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Thesis advisor: Britt F. Pados / Background. Ankyloglossia, commonly known as tongue-tie, reduces tongue mobility through restriction of the lingual frenulum. A recent professional consensus notes that tongue-tie is one possible reason for breastfeeding challenges. Prevalence reporting of tongue-tie has been variable, and an understanding of which infants benefit most from treatment is unknown.Screening and treatment guidelines have not been developed, mainly due to low-level evidence in published research. Despite this, there has been a substantial increase in tongue-tie treatment via frenotomy in the last 15 years. Purpose. The purpose of this program of research was to improve our understanding of tongue- tie and its impact on infant feeding. Eight specific aims were developed to achieve this purpose: 1) identify the prevalence rate of anyloglossia in infants age birth through 12 months; 2) review and evaluate the diagnostic criteria used to diagnose ankyloglossia; 3) identify and summarize original research addressing the impact of ankyloglossia on infant feeding, comparing symptoms of problematic feeding before and after frenotomy; 4) review the quality of the feeding-related outcome measures and psychometric properties of the assessment tools used; 5) describe changes in problematic feeding symptoms, as measured by the NeoEAT, pre- and post-frenotomy; 6) explore the contribution of infant age to the magnitude of change in problematic feeding pre- and post-frenotomy; 7) describe changes in maternal symptoms pre- and post-frenotomy; and 8) evaluate the relationships between maternal symptoms and symptoms of problematic feedingpre- and post-frenotomy. Methods. First, we performed a systematic review and meta-analysis of the literature on tongue- tie to determine the prevalence of the anomaly in the infant population and critiqued the methods used to achieve tongue-tie diagnosis. Second, we identified and summarized original research addressing the impact of tongue-tie on infant feeding, comparing symptoms of problematic feeding before and after frenotomy. In this same study, we evaluated the psychometric properties of the assessment tools used in the published research. Next, we assessed maternal and infant symptoms of problematic feeding pre- and post-frenotomy. In this same study, we utilized a comprehensive evaluation of infant feeding symptoms using a validated measure. Results. Cumulatively, this dissertation research has identified symptoms in both mothers and their infants in the setting of tongue-tie. Each of the eight specific aims proposed for this dissertation were addressed. Specifically, through the meta-analysis and systematic review, we determined 1) prevalence of tongue-tie is higher than previously thought, affecting 8% of the infant population, 2) current screening tools for tongue-tie require psychometric evaluation, 3) LATCH scores and maternal self-efficacy improve following frenotomy but little is known about the effect of frenotomy on infant feeding, and 4) infant feeding has not been evaluated comprehensively or with a validated measure for babies with tongue-tie. The research study conducted in Chapter IV found that 5) infants with severe tongue-tie experienced significant improvements in problematic feeding symptoms following tongue-tie correction as measured by the NeoEAT, 6) regardless of infant age, improvements in symptoms of problematic feeding were seen post-frenotomy in babies with severe tongue-tie, 7) maternal symptoms previously thought to occur in the setting of tongue-tie improved following frenotomy (e.g., painful or difficult latch), and 8) symptoms that have not been assessed in earlier research also improved after tongue-tie correction (e.g., chewing on nipple, incomplete breast drainage, and over supply of breastmilk). Conclusions. The program of research in this dissertation has made meaningful contributions to the literature on tongue-tie. Through the production of the first meta-analysis of prevalence data, a thorough evaluation of the available research, and the determination of maternal and infant symptoms associated with tongue-tie, we have crafted recommendations for future research and recommendations for improvements in the clinical management of infants with this oral anomaly. / Thesis (PhD) — Boston College, 2021. / Submitted to: Boston College. Connell School of Nursing. / Discipline: Nursing.

Submitted by Nadir Basilio (nadirsb@uninove.br) on 2018-06-15T15:07:24Z No. of bitstreams: 1 Cibelle Quaglio.pdf: 2331550 bytes, checksum: f2fb4ef2150b897753950372db1bf24d (MD5) / Made available in DSpace on 2018-06-15T15:07:24Z (GMT). No. of bitstreams: 1 Cibelle Quaglio.pdf: 2331550 bytes, checksum: f2fb4ef2150b897753950372db1bf24d (MD5) Previous issue date: 2018-03-20 / Ankyloglossia, also known as "tongue tie", is one of the several alterations that may occur in the oral cavities of newborns. This congenital abnormality limits tongue movements and can lead to difficulties in breastfeeding, swallowing, speech, as well as mandibular development. The incidence of alteration of the lingual brake in the population is of 0.2 to 12%. The great rate span is mainly due to scarcity of standardized protocols for the correct identification of ankyloglossia. Protocols are important for solving various problems in service delivery and management. Among the most common standardization methods, the Standard Operating Procedures (SOP), comprise detailed instructions for achieving uniformity in the execution of a library, in addition to being scientifically supported and adjusted whenever necessary. ELFABS (Lingual Frenulum Assessment with Baby Scores), better known as " Neonatal Tongue Screening Test" is a protocol that identifies whether the newborn has an alteration of the lingual frenulum. ELFABS was established as mandatory by the Ministry of Health (MH) in 2014 for all maternity hospitals in the country. This study checked validation of ELFABS in a maternity hospital of the city of São Paulo. Questionnaire was used with open and closed questions. The ELFABS, however, was not validated in studied institution. According to the evaluators the protocol is very extensive, complicated and unnecessary. This research suggests that protocols should be tested in a great number of locations before being mandatory tests. / Várias são as alterações encontradas nas cavidades orais dos recém-nascidos, dentre elas, as alterações do freio lingual ou anquiloglossia, também conhecida como “língua presa”. A anquiloglossia é uma anormalidade congênita que limita os movimentos da língua e pode acarretar dificuldades na amamentação, deglutição, fala e desenvolvimento mandibular. Na população há uma incidência de 0,2 a 12% de alterações no freio lingual, essa divergência de valores é dificultada pela escassez de protocolos padronizados para sua identificação. Protocolos são importantes instrumentos para o enfrentamento de diversos problemas na assistência e na gestão dos serviços. Um modo muito utilizado para se padronizar é feito por meio dos Procedimentos Operacionais Padrão (POPs) que são instruções detalhadas descritas para alcançar a uniformidade na execução de uma função específica, são apoiados em bases científicas e ajustados sempre que necessário. Esse estudo teve como objetivo checar a validação do Protocolo de avaliação do Frênulo da língua com Escores para Bebês (PAFLEB) em uma maternidade do município de São Paulo. O PAFLEB, mais conhecido como “Teste da Linguinha”, foi instituído como obrigatório pelo Ministério da Saúde (MS) em 2014, para todas as maternidades do país. Esse protocolo identifica se o recém-nascido apresenta a anquiloglossia. Foi utilizado questionário com questões abertas e fechadas. Não houve validação do teste da linguinha naquela instituição. De acordo com os avaliadores o protocolo é muito extenso, complicado e desnecessário. A sugestão desse estudo é que Protocolos sejam validados em maior número de locais possíveis antes de virarem leis.

Introduction: The most common symptom of ankyloglossia is breastfeeding problems. Lately, more attention has been given to problems beyond infancy, like with speech and mobility. There is limited research done in that area though, and there is no research made comparing indication groups with each other.Aim: To investigate if there is a difference in the self-experienced benefit of the tongue-tie release, in relation to the indication for cutting the tongue-tie.Methods: A retrospective survey of all patients who underwent a tongue-tie release in Örebro county under a period of two years. The patient, or their caregiver if the patient was under 18 years old, were contacted for a telephone survey. 73 patients completed the survey.Results: The results demonstrated no significant difference in self-experienced benefit between the indication-groups. 88% of all patients included in the study experienced benefit, 98% of these patients had a primary (n=57) or secondary (n=6) symptom that got better. The remaining 2% (n=1) experienced benefit despite any symptom relief because of the possible future benefit. The 12% that did not experience benefit did not experience any symptom relief from the surgery.Conclusions: The self-experienced benefit after the tongue-tie release was high in general, without differences between the indication-groups. It turned out to be important to ask for other symptoms than just the primary to see the whole picture. More research with a larger study population is encouraged.

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