Prevalence of breastfeeding difficulties in newborns with a lingual frenulum: a prospective cohort series

Breastfeed Med. 2014 Nov;9(9):438-41. doi: 10.1089/bfm.2014.0040. Epub 2014 Sep 19.


Objective: The prevalence of a lingual frenulum in newborn infants is reportedly 0.3-12%. The purpose of this study was to describe the prevalence of a lingual frenulum based on the Coryllos classification in nonselected newborn infants after delivery, hypothesizing that it is higher than the values reported in the literature.

Study design: The lingual frenula of 200 healthy infants were evaluated by visual examination and palpation within the first 3 days after delivery. The frenulum was categorized according to the four Coryllos classifications. Each infant's mother responded, immediately after the examination, to a structured questionnaire on the quality and type of feeding. An additional structured telephone interview with the 179 breastfeeding mothers was conducted 2 weeks later.

Results: All but one infant (n=199) had an observable or palpable lingual frenulum that was Coryllos type 1 (n=5), type 2 or 3 (n=147), or type 4 (n=47). Although our study was not powered enough to test for any correlation between the cessation of breastfeeding and the type of frenulum, we found no statistical correlation between the Coryllos type of lingual frenulum and the presence of breastfeeding difficulties.

Conclusions: A lingual frenulum is a normal anatomical finding whose insertion point and Coryllos classification are not correlated with breastfeeding difficulties. We suggest that the term "lingual frenulum" should be used for anatomical description and that the term "tongue-tie" be reserved for a lingual frenulum associated with breastfeeding difficulties in newborns.

MeSH terms

  • Breast Feeding*
  • Cohort Studies
  • Female
  • Humans
  • Infant, Newborn
  • Israel / epidemiology
  • Lingual Frenum / abnormalities*
  • Lingual Frenum / physiopathology
  • Lingual Frenum / surgery
  • Male
  • Mothers* / psychology
  • Prevalence
  • Prospective Studies
  • Sucking Behavior*
  • Surveys and Questionnaires
  • Terminology as Topic