title: Nipple pain at presentation predicts success of tongue-tie division for breastfeeding problems.
abstract: BACKGROUND
  In mother-infant pairs experiencing breastfeeding difficulties, frenulotomy for tongue-tie may improve breastfeeding. We tested the hypothesis that those experiencing nipple pain are most likely to benefit from the procedure in a prospective cohort study.
  
  
  METHODS
  Mother-infant pairs attending a dedicated clinic for the assessment and treatment of tongue-tie completed a standardised, structured symptom questionnaire. Three months later outcome was assessed by questionnaire. Multivariate logistic regression analysis was used to determine preoperative predictors of successful outcome.
  
  
  RESULTS
  Sixty-two infants <90 days old underwent frenulotomy and completed follow-up. At presentation, 52 mothers (84%) reported nipple pain, and 32 mothers (52%) nipple trauma. Three months after frenulotomy, 78% of respondents were still breastfeeding. Feed lengths (mean reduction: 17 mins; p<0.001) and time between feeds (mean increase: 38 mins; p<0.001) had significantly improved, as had difficulty of feeding (mean improvement in self-rated difficulty score: 42%; p<0.001). Those having difficulty breastfeeding due to nipple pain showed a significant long-term benefit from frenulotomy; pre-frenulotomy nipple pain was associated with an increased likelihood of breastfeeding at 3 months in adjusted multivariate analysis (OR 5.8 [95% CI 1.1-31.6]).
  
  
  CONCLUSIONS
  Mother-infant pairs with tongue-tie and breastfeeding difficulties due to nipple pain are most likely to benefit from frenulotomy.
authors.affiliation: Department of Paediatric Surgery, King's College Hospital, Denmark Hill, London, United Kingdom.
authors.forename: A K K
authors.initials: AK
authors.lastname: Khoo
authors.forename: N
authors.initials: N
authors.lastname: Dabbas
authors.forename: N
authors.initials: N
authors.lastname: Sudhakaran
authors.forename: N
authors.initials: N
authors.lastname: Ade-Ajayi
authors.forename: S
authors.initials: S
authors.lastname: Patel
mesh_terms: D000328:Adult; D001942:Breast Feeding; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008035:Lingual Frenum / Q000002:abnormalities / Q000601:surgery*; D016015:Logistic Models; D009035:Mothers / Q000706:statistics & numerical data*; D015999:Multivariate Analysis; D009558:Nipples / Q000293:injuries*; D010146:Pain / Q000209:etiology*; D011446:Prospective Studies; D013391:Sucking Behavior; D011795:Surveys and Questionnaires