes	3–10 minutes	Over 10 minutes	Did latch not at all
Which of the following phrases best describes the baby's feeding pattern at this feed?	Sucked well on one or both breasts	Sucked fairly well (sucked off and on but needed some encouragement)	Sucked poorly, weak sucking, some sucking for short periods	Baby did not suck

	0	1	2	Example questions
L– latch	Too sleepy or reluctant No latch obtained	Repeated attempts Must hold nipple in mouth Must stimulate to suck	Grasps breast Tongue down and forward Lips flanged Rhythmic suckling	How did your baby grasp your breast? Did you baby suckle on his own or did you have to work with him?
A–audible swallow	None	A few with stimulation	Spontaneous	Did your you baby hear swallow? How frequently?
T– type of nipple	Inverted	Flat	Everted (after stimulation)	Do your nipples stand out or do they flatten easily?
C– comfort	Engorged Cracked, bleeding, large blisters or bruises Severe discomfort	Filling Small or bruises blisters Mother complains of pinching Mild/moderate discomfort	Soft Tender Intact nipples (no damage)	Are your nipples tender? Are your breasts becoming full and heavy?
H– hold	Full assist (Staff holds infant at breast)	Minimal assist (i.e. elevate head of bed, place pillows) Teach one side mother does other Staff help, mother takes over feeding	No assist from staff Mother able to position/ /hold infant	Did someone help you put your baby to breast? Do you need help with the next feeding?

Calendario de la edición:: Volume Open
Temas de la revista:: Medicine, Clinical Medicine, Pediatrics and Juvenile Medicine, Paediatric Haematology and Oncology, Public Health