What is Ankyloglossia and Why Does It Matter for Breastfeeding?

Ankyloglossia, commonly known as tongue-tie, is a congenital condition where the lingual frenulum—a thin membrane connecting the underside of the tongue to the floor of the mouth—is too short or tight, restricting tongue movement. This limitation can significantly impact a newborn's ability to breastfeed effectively. In Brazil, where exclusive breastfeeding is strongly promoted by health authorities, such difficulties pose challenges for both infants and mothers.

Infants with ankyloglossia often struggle with latching, creating an inadequate seal around the nipple, leading to inefficient milk transfer. This results in prolonged feeding sessions, maternal nipple pain, and potential early weaning. The condition affects sucking dynamics, where the tongue fails to properly cup the breast and create the necessary vacuum.

Since December 2014, Brazil mandates the 'Teste da Linguinha' (Little Tongue Test) in all public and private maternity wards, screening newborns for ankyloglossia to promote early intervention and support breastfeeding success.

Prevalence of Tongue-Tie in Brazilian Newborns

Studies across Brazil report varying prevalence rates for ankyloglossia in newborns, ranging from 0.8% to 29.4%, depending on diagnostic criteria and sample size. A UFPE study involving 1,344 newborns found an 8.2% prevalence, highlighting common anatomical features like anterior frenulum insertion. Other research in public maternities shows rates around 4.3%, underscoring the need for consistent screening protocols.

• Lower rates (0.88-4%) in stricter classifications focusing on functional impact.
• Higher rates (up to 16-29%) when including milder forms via tools like Neonatal Tongue Screening Test.
• Male infants more affected (3:1 ratio), hereditary factors implicated.

These statistics emphasize why university-led research is crucial for refining diagnostics in Brazil's diverse healthcare settings.

The Groundbreaking UFPE Study Published in CoDAS

A recent study from Universidade Federal de Pernambuco (UFPE), published in the prestigious Brazilian journal CoDAS, provides compelling evidence on frenotomy's benefits. Titled 'Thermographic Analysis of Infants' Faces During Breastfeeding Before and After Lingual Frenotomy,' it demonstrates how surgery reduces infant effort.

Led by speech-language pathologist Midiane Gomes da Silva from UFPE's Graduate Program in Human Communication Health, the research involved 40 full-term infants (2-30 days old, >2.5kg) diagnosed with ankyloglossia via the Neonatal Tongue Screening Test (score ≤7).

Innovative Methodology: Using Infrared Thermography

The study's innovation lies in using infrared thermography (IRT)—a non-invasive imaging technique capturing skin surface temperature variations—to quantify muscle effort. Higher muscle activation generates heat via increased blood flow, visible as hotspots.

Procedure step-by-step:

1. Pre-frenotomy: Assess frenulum, breastfeeding (WHO/UNICEF protocol), maternal pain scale; capture IRT of temporal, masseter, buccinator muscles at 1, 3, 5 min of feeding.
2. Frenotomy: Performed by pediatric dentist with local anesthesia, lifting tongue to sever frenulum.
3. Post-frenotomy (7 days): Repeat assessments under controlled conditions (22-24°C, 40-60% humidity).

Two blinded evaluators analyzed IRT qualitatively (patterns) and quantitatively (ROI temperatures via FLIR Tools). Sample powered for 80% detection of 0.5 SD change.

Key Findings: Measurable Reductions in Effort

Results were striking:

• Tongue mobility improved significantly (p<0.001) across all Neonatal Tongue Screening Test items.
• Breastfeeding protocol: Favorable shifts in mother's general aspect (p<0.001), breast pain (p=0.03), suction efficiency (p<0.001).
• 92.5% mothers reported better sucking post-surgery; only 7.5% persistent difficulties.
• IRT: Qualitative increase in temporal/masseter temperatures (majority at 3 min); quantitative elevations indicating proper muscle recruitment, less compensation.

No buccinator changes, suggesting targeted levator muscle benefits.

Read the full CoDAS study here.

Implications for Maternal and Infant Health in Brazil

This UFPE research validates frenotomy, reducing invisible energy expenditure in babies, alleviating maternal pain, and supporting exclusive breastfeeding—vital as Brazil aims for WHO's 6-month target (current ~50% adherence). It addresses gaps in objective sucking measures, empowering informed parental decisions.

Stakeholder views: Lead author Midiane Gomes da Silva notes, 'Babies with ankyloglossia have less efficient sucking patterns, longer sequences, more interruptions—leading to greater effort.' Post-surgery shifts to functional musculature confirm benefits.

UFPE's Role: Excellence in Speech-Language Pathology Research

UFPE, a leading federal university in Northeast Brazil, exemplifies higher education's impact through its Fonoaudiologia (speech-language pathology) department. The study stems from interdisciplinary efforts with Odontologia, building on the 'Projeto Língua Solta'—an extension program offering free screening and frenotomy since 2014 for Recife families.

Such initiatives train students in clinical research, diagnostics, and public health, positioning UFPE as a hub for pediatric orofacial disorders. Brazilian universities like UFPE contribute globally via CoDAS, an open-access journal by Sociedade Brasileira de Fonoaudiologia.

For aspiring researchers, explore research jobs in higher ed or higher ed jobs in Brazil via AcademicJobs Brazil.

Challenges and Controversies in Tongue-Tie Management

Despite evidence, debates persist: Not all cases require surgery; mild ankyloglossia may self-resolve. Risks include bleeding, infection (rare in neonates). Brazilian protocols emphasize functional assessment over anatomy alone. International reviews show modest benefits, but UFPE's thermography adds objective data.

• Pros: Immediate latch improvement, pain relief, sustained breastfeeding.
• Cons: Overdiagnosis risks, need for trained providers.
• Solutions: Multidisciplinary teams (fonoaudiólogos, dentists, lactation consultants).

Real-World Case Studies from Brazilian Universities

UFPE's Projeto Língua Solta has treated hundreds, with follow-ups showing 85% breastfeeding success post-frenotomy. Similar programs at UFRN, Fiocruz report prevalence-aligned interventions. A case: Infant with grade 3 ankyloglossia improved latch within days, mother weaned pain-free at 6 months.

These cases illustrate university extension's societal impact, training future professionals.

Future Outlook: Advancing Research in Brazilian Higher Ed

Upcoming: Longitudinal studies on speech development, AI-enhanced IRT. UFPE plans expansions amid Brazil's health priorities. Federal funding via CNPq supports such work, fostering PhD opportunities in human communication health.

Explore academic career advice or scholarships for Brazilian unis.

Career Opportunities in Pediatric Speech Pathology

This field booms in Brazil, with demand for fonoaudiólogos in universities, hospitals. Roles: Researchers, clinicians, extension coordinators. Salaries average R$5,000-10,000/month; advanced degrees boost prospects.

Check faculty positions, lecturer jobs, university jobs in Brazil.

Conclusion: Empowering Breastfeeding Through University Innovation

UFPE's CoDAS study illuminates frenotomy's role in easing breastfeeding burdens, showcasing Brazilian higher ed's vital contributions. Parents, consult professionals; academics, pursue such impactful research.

Share experiences at Rate My Professor. Find roles at Higher Ed Jobs, career tips at Higher Ed Career Advice, post openings at Recruitment, explore University Jobs.

Photo by Cheng Qi Huang on Unsplash