Siegel Int J Clin Pediatr.

2016;5(1):6-8

Evaluation for possible lip/tongue tie in had infants nochange with inrefluxsymptoms,suggestingothercause
symptomsofrefluxshouldbeconsideredaspartofthe reflworkup
ux,andshowed
(19.%) improvementinpost-feedirri-
in diagnosis and treatment. tabilityandlesssymptomsofrefluxbutcouldnotsucce
Recent studies have shown that PPIs have no wean off medications.
effect on
crying and irritability in infants with reflux and actually have
shown an increase in upper respiratory infections and other
adverse effects [6]. This may suggest an alternative Discussion causeand of conclusion
refluxaswell[1-3].
The author is posing a potential addition to the current This study is the first to look at a larger number of
guidelines in diagnosis and treatment of infant showing reflux, the espe-potential linkage of aerophagia and re
ciallyinthebreastfeedinginfant.Anoralexamination in breastfeeding andas- infants as it is associated with tethered oral
sessment can be performed for possible tethered oral tissues tissues of ankyloglossia and maxillary shortene
such as tongue and lip tie whose treatment may Therebenefit appears to be a correlation between aerophagia associ-
the
infantthatisexperiencingsymptomsofreflux.Thismay ated result
refluxwithlipandtonguetiedinfants.
in prevention or cessation of medication that can potentially Surgical release of these ties may help resolve these symp-
have deleterious side effects. tomsrapidly[1,2710].
There is a lack of literature and research looking at a po-
tentialcausalrelationshipwithaerophagiaandr
Patients and Methods feeding infants [1-3]. It is the goal of the author to ad
phenomenon to the differential diagnosis in breastfeeding in-
This was a retrospective analysis of 1,000 breastfeeding moth- fantswithrefluxwhentheyarebeingevaluatedandtr
er-infant dyads over 5 years in private oral and maxillofacial pediatric medical providers of various specialties and subspe-
surgery practice that has a heavy emphasis on breastfeeding cialties.AddingtheacronymAIRanddefinitionofAIRcana
medicine and treatment of ankyloglossia in breastfeeding in- sist in the differential diagnosis and management of the infant
fants. withrefluxsymptoms.
Inclusion criteria were from intake questionnaires looking These infants may be spared from more invasive studies
for positive answers to the following questions: and 1)medications
presencethat may have potentially serious side ef-
of pain on breastfeeding; 2) presence of loud clicking noises fects. The author is proposing studies to objectively look at the
during breastfeeding; 3) extended feeding times; 4) poor seal role of tethered oral tissue (lip and tongue ties) a
aroundthebreast;5)infantfussinessduringandcause afterfeeding; of reflux, as well as the need for a unifying - classi
6)presenceofrefluxsymptoms,especiallyafterfeed;7)pres- tion system/validated tool for the description of lip and tongue
ence of post-feed gastric distention (aerophagia) restrictions
; 8) infant on [10]. Further studies are necessary t
H2blockersand/orPPIswithoutimprovementinrefluxsymp- lish this relationship. Also it is imperative to objectify further
toms;and9)abdominaldistentionimmediatelyafter the combination
feed. of the tongue and lip restrictions or perhaps a
Ages of infants were less than 6 months. single restriction that may pose the problem. Looking at pos-
Clinicalexamofinfantswasperformedbytheauthor sible confoundingand factors and the authors awareness of other
maxillary lip and ankyloglossia was confirmed using the Ha- causes of infantile reflux,thisisstillapotentialc
zelbaker assessment tool for lingual frenulum function with a tile refl ux and therefore shouldnotbeoverlookedan
score of < 8 indicating surgical intervention [7]. Kotlow the differentialclas-diagnosis of practitioners who are involved in
sificationsystemformaxillarylabialfrenulumwas treating these infants.
utilized to
characterizeanatomicposition[8-10]. This will help add to the diagnostic and treatment guide-
The infants underwent frenectomy/frenotomy - lines
of maxil forrefluxthatarecurrentlyinuse.
lary and lingual frenula by author with a CO2 laser of 3 W,
1,20 mJ (novapulse LX 20, or Lightscalpel), and prilocaine/ Funding Source
lidocaine topical anesthesia.
Post-proceduresurveyswereatand 1 weeks
2 aftersurgery.
Inclusion consisted of answers signifying improvement No funding was secured for this study.
fromtheintakequestionnaire,specificallylookingatreduction
or elimination of reflux symptoms and weaning off or cessa-
Financial Disclosure
tion of medication.

Theauthorhasnofinancialrelationshiprelevant
Results to disclose.

Of the 1,0 infants, 526 (52.6%) had an improvement of

Conflict of Interest
symptoms of reflux within the first week after the procedure.
This was significant to the point of either reduction or cessa-
tionofH2/PPImedications.Twohundredeighty-threeThe (28.3%) authorhasnoconflictofinteresttodisclose.

Articles The authors | Journal compilation Int J Clin Pediatr and Elmer Press Inc | www.ijcp.elmerpress.com 7
Aerophagia Induced Reflux Int J Clin Pediatr. 2016;5(1):6-8

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8 Articles The authors | Journal compilation Int J Clin Pediatr and Elmer Press Inc | www.ijcp.elmerpress.com