What does the research tell us about rates of infant frenotomy worldwide?

Research demonstrates a dramatic increase in frenotomy rates in many countries over the past couple of decades

Frenotomy rates have been shown to have significantly increased over the past two decades in various regions particularly in young infants for feeding concerns. Although the International Consortium of Ankylofrenula Professionals claims that these increases are occurring because increasing breastfeeding rates and increased desire by both parents and health professionals to support breastfeeding success, researchers are clear that these dramatic increases are consistent with epidemiological patterns of overdiagnosis and overtreatment. In Australia, for example, where frenotomy rates have been shown to have increased dramatically (below), there has been no concurrent change in breastfeeding rates.

• A retrospective Canadian cohort study by Lisonek et al 2018 (excluding Quebec) from 2002 to 2014 found that ankyloglossia rates increased from 6.86 to 22.6 per 1000 live births, a

• A population-based study in British Columbia, Canada, by Joseph et al 2016 from 2004 to 2013 reported a 70% increase in ankyloglossia incidence (from 5.0 to 8.4 per 1000 live births) and an 89% increase in frenotomy rates (from 2.8 to 5.3 per 1000 live births).

• Wei et al 2020 showed that in the US, from 2012 to 2016, there was a 110.4% increase in reported ankyloglossia diagnoses and similar increases in lingual frenotomy procedures in the inpatient setting

• Another analysis of US claims data published by Wei et al 2023 showed that ankyloglossia diagnoses increased from 3377 to 13,200, and lingual frenotomies increased from 1483 to 6213 from 2004 to 2019. The proportion of frenotomies performed by pediatricians also rose from 13.01% to 28.38%.

• Kapoor et al, an Australian team including myself, found that the rate of infant frenotomy identified through Medicare data (which was unable to account for frenotomies which occurred in the private sector by dentists and others, whom authors estimated were performing the majority of frenotomies) increased by 420% for children aged 0-4 years between 2006 and 2016.

• A 2025 US study shows that the rate of diagnoses of upper lip-ties have increased by 3500% and performance of maxillary frenotomy (for the lip-tie) increased by 390% between 2009 and 2023 children 0-4 years of age. The average age of these babies diagnosed with lip-tie and treated with frenotomy was about 12 months of age.

• A 2026 cohort study of all infants born in Denmark 2014-2024 found a doubling in the rate of frenotomy among infants, with most procedures performed early in life. Also, 6.3% of infants underwent repeat procedures. The authors state that these findings highlight the need for improved implementation of evidence-based treatment and further evaluation of the clinical appropriateness of widespread infant frenotomy.

Some countries with ongoing high breastfeeding rates have not shown an increase in frenotomy rates

In 2018 Jin et al noted that there was no similar rise of frenotomy rate in Japan or in a number of countries in Europe including Italy, the Netherlands and the Scandinavian countries which have among the highest incidence of breastfeeding in the developed world.

Research demonstrates variations in frenotomy rate depending on demographics

• A 2023 US study by Wei et al found socioeconomic differences in ankyloglossia management, with frenotomy significantly associated with male sex, White non-Hispanic ethnicity, higher parental income and education, and a greater number of siblings

• In the US, Kelly et al 2025 analysed pre-intervention data from a retrospective cohort study on frenotomy practice and showed that privately insured patients were 2.75 times more likely to receive a frenotomy than those with public insurance (OR 2.75, 95% CI: 2.43-3.12, p < 0.0001). Non-Hispanic White infants were also 2.3 times more likely than non-Hispanic Black patients and 3.9 times more likely than Hispanic infants to undergo the procedure.

• In Denmark, Sonne et al 2026 showed a nearly 10-fold variation in infant frenotomy rate according to geographic region.

Two co-ordinated health system efforts to decrease frenotomy rates have been successful

• In the US, a "paradigm shift newborn feeding difficulties model" implemented in a tertiary academic pediatric hospital between 2023 and 2024 was shown by Khalsa et al 2025 to lead to a decrease in frenotomy rates from 45.4% to 17.7%.

• A program implemented in Canterbury, New Zealand, was found by Dixon et al 2018 to have significantly decreased the frenotomy rate from 11.3% to 3.5%, by standardizing assessment and providing education. Despite this reduction, no overall difference in feeding patterns was observed between treated and untreated infants.

Recommended resources

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NIPPLE PAIN & DAMAGE - IS IT TONGUE-TIE? Demonstration of oromotor examination + frenotomy discussion. Simone and newborn Maggie PART 1. Dr Pamela Douglas, F2F Nova Health Co. 19_10_23

Selected references

Dixon B, Gray J, Elliot N, Shand B, Lynn A. A multifaceted programme to reduce the rate of tongue-tie release surgery in newborn infants: Observational study. international Journal of Pediatric Otorhinolaryngology. 2018;113:156-163.

Joseph KS, Kinniburgh B, Metcalfe A, Razaz N, Sabr Y, Lisonkova S. Temporal trends in ankyloglossia and frenotomy in British Columbia, Canada, 2004-2013: a population-based study. CMAJ Open. 2016;4(1):E33-E40. Published 2016 Jan 26. doi:10.9778/cmajo.20150063

Khalsa IK, Pappas A, Cafferkey M, Banik G, Rosbe KW. Avoiding frenotomies and improving health equity: Findings from a paradigm shift newborn feeding difficulties model. Int J Pediatr Otorhinolaryngol. 2025;194:112355. doi:10.1016/j.ijporl.2025.112355

Kapoor V, Douglas PS, Hill PS, Walsh L, Tennant M. Frenotomy for tongue-tie in Australian children (2006-2016): an increasing problem. MJA. 2018;208(2):88-89.

Kelly A, Wexelblatt S, Ward L, Nidey N, McAllister J. Reducing Racial, Ethnic, and Socioeconomic Disparities in Frenotomy Practice. Breastfeed Med. 2025;20(10):715-721. doi:10.1177/15568253251360779

Lisonek M, Shiliang L, Dzakpasu S, Moore AM, Joseph KS. Changes in the incidence and surgical treatment of ankyloglossia in Canada. Paedaitrics and Child Health. 2017;22(7):382-386.

Naseem DF, Sheth AH, Cheng AG, Qian J. Is public interest associated with real-world management of ankyloglossia? Otolaryngology - Head and Neck Surgery. 2024;170(5):1442-1448.

Smart S, Kittrell A, Merkel-Walsh R, Tseng RJ. International Consortium of oral ankylofrenula professionals (ICAP) practice guidelines for ankylofrenula management. International Journal of Orofacial Myology and Myofunctional Therapy. 2024 A;50(2):10.52010/ijom.52024.52050.52012.52013

Smart et al. "Debate over tongue tie procedures in babies continues. Here’s why it can be beneficial for some infants". The Conversation, 2024 B. https://theconversation.com/debate-over-tongue-tie-procedures-in-babies-continues-heres-why-it-can-be-beneficial-for-some-infants-230008

Sonne H, Pottegard A, Hjuler T. Temporal trends and geographic variation in frenotomy procedures smong infants. JAMA Otolaryngology Head & Neck Surgery. 2026:doi:10.1001/jamaoto.2026.0113.

Wei E, Tunkel D, Boss E, Walsh J. Ankyloglossia: update on trends in diagnosis and management in the United States, 2012-2016. Otolaryngology - Head and Neck Surgery. 2020:https://doi.org/10.1177%1172F0194599820925415.

Wei EX, Meister KD, Balakrishnan K, Cheng AG, Qian ZJ. Ankyloglossia: Clinical and Sociodemographic Predictors of Diagnosis and Management in the United States, 2004 to 2019. Otolaryngol Head Neck Surg. 2023;169(4):1020-1027. doi:10.1002/ohn.332