Ankyloglossia Identification, Diagnosis, and Frenotomy: A Qualitative Study of Community Referral Pathways. (August 2020)

• Record Type: Journal Article
• Authors: Unger, Crystal; Chetwynd, Ellen; Costello, Rebecca
• Is Part Of: Journal of human lactation. Volume 36:Number 3(2020:Aug.)
• Page Start: 519
• Page End: 527
• Publication Date: 2020-08
• Subjects: access to care -- ankyloglossia -- breastfeeding -- qualitative methods -- referral and consultation -- tongue-tie; Breastfeeding -- Periodicals; Lactation -- Periodicals; 612.664
• DOI: 10.1177/0890334419887368
• Languages: English
• ISSNs: 0890-3344

Abstract

Background: Researchers and practitioners continue to debate the most appropriate assessment, diagnostic, and treatment practices for ankyloglossia (tongue-tie). Health care workers struggle to provide evidence-based care in the absence of consistent standards. Research aim: The aims of this pilot study were to qualitatively (a) evaluate the knowledge of, and attitudes toward tongue-tie and (b) describe how they shaped referral pathways and the establishment of practice patterns of frontline practitioners (pediatric dentists, speech-language pathologists, pediatric chiropractors, and International Board Certified Lactation Consultants). Methods: We recruited clinicians ( N = 9) using nonprobability purposive sampling. Participants were interviewed using survey schedules adjusted to reflect their specialty area. Semistructured interviews were transcribed and coded using manual and inductive coding techniques common in grounded theory. Themes were iteratively developed using memoing techniques, in which observations and potential concepts were recorded using the aforementioned codes. Results: Participants were familiar with a variety of protocols and assessment tools, but did not consistently use them. No formal training about the management of tongue-tie was received through their degree programs. Instead they pursued self-guided study. Interprofessional consensus guided opinions about tongue-tie best practices, and referral pathways reflected these consensuses. International Board Certified Lactation Consultants were viewed as pivotal to the care of infants with tongue-tie while primary care physicians—primarily pediatricians—were omitted from referral pathways. Conclusion: Lack of formalized training, professional consensus about best practices, and insufficient resources for assessing and treating tongue-tie led participants to incomplete referral pathways and personal interpretations of the data through the lens of anecdotal evidence.