Prevalence of ankyloglossia according to different assessment tools: A meta-analysis.

BACKGROUND: Prevalence of ankyloglossia may vary depending on the assessment tool. This systematic review aimed to evaluate the prevalence of ankyloglossia in distinct age groups according to different assessment tools. TYPES OF STUDIES REVIEWED: Nine electronic databases were searched from inception through November 2021 without restrictions of language or year of publication. Paired independent reviewers selected cross-sectional and cohort studies reporting the diagnosis of ankyloglossia, extracted data, and assessed methodological quality. The number of patients with ankyloglossia and the sample were extracted to calculate the overall prevalence of ankyloglossia and 95% CI. The authors calculated the prevalence of ankyloglossia per assessment tool, age group, and sex. They assessed the certainty of evidence using the Grading of Recommendations Assessment, Development and Evaluation approach. RESULTS: Seventy-one studies were included. Seven different diagnostic tools were used. The overall prevalence of ankyloglossia was 5% (95% CI, 4.0% to 5.0%) and ranged from 2% (using an unspecific tool) to 20% (Coryllos classification). The prevalence per age group was higher in infants (7%). The prevalence ratio was 1.34 (95% CI, 1.17 to 1.54) for boys, with very low certainty of evidence. PRACTICAL IMPLICATIONS: The prevalence of ankyloglossia is higher among infants and differs depending on the assessment tool used for the diagnosis. It is uncertain whether boys are more affected by ankyloglossia than girls.

Tongue-tie: incidence and outcomes in breastfeeding after lingual frenotomy in 2333 newborns.

AIM: To determine the prevalence of ankyloglossia in newborns with breastfeeding problems and to assess the effectiveness of frenotomy in the maintenance of exclusive breastfeeding at 1 month, 3 months and 6 months in newborns at an Andorran Hospital. STUDY DESIGN: A descriptive, cross-sectional, population-based, retrospective study of newborns over a 5-year period (2016-2020) was performed. Nine medical history variables (presence or absence of ankyloglossia and type of frenulum, surgical intervention or not, first degree hereditary component, gender, Rh and blood group, type of breastfeeding, causes of cessation and duration of breastfeeding) related to perinatal and feeding history were collected confidentially and anonymously. The Coryllos classification was used for the diagnosis of ankyloglossia. Descriptive analysis of the data, Chi-square test and prevalence ratios were calculated. RESULTS: A total of 2333 newborns were included in the study (50.02% males and 49.98% females). The prevalence of ankyloglossia was 7.84% (n = 183). Of the infants examined, 136 underwent lingual frenotomy. The number of infants who maintained exclusive breastfeeding, both surgically and non-surgically treated, was no statistically significant differences at 1 month (p = 0.65), 3 months (p = 0.61) and 6 months (p = 0.49). CONCLUSIONS: Lingual frenotomy was only performed on patients with ankyloglossia associated with ineffective suction that causes BF difficulties. The realization or not of frenotomy was not a determining factor for the maintenance of breastfeeding at 1 month, 3 months and 6 months. On the contrary, it was a determining factor for the prolongation of mixed feeding. Ankyloglossia related to breastfeeding difficulties should be treated by a multidisciplinary team.

25 Years of Research in Human Lactation: From Discovery to Translation.

Researchers have recently called for human lactation research to be conceptualized as a biological framework where maternal and infant factors impacting human milk, in terms of composition, volume and energy content are studied along with relationships to infant growth, development and health. This approach allows for the development of evidence-based interventions that are more likely to support breastfeeding and lactation in pursuit of global breastfeeding goals. Here we summarize the seminal findings of our research programme using a biological systems approach traversing breast anatomy, milk secretion, physiology of milk removal with respect to breastfeeding and expression, milk composition and infant intake, and infant gastric emptying, culminating in the exploration of relationships with infant growth, development of body composition, and health. This approach has allowed the translation of the findings with respect to education, and clinical practice. It also sets a foundation for improved study design for future investigations in human lactation.

The Relationship of Ankyloglossia With Gender in Children and the Ideal Timing of Surgery in Ankyloglossia.

INTRODUCTION: Ankyloglossia is a congenital condition that restricts tongue mobility. The aim of this study is to evaluate the relationship between gender and pediatric ankyloglossia and evaluate the planning of ideal timing of surgery. METHODS: The files of pediatric patients in the Turkish population treated surgically for tongue-tie between June 2014 to June 2018 were scanned retrospectively. RESULTS: Three hundred and eighty-two pediatric patients were included in the study. Of these, 115 (30.1%) were female and 267 (69.9%) were male. The prevalence of ankyloglossia was significantly higher in males than in females (P < .001). The age of the patients at time of surgery ranged from 1 day to 114 months. The most common indication was sucking/feeding difficulties (82%) in patients younger than 2 years, and the most common symptom was speech problems (67%) in patients aged 2 years and older. CONCLUSION: In our study, the prevalence of ankyloglossia in Turkish society was significantly higher in males. Frenectomy surgery is a safe procedure that can be performed on the first day of life in newborns.

Upper Lip Tie: Anatomy, Effect on Breastfeeding, and Correlation With Ankyloglossia.

OBJECTIVES: There is debate among otolaryngologists and other practitioners about whether upper lip tie contributes to difficulty with breastfeeding and whether upper lip tie and ankyloglossia are linked. Our objectives were to evaluate the anatomy of the upper lip (maxillary) frenulum, to determine if the visual anatomy of the upper lip has an effect on breastfeeding, and to determine whether the occurrence of lip tie and tongue tie are correlated. METHODS: A prospective cohort study of 100 healthy newborns was examined between day of life 3-7. Surveys were completed by the mother at the time of the initial exam and 2 weeks later. The maxillary frenulum was graded based on the Stanford and Kotlow classifications by two independent reviewers. Inter-rater reliability and relationships between tongue tie, lip tie, and the infant breastfeeding assessment tool (IBFAT) were calculated. RESULTS: Inter-rater reliability showed fair agreement (κ = 0.302) using the Kotlow scale and better agreement using the Stanford classification (κ = 0.458). There was no correlation between the upper lip tie classification and breastfeeding success score. Lastly, there was a modest inverse correlation in the degree of tethering for the tongue and lip. CONCLUSIONS: There was no correlation between maxillary frenulum grade and comfort with breastfeeding, pain scores, or latch. There was also no relationship between tip to frenulum length (tongue tie) and visualized lip anatomy, suggesting that tongue tie and lip tie may not cluster together in infants. LEVEL OF EVIDENCE: 2 Laryngoscope, 131:E1701-E1706, 2021.

The prevalence of ankyloglossia in children aged <1 year: a systematic review and meta-analysis.

BACKGROUND: Despite the low level of evidence supporting the correction of tongue-tie for breastfeeding problems, recognition and treatment has increased substantially over the past 15 years. Prevalence reporting of tongue-tie is variable. The purpose of this study was to quantitatively synthesize the prevalence of tongue-tie in children aged <1 year and to examine the psychometric properties of the assessment tools used for diagnosing tongue-tie in these studies. METHODS: PRISMA and MOOSE guidelines were followed, with selection of studies and data extraction verified by two authors. Random-effects meta-analyses were performed to determine an overall prevalence rate, prevalence by infant sex, and prevalence by diagnostic method. RESULTS: There were 15 studies that met inclusion criteria. Overall prevalence of tongue-tie (N = 24,536) was 8% (95% CI 6-10%, p < 0.01). Prevalence was 7% in males and 4% in females. Prevalence was 10% when using a standardized assessment tool compared to 7% when using visual examination alone (p = 0.16). Available assessment tools for diagnosis of tongue-tie do not have adequate psychometric properties. CONCLUSIONS: Tongue-tie is a common anomaly, which has the potential to impact infant feeding. Development of a psychometrically sound assessment of tongue-tie is needed. IMPACT: The overall prevalence of tongue-tie in infants aged <1 year is 8%. Available diagnostic tools for tongue-tie do not have adequate psychometric testing. Prevalence data can assist health care providers in the recognition of tongue-tie as a potential barrier to infant feeding to promote maternal breastfeeding success.

Prevalencia de anquiloglosia en neonatos y relación con datos auxológicos del recién nacido o con otras malformaciones o enfermedades asociadas / Prevalência de anquiloglossia em recém-nascidos e relação com dados auxológicos do recém-nascido ou com outras malformações ou doenças associadas / Prevalence of ankyloglossia in neonates and relationship with auxological data of the newborn or with other malformations or associated diseases

Objetivo: determinar la prevalencia de anquiloglosia en neonatos del Hospital Nostra Senyora de Meritxell del Principado de Andorra, Europa, así como la relación existente con datos auxológicos u otras malformaciones o enfermedades asociadas. Material y métodos: Se realizó un estudio descriptivo, transversal, retrospectivo poblacional de los recién nacidos durante un período de 8 meses. Se estudiaron once variables: presencia o no de anquiloglosia, tipo de frenillo corto, talla, peso, perímetro craneal, sexo, Rh y grupo sanguíneo, edad gestacional, malformaciones y patologías neonatales asociadas, de forma confidencial y anónima, correlacionándolas para ver si existía alguna asociación entre ellas. Resultados: Un total de 306 recién nacidos fueron incluidos en el estudio (52% varones y 48% mujeres). La prevalencia de anquiloglosia fue del 6,54% (n=20). Del total de varones (159/306), el 8,125% (n=13) presentaban anquiloglosia, mientras que en mujeres (147/306), la prevalencia fue del 4,79% (n=7), sin encontrar diferencias estadísticamente significativas respecto al sexo (p-valor=0,24). Según la clasificación de Coryllos, el tipo II fue el más frecuente (95% de los casos) y el 4,58% de los lactantes con anquiloglosia exhibieron patología/malformación. Conclusiones: La prevalencia de anquiloglosia en recién nacidos en Andorra, Europa, es similar a la observada por otros autores en investigaciones similares. No se observó asociación entre la presencia o no anquiloglosia y las variables estudiadas.

Objetivo: determinar a prevalência de anquiloglossia em recém-nascidos do Hospital Nostra Senyora de Meritxell do Principado de Andorra, Europa, bem como a relação existente com dados auxológicos ou outras malformações ou doenças associadas. Material e métodos: Foi realizado um estudo descritivo, transversal e retrospectivo da população de recém-nascidos durante um período de 8 meses. Onze variáveis foram estudadas: presença ou não de anquiloglossia, tipo de frênulo curto, altura, peso, perímetro craniano, sexo, Rh e grupo sanguíneo, idade gestacional, malformações e patologias neonatais associadas, de forma confidencial e anônima, correlacionando-as para ver se existia alguma associação entre eles. Resultados: Um total de 306 recém-nascidos foram incluídos no estudo (52% masculino e 48% feminino). A prevalência de anquiloglossia foi de 6,54% (n=20). Do total de homens (159/306), 8.125% (n=13) apresentavam anquiloglossia, enquanto nas mulheres (147/306) a prevalência foi de 4,79% (n=7), sem encontrar diferenças estatisticamente significantes em relação ao sexo (valor-p = 0,24). De acordo com a classificação de Coryllos, o tipo II foi o mais frequente (95% dos casos) e 4,58% dos lactente com anquiloglossia apresentaram patologia / malformação. Conclusões: A prevalência de anquiloglossia em recém-nascidos em Andorra, Europa, é semelhante à observada por outros autores em investigações semelhantes. Não foi observada associação entre a presença ou não anquiloglossia e as variáveis estudadas

Aim: to determine the prevalence of ankyloglossia in new-borns of the Nostra Senyora de Meritxell Hospital in the Principado de Andorra, Europe, as well as the existing relationship with auxological data or other malformations or associated diseases. Material and methods: A descriptive, cross-sectional, retrospective population study of 306 newborns was carried out over a period of 8 months. Eleven variables were studied: presence or no of ankyloglossia, type of short frenulum, height, weight, cranial perimeter, sex, Rh and blood group, gestational age, malformations and associated neonatal pathologies, confidentially and anonymously, correlating them to see if there was any association between them. Results: A total of 306 new-borns were included in the study (52% male and 48% female). The prevalence of ankyloglossia was 6,54% (n=20). Of the total of men (159/306), 8,125% (n=13) presented ankyloglossia, while woman (147/306), the prevalence was 4,79% (n=7), without finding statistically significant differences regarding sex (p-value=0,24). According to the Coryllos classification, type II was the most frequent (95% of cases) and 4,58% of infants with ankyloglossia exhibited pathology/malformation. Conclusions: The prevalence of ankyloglossia in new-borns in Andorra, Europe, is similar to that observed by other authors in similar research. No association was observed between the presence or not of ankyloglossia and the variables studied

Ankyloglossia: Update on Trends in Diagnosis and Management in the United States, 2012-2016.

Ankyloglossia, or "tongue-tie," refers to limited tongue mobility caused by a restrictive lingual frenulum. Previous studies have demonstrated rapid increases in diagnosis and treatment of ankyloglossia in the United States up to 2012. We performed an updated retrospective review of data from the National Inpatient Sample (NIS), Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality (AHRQ) to evaluate trends in diagnosis of ankyloglossia and use of lingual frenotomy in the hospital setting. From 2012 to 2016, there was an 110.4% increase in reported diagnosis of ankyloglossia in the inpatient setting with similar increases in lingual frenotomy procedures. As seen previously, sex, type of insurance, median income ZIP code, and geographic region were associated with diagnosis of ankyloglossia. The observed trends from prior to 2012 have continued to increase, while unanswered questions about diagnostic criteria and about which infants should undergo frenotomy remain.

Trends of ankyloglossia and lingual frenotomy in hospital settings among children in Denmark.

INTRODUCTION: It has been proposed that ankyloglossia and lingual frenotomy have increased. The aim of this study was to analyse the trends of ankyloglossia and lingual frenotomy among children treated in hospitals in Denmark in the 1996-2015 period. METHODS: We included children aged 0-17 years registered with the diagnosis ankyloglossia (DQ381) or the procedure frenotomy (KEJC20) using nationwide hospital-based data from the Danish National Patient Registry in 1996-2015. The incidence during the study period and the average annual percentage change (AAPC) and age-specific incidences were calculated. RESULTS: A total of 1,608 children were diagnosed with ankyloglossia (67% boys). The overall incidence of ankyloglossia increased from 3.2 per 100,000 in 1996 to 13.6 per 100,000 in 2015, corresponding to an AAPC of 7.1%. The age-specific incidence revealed a more than ten times higher incidence of ankyloglossia among patients less than one year old compared with those aged one year or above. In all, 3,625 frenotomy procedures were carried out (66% boys). The frequency of frenotomy increased from 5.1 per 100,000 in 1996 to 38.5 per 100,000 in 2015, corresponding to an AAPC of 11.1%. The age-specific incidence of frenotomy showed a more than thirty times higher frequency among children less than one year of age. CONCLUSIONS: Ankyloglossia and frenotomy increased significantly during the period 1996-2015 among children in Denmark according to nationwide hospital data. Rates of both ankyloglossia and frenotomy were highest in children less than one year of age and among boys. FUNDING: none. TRIAL REGISTRATION: not relevant.

Pre-conceptional folic acid supplementation: A possible cause for the increasing rates of ankyloglossia.

BACKGROUND: There is an increasing awareness to ankyloglossia (tongue-tie) in infants, with marked increase in its report in the medical literature. Some reports indicate increase in prevalence. Whether the increase ankyloglossia rate is a real phenomenon or merely reflects increased awareness and reports has to be determined. One explanation for the increasing ankyloglossia rates is the growing trend of breast feeding initiation, often impaired by ankyloglossia, which brings it to medical attention. We propose an alternative hypothetical explanation based on increasing utilization of periconceptional folic acid supplementation for the prevention of neural tube defects (NTDs). Inadequate folic acid supply during organogenesis impairs cell division, and the mid-line structures are at the highest risk. We postulated that higher folic acid supply during organogenesis might enhance tissue synthesis with tighter closure of mid-line structures including the lingual frenulum, resulting in ankyloglossia. METHODS: To assess this hypothesis, we undertook an observational case control study comparing folic acid utilization before pregnancy in mothers of infants with and without ankyloglossia. Infants with ankyloglossia (n = 85) were compared to a control group without ankyloglossia (n = 140). RESULTS: There was a slight, insignificant elevated frequency of reported utilization of folic acid ("any intake") among mothers of infants with ankyloglossia compared with controls (74.1% and 66.4%, respectively). This difference was slightly higher, yet insignificant when folic acid intake "in most days" was considered (65.9% and 53.6%, respectively, OR = 1.67, 95%CI = 0.93-3.05, P = 0.07). In contrast, the reported intake of pre-conceptional folic acid "on a regular basis" was significantly higher among mothers of infants with ankyloglossia compared with controls (54.1% and 25.7%, respectively, OR = 3.41, 95%CI = 1.85-6.27, p < 0.0001). INTERPRETATION: The reported association between higher frequency of regular pre-conceptional folic acid intake and ankyloglossia, supports the hypothesis for this association. More studies are required to test this hypothesis.

Implications of Ankyloglossia on Breastfeeding.

OBJECTIVE: The purpose of this integrative review was to synthesize the literature on the relationship between infant breastfeeding and ankyloglossia. DATA SOURCES: The search terms tongue-tie or ankyloglossia and breastfeeding were used via CINAHL, Ovid MEDLINE, Health Reference Academic, and PsycINFO. Primary research articles and clinical reviews were considered in the search parameters. STUDY SELECTION: Searches yielded 201 articles written in English and published between 1999 and 2018. After screening, 50 full-text articles were assessed for eligibility, 43 of which were omitted for irrelevance. Three qualitative and four quantitative studies remained for inclusion in the review. DATA EXTRACTION: Studies were reviewed for information on the relationship between ankyloglossia and breastfeeding. Studies examining results of ankyloglossia treatment were omitted. Preferred Reporting Items of Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used. DATA SYNTHESIS: Analysis revealed a varied degree of difficulties with breastfeeding when the infant has ankyloglossia. Prevalence is uncertain due to lack of universal screening guidelines, and infrequent use of screening tools. No studies were found that examined psychological ramifications of feeding difficulties with ankyloglossia. There are no validated screening tools for ankyloglossia. CONCLUSION: More research is necessary on effects of breastfeeding difficulties of infants with ankyloglossia on the mother-infant relationship. A reliable screening tool needs to be developed and validated. Education for nurses to assess infants with ankyloglossia in a systematic fashion should be explored. Investigation of psychological sequelae, including maternal stress, postpartum depression, and mother-infant bonding is an important next step in the research of infants with ankyloglossia.

Comparing barriers to breastfeeding success in the first month for non-overweight and overweight women.

BACKGROUND: Women who enter pregnancy overweight or obese tend to have poorer breastfeeding outcomes compared to non-overweight women. Women's experiences of specific breastfeeding-related problems and reasons for use of formula have not been systematically investigated according to pre-pregnancy BMI. The aim of this study was to compare self-reported breastfeeding problems in non-overweight and overweight women and identify the main reasons for use of infant formula during the first month postpartum. METHODS: The present study involved a cross-sectional secondary analysis of data collected as part of a hospital-based longitudinal study of women that commenced in pregnancy (~ 16 weeks). At ~ 4 months postpartum Australian women (N = 477) self-reported breastfeeding problems and reasons for use of infant formula during the first month postpartum. Pre-pregnancy BMI was calculated based on self-reported pre-pregnancy weight and measured height. Binary logistic regression analyses were used to compare pre-pregnancy weight status groups ("non-overweight" [BMI < 25 km/m2] and "overweight" [BMI ≥25 km/m2]) on self-reported breastfeeding problems and reasons for use of infant formula. Analyses were adjusted for covariates that differed between groups (P < .1). RESULTS: Frequency of self-reported breastfeeding problems was similar across weight status groups. "Not enough milk" was the predominant reason for giving infant formula. Overweight women were more likely than non-overweight women to agree that infant formula was as good as breastmilk. CONCLUSIONS: Overall it does not appear that overweight women are more likely to experience a range of specific breastfeeding problems in the first months compared to non-overweight women. However, the severity and duration of the problems needs to be examined. Breastfeeding interventions need to addresses concerns around milk supply as these are common and are likely to be of universal benefit however overweight women in particular may benefit from guidance regarding the benefits of breastfeeding for both themselves and their infants.

Ankyloglossia in Infancy: An Indian Experience.

OBJECTIVE: To study the prevalence, clinical presentation and management of infants with ankyloglossia. METHODS: A retrospective file review of infants less than 6 months of age with a diagnosis of ankyloglossia. RESULTS: Of the 25786 babies born during the assessment period (2007-2015), 134 (0.52%) had ankyloglossia. Sixty-four (47.7%) infants who presented with breastfeeding difficulties were diagnosed significantly earlier than the asymptomatic group (P<0.05). Of the symptomatic group, 85.9% underwent frenotomy with satisfactory results. Seventy asymptomatic infants were managed conservatively with counselling. CONCLUSION: Frenotomy seems to be a safe and effective procedure in infants with symptomatic ankyloglossia.

Ankyloglossia and Lingual Frenotomy: National Trends in Inpatient Diagnosis and Management in the United States, 1997-2012.

Objectives (1) Describe trends in the diagnosis of ankyloglossia and the use of lingual frenotomy and (2) analyze patient- and hospital-level factors as compared with the total pediatric discharge population. Study Design National database analysis. Methods We reviewed available data from 1997 to 2012 using the Kids' Inpatient Database, Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality. All weighted pediatric discharges with ankyloglossia, newborn feeding difficulty, or lingual frenotomy were analyzed for variables of sex, payer, zip code median income, hospital ownership, location/teaching status, bed size, region, and children's hospital status. Chi-square analysis with 95% CIs and odds ratio were used to identify differences between the study group and the total database discharge population. Results Diagnosis of ankyloglossia increased each year of publication (every third year)-with 3934, 5430, 7785, 11,397, 19,459, and 32,837 children, respectively, from 1997 to 2012-with the largest increase in the last 6 years. Similarly, frenotomy increased with 1279, 1633, 2538, 3988, 6900, and 12,406 procedures. Compared with the total discharge population, children with ankyloglossia or frenotomy were more often male (63.6% ankyloglossia, 65.3% frenotomy vs 51.2%), privately insured (60.1%, 62.1% vs 43.6%), from a higher median-income zip code (78.1%, 78.2% vs 68.6%), and in Midwest region (29.3%, 32.3% vs 21.7%). Conclusion These pilot data show increases in diagnoses of ankyloglossia and use of frenotomy. There is a preponderance of children who are male, privately insured, or Midwest residents being diagnosed and treated for ankyloglossia. This broad variation may reflect local practice patterns or imply cultural and socioeconomic bias.

The prevalence of ankyloglossia in 302 newborns with breastfeeding problems and sucking difficulties in Barcelona: a descriptive study.

AIM: Oral and maxillofacial development is influenced by the lingual frenulum and also affects breathing, occlusion, sucking, swallowing, speech, among others. Ankyloglossia in the newborn may result in breastfeeding difficulties: maternal nipple pain and/or erosion or mastitis, poor weight gain and excessively long breastfeeds. The main objective of this work is to study the prevalence of ankyloglossia in newborns with breastfeeding difficulties. MATERIALS AND METHODS: This is a transversal descriptive study of 302 patients, between 0 and 6 months, who attended the hospital as a result of breastfeeding difficulties. All patients with sucking problems and ankyloglossia were included in this study and followed the multidisciplinary treatment protocol made up of the services of Breastfeeding, Speech Therapy and Orofacial Rehabilitation and Oral and Maxillofacial Surgery. RESULTS: 1,102 newborns were seen at the paediatric service of Hospital de Nens, Barcelona (Spain) during 2 years; 302 had breastfeeding difficulties and of these, 171 were diagnosed with ankyloglossia (60 girls and 111 boys). Coryllos Grade 3 ankyloglossia was the most prevalent (59.6%) type; 85 infants (49.7%) were exclusively breastfed and 26 (50.35%) were mixed fed (formula and breastfeeding). Only 43 patients had a family history of tongue-tie (25.1%). CONCLUSION: Ankyloglossia linked to breastfeeding difficulties must be treated by a multidisciplinary team. We have found a high prevalence of the condition since the population studied are newborns with sucking problems. If a frenotomy is necessary, we recommend stimulating suction with myofunctional therapy before and after surgery to avoid scar retraction.

Prevalência de anquiloglossia em recém-nascidos e avaliação da confiabilidade e validade do Teste da Linguinha na triagem neonatal / Prevalence of ankyloglossia in newborns and reliability and validity of the Lingual Frenulum Assessment Protocol in Babies (Teste da Linguinha) in neonatal screening

Introdução: O exame de triagem neonatal, conhecido como "Teste da Linguinha" (TL), é realizado através da aplicação do "Protocolo de Avaliação do Frênulo da Língua em Bebês". Este exame é obrigatório em todos os hospitais e maternidades do Brasil desde dezembro de 2014 e tem por objetivo diagnosticar a anquiloglossia que tenha potencial de interferir negativamente no aleitamento materno. Objetivos: 1. Estimar a prevalência de anquiloglossia em recém-nascidos saudáveis de uma maternidade da rede pública de saúde do Rio de Janeiro; 2. Avaliar a confiabilidade e a validade de construto do TL na triagem neonatal. Métodos: O estudo foi realizado em uma maternidade pública do Rio de Janeiro. A amostra de díades mãe/filho incluiu neonatos saudáveis, a termo, de até 48 horas de vida e peso maior ou igual a 2.500 g. Os dados foram coletados por três examinadoras treinadas (duas odontopediatras e uma fonoaudióloga), através de entrevistas com as puérperas, observação da mamada e aplicação do TL. As mães foram entrevistadas um mês após o nascimento da criança, por telefone, por estudantes de odontologia. A confiabilidade do protocolo foi medida através da sua consistência interna e estabilidade. A validade de construto foi analisada através da correlação entre: os escores produzidos com a aplicação do instrumento; indicadores autopercebidos de sucesso e insucesso da amamentação; e a dificuldade na amamentação, medida através do Protocolo de Observação da Mamada ­ UNICEF adaptado. A análise estatística foi feita com o programa Stata 14.0®. Resultados: Entre 25.08.2015 a 30.09.2015 foram examinadas 268 díades mãe/filho. A prevalência da anquiloglossia foi igual a 2,24% (IC 95% = 0,83%; 4,81%). O valor do coeficiente de correlação intraclasse para a confiabilidade entre as três examinadoras foi 0,77 (IC95%:0,64; 0,89) e o valor do coeficiente Alfa de Cronbach para a consistência interna foi 0,28 (limite inferior do IC 95%: 0,14). A correlação entre a pontuação total da escala e a autopercepção: da dificuldade para amamentar, da satisfação com a amamentação, e da dor ao amamentar foram 0,05 (p=0,42), 0,01 (p=0,87) e 0,007 (p=0,92), respectivamente. A correlação entre a pontuação do "TL" e o Protocolo de Observação da Mamada UNICEF- adaptado foi 0,27 (p<0,001). Conclusão: A prevalência da anquiloglossia foi muito baixa O "TL" utilizado na triagem neonatal apresentou estabilidade aceitável e baixa consistência interna. Não foi possível confirmar a sua validade. Esses achados sugerem que o seu uso na identificação de recém-nascidos com anquiloglossia capaz de interferir negativamente na amamentação não deve ser recomendado.

Introduction. The "Lingual Frenulum Assessment Protocol in Babies", popularly known as "Teste da Linguinha" (TL), is a neonatal screening test mandatory in all hospitals and maternity hospitals in Brazil since December 2014. The TL aims to diagnose ankyloglossia that may have a negative impact on breastfeeding. Objectives. 1. To estimate the prevalence of ankyloglossia in healthy newborns from a public maternity in Rio de Janeiro; 2. To evaluate the reliability and validity of the "Lingual Frenulum Assessment Protocol in Babies" when it is used as a screening test. Methods. This study was conducted at a public maternity in the city of Rio de Janeiro, Brazil. The TL was applied to a sample of healthy term newborns, weighing 2.500 g or more, within 48 hours of birth. Data were collected by three trained examiners (two pediatric dentists and one speech therapist), through interviews with the mothers, assessment of breastfeeding and the application of the TL to newborns. One month after the child´s birth, mothers were interviewed by phone by undergraduate dental students in order to collect information about their experiences with breastfeeding after hospital discharge. The assessment of the reliability of the TL included the measurement of its internal consistency and stability. The validity of the protocol was analyzed by the correlation between the scores of the instrument and those of self-perceived indicators of breastfeeding success and failure, and professionally determined breastfeeding difficulty as measured by the Adapted Breastfeeding Observation Aid UNICEF protocol. Statistical analysis was performed with Stata 14.0® software. Results. Total sample comprised 268 dyads mothers/child, recruited between August 25 and September 30, 2015. The prevalence of anklyloglossia was 2.24% (IC 95% = 0.83; 4.81%). The inter-rater reliability among the three examiners as measured by the intraclass correlation coefficient was 0.77 (95% CI: 0.64, 0.89) and the Cronbach's alpha coefficient for internal consistency was 0.28 (95% CI lower limit: 0.14). The correlations between the total TL score and self-perceived difficulty to breastfeed, satisfaction with breastfeeding, and pain while breastfeeding were respectively 0.05 (p = 0.42), 0.01 (p = 0.87) and 0.007 (p = 0.92). The correlation between the TL score and the adapted UNICEF protocol was 0.27 (p <0.001). Conclusion. The prevalence of anklyloglossia was very low. The "Lingual Frenulum Assessment Protocol for Babies" used as a screening test presented acceptable stability and low internal consistency. It was not possible to confirm its validity. These findings suggest that the use of the "Lingual Frenulum Assessment Protocol for Babies" for identifying newborns with ankyloglossia that may negatively interfere with breastfeeding should not be recommended.