Plain English Summary
Background and study aims
Babies are sometimes born with a tongue tie. This is where the flesh which holds the tongue to the floor of the mouth, underneath the tongue, is too tight or too long and hence the baby cannot move the tongue as much as a normal baby. It is said that up to 3% of babies are affected i.e. a lot of babies.
It is possible to snip the tongue tied tissue (called the frenulum) and release the tongue tie. Recently this has become a spreading practice across different places in the UK. The reason this is done is that by releasing the tongue, the affected baby can breast feed more easily as able to latch onto the mothers breast without causing pain to the mother or irritation and failure of breast feeding.
We are conducting a study which will attempt to determine a way of measuring tongue tied babies, assessing their breast feeding, and if deemed to be tongue tied just after birth, the Mum will be invited to join our study. It is uncertain if cutting the tongue tie (called frenotomy) really does result in better breast feeding and also sustained breast feeding. Previous research has not been conclusive and that is why an initial study is required.
Who can participate?
100 babies and their Mums in the first few weeks after birth. If a baby is assessed to have severe tongue tie, they will not be invited to participate. We will not involve premature or other babies needing ongoing in patient medical care. Only mature term babies will be invited (via their Mums!) to be involved.
What does the study involve?
If the Mums agree to participate they will be randomly allocated to either immediate tongue tie treatment or a delay of 5 days whereby standard breast feeding advice /support will be given. If the infant is still struggling to feed, tongue tie release will be done on the other half of the group (i.e. 50 babies) at day 5 after study entry. Some babies at that point could be feeding well without that help.
Assessments will look at breast feeding competency including a questionnaire filled in by the Mums after the tongue tie treatment.
What are the possible benefits and risks of participating?
Frenotomy is a simple procedure done by a trained midwife and causes minimal discomfort to the baby.
If we find that we can involve 100 Mums and their babies over this time frame and our measures of assessment prove reliable and useful, a larger study will be run. If we show that tongue tie treatment genuinely benefits breast feeding babies, it would make a case for every district to offer this service.
Where is the study run from?
The study is carried out in Southmead Hospital Bristol, UK.
When is study starting and how long is it expected to run for?
October 2011 to October 2012.
Who is funding the study?
National Institure for Health Research (NIHR), UK
Who is the main contact?
Dr Alastair Sutcliffe
Institute of Child Health
General and Adolescent Paediatrics Unit
University College London
30 Guilford Street
+44 (0)20 7794 0500 x 35169
A feasibility study for a randomised controlled trial to measure the impact of frenotomy in breastfed infants with tongue tie
A pilot study involving infants in their first few weeks of life whose mothers experience difficulty in breast feeding thought to be due to Tongue Tie.
Interventional, treatment, randomised controlled trial
Primary study design
Secondary study design
Randomised controlled trial
Patient information sheet
Topic: Generic Health Relevance and Cross Cutting Themes; Subtopic: Generic Health Relevance (all Subtopics); Disease: Paediatrics
These babies will be randomised to Frenotomy (incision of the frenulum of the tongue in a tongue tied infant) at day 0 or day 5. They will be assessed using the LATCH tool (primary outcome). The Hazelbaker tool for tongue tie severity and reassessed at day 5.
Those randomised to delayed frenotomy will be given standard breast feeding support.
The main aim of the feasibility study is to establish if Mothers are willing to participate and complete the protcol. this will be a single blind assessment in which a person unaware of frentomy status will do the LATCH and other assessments.
Follow Up Length: 2 month(s); Study Entry: Single Randomisation only
Primary outcome measure
LATCH score, measured pre and post frenotomy
Secondary outcome measures
1. Bresat feeding duration measured 8 weeks post procedure
2. HASLIFF score measured pre and post frenotomy
3. Maternal pain on breast feeding Likert scale measured pre and post frenotomy
Overall trial start date
Overall trial end date
Reason abandoned (if study stopped)
Participant inclusion criteria
1. Term born infants with a functionally significant tongue tie (Hazelbaker Assessment Tool for Lingual Frenulum Function [HATLFF] score between 6-12) with breast feeding difficulties (LATCH score <-8)
2. Male and female participants
3. Upper Age Limit is 14 days
Target number of participants
Planned Sample Size: 100; UK Sample Size: 100; Description: This is a feasibility study which would determine sample size for a main study.
Participant exclusion criteria
1. Preterm infants
2. Infants with serious congenital anomalies
3. Infants who have lost >10% of their birth weight unless found to be well enough after checking by a neonatologist
4. Infants with a HATLFF score of <6, and those over 2 weeks old will be excluded from the study
5. Mothers who do not want their baby to have surgery
6. Babies that have not received vitamin K soon after birth, unless the mother agrees to an injection of vitamin K one hour before entering the trial
Recruitment start date
Recruitment end date
Countries of recruitment
Trial participating centre
Institute of Child Health
Southmead Hospital (UK)
National Institure for Health Research (NIHR) - Research for Patient Benefit (RfPB)
Funding Body Type
Funding Body Subtype
Results and Publications
Publication and dissemination plan
Not provided at time of registration
Intention to publish date
Participant level data
Not provided at time of registration
Basic results (scientific)
2013 results in: http://www.ncbi.nlm.nih.gov/pubmed/24249695
Emond A, Ingram J, Johnson D, Blair P, Whitelaw A, Copeland M, Sutcliffe A, Randomised controlled trial of early frenotomy in breastfed infants with mild-moderate tongue-tie., Arch. Dis. Child. Fetal Neonatal Ed., 2014, 99, 3, F189-95, doi: 10.1136/archdischild-2013-305031.