Ear, Nose and Throat Disorders Case

You are attending in the newborn nursery and the lactation consultant has concerns that a full-term, 2-day old male infant is not feeding well due to a short lingual frenulum.
Ear, Nose and Throat Disorders Case

On exam, you notice that the infant is unable to protrude the tongue past the alveolar ridge and his weight is down 8% from birthweight. The mother has experience breastfeeding her other two children and feels that the infant does not latch on well during feeding.

Which of the following is the most appropriate next step in the management of this infant?

A. Order a CBC with white blood cell count differential, C-reactive protein, and blood culture.

B. Start empiric IV ampicillin and gentamicin for presumed early-onset sepsis.

C. Start intravenous fluids for dehydration.

D. Arrange for a frenulectomy.

E. Instruct the mother to increase the frequency of feeding attempts to every 2 hours.

The correct answer is “D.” This infant has a tongue-tie (ankyloglossia), which results from a short lingual frenulum and subsequent difficulty with protrusion and elevation of the tongue. Tongue-tie may result in neonatal feeding difficulties or dental and speech problems later in childhood. If the infant is having difficulty with breastfeeding and the tongue cannot protrude past the alveolar ridge, a frenulectomy should be performed by a trained provider in the newborn period. A quick clip is all this infant needs.


Question & Explanation: Peterson AR, Wood KE. Pediatrics Examination and Board Review. New York, NY: McGraw-Hill Education; 2017.

Photo: Kline MW. Rudolph's Pediatrics, 23e; 2018