If you have chosen to breastfeed your baby we are in full support of your choice. There are so many advantages to breastfeeding and there is no coincidence that they call breast milk “liquid gold.” We strongly support breastfeeding and hope to be a member of your team. In addition to working with our office, we strongly recommend seeking the assistance of an International Board Certified Lactation Consultant (IBCLC). Working together with an IBCLC we can help you achieve your breastfeeding goals. If you are not currently working with an IBCLC please contact our office and we will do our best to refer you to an IBCLC in your area.
What Is A Tongue-Tie?
During pregnancy, the developing tongue of your baby separates from the floor of the mouth. Sometimes this process is incomplete and some of the tissue remains. This remaining tissue is called a frenulum. If the frenulum interferes with the normal movement or function of the tongue, it is called “ankyloglossia”, or “tongue-tie” more commonly.
How Can A Tongue-Tie Affect Breastfeeding and Normal Mouth Development?
For comfortable and effective breastfeeding, the baby must latch deeply onto the breast with the mouth wide open and the tongue forward. The tongue then moves in a wave-like motion, rising to compress breast tissue and dropping to create a vacuum to help draw out milk. Tongue-tie can make it hard for the baby to do these things and can contribute to:
- Compressed or pinched nipples, nipple damage, soreness and severe pain.
- Increased risk of nipple and breast infections.
- Difficulty expressing milk from the breast which can lead to:
- Long and/or inefficient, frequent feedings, decreased milk production and slow weight gain.
- Blocked ducts, and mastitis.
- Difficulty latching or maintaining the latch, clicking sounds, or loss of suction.
- Difficulty coping with fast flow, pulling off, choking, sputtering, spitting up or swallowing air.
- Swallowing excessive air can lead to a gassy, irritable baby.
- Bump or callous (nursing blister) on his/her lips.
Baby’s Developmental Concerns and Other Issues:
- Narrow upper jaw development. The tongue is intended to “rest” against the roof of the mouth. The steady tongue pressure against the upper jaw influences the upper jaw to develop as it was intended, broad and relatively flat. Without this influence the upper jaw has an increased risk of developing to be narrower which can result in dental cross-bites, increased risk of crowding and even the possibility of nasal septum development problems.
- In older children a tongue-tie can have the potential to interfere with proper speech development.
- Ongoing studies suggest a restrictive tongue-tie can be associated with sleep apnea or poor sleep in children.
How Is A Tongue-Tie Assessed?
Some tongue-ties are obvious upon an initial exam, but many are more subtle and require an evaluation that goes beyond just looking. Most health care professionals have not been trained to assess for tongue-ties that can impact breastfeeding and may not recognize tongue-ties that are anywhere but at the tip of the tongue. Many pediatricians will examine a baby’s mouth and say, “everything looks normal.” At Granger Pediatric Dentistry we assess for tongue-ties by performing an exam on your baby, asking about your baby’s symptoms and finding out about your symptoms. By combining all of this information together we can make a thorough assessment regarding your baby’s tongue-tie.
What Is A Tongue-Tie Release And How Is It Done?
If we feel that tongue-tie may be contributing to your breastfeeding challenges, we will offer to release it. The procedure to release a tongue-tie called a “frenotomy” (also know as a “release”, “revision”, or “division.” Historically some people have referred to the procedure as a “frenectomy”, or “frenulectomy.”). A Frenotomy only takes a few minutes and is done in our treatment rooms during your baby’s appointment if you choose to have the procedure done.
- We initially swaddle your baby.
- After swaddling, we place protective eye wear on your baby. This is adequate to complete the procedure for most infants.
- In toddlers 2-4 years old we may recommend a light oral sedation to help them have a better experience during the procedure. This can be discussed in detail during your consultation appointment if needed.
- We perform our frenotomies with a soft tissue laser. The laser helps us to be extremely accurate in our release releasing only the desired tissue.
- Our staff will go over all the details of the procedure, answer any questions you may have, and ask you to sign a consent form.
- We recommend breastfeeding or bottle-feeding immediately after the procedure to help soothe your baby.
Releasing a tongue-tie often helps with breastfeeding, but unfortunately we cannot guarantee that it will. It is always up to you to decide if you would like to have the procedure done.
The frenotomy can be done during any of your baby’s appointments at our offices. If you have received another consultation regarding your baby’s tongue-tie and they wanted to put your baby under general anesthesia for the release, we recommend obtaining a 2nd opinion.
After A Tongue-Tie Release:
Babies generally cry as soon as they are swaddled and crying continues for varying amounts of time after the procedure is complete. Immediately after the procedure, we recommend breastfeeding or bottle-feeding your baby. Feeding generally helps soothe your baby and allows them to immediately start utilizing their new range of motion. Many babies latch and calm quickly while others take a little longer to settle, perhaps while being walked by a parent or caregiver. There is usually minimal to no bleeding during or after the frenotomy.
Baby’s latch may feel different immediately or it may take a few days or longer for baby to use his/her tongue differently and for the breastfeeding or bottle feeding situation to improve.
Some babies are fussier than others and some may refuse the breast for a few hours after the release and, in these cases, a dose of infant acetaminophen may be helpful. More information and dosing pain relief medication will be provided to you after the release.
We occasionally hear that a baby is still fussy about feeding or refusing the breast a few days after the procedure.
Healing, Reattachment, and Tongue-Tie Exercises:
The tiny incision creates a diamond shaped wound, which turns creamy white, or yellow, or orange for up to 10-14 days before healing completely. This is normal healing in the mouth and not a sign of infection. Infection does not seem to be an issue with tongue-tie releases in babies.
During healing, the surfaces of the wound tend to close together forming some degree of reattachment, which varies from baby to baby. To help minimize the chances for reattachment we recommend a series of stretches and massages after the procedure. One of our doctors or assistants will demonstrate the stretches or massages on your baby and then you will be given the opportunity to demonstrate them back to us. We want to make sure you are completely comfortable performing the exercises before you leave our office.
If there is significant reattachment and restriction in the frenum, which happens in a small percentage of babies, a second release may be suggested.
Many babies have a small piece of tissue connecting the upper gums to the underside of the top lip. If this tissue is tight and/or broad and seems to restrict the ability of the lip to form a tight seal at the breast or causes rubbing of the lip against the breast, it is called a “lip-tie”.
We may offer to release a lip-tie, usually along with a tongue-tie release, if it seems to be contributing to your breastfeeding concern(s) (especially nipple pain and difficulty latching or maintaining a latch).
How Can Lip-Ties Effect The Mouth
A heavy lip-tie can restrict the movement of the upper lip and keep it closely held against the upper teeth. When this occurs it is difficult to brush and and keep the upper front teeth clean. When food and bacteria get trapped between the frenum your child’s teeth they are at an increased risk for developing cavities on those front teeth. Releasing the upper frenum allows the lip to “pull away” from the teeth allowing easier brushing and decreasing their cavity risk on those teeth.
If the frenum is thick enough it can also keep the upper front teeth from growing in next to each other. When this occurs the heavy frenum creates a large gap between the front teeth.
A lip-tie release takes only a few minutes and can be done immediately after a tongue-tie release. There will also be limited to no bleeding from the area similar to what is described regarding tongue-tie release. We cannot guarantee a lip-tie release will help with breastfeeding. It is always up to you to decide if you would like to have the procedure done.
Post Procedure Care:
Stretching and Massaging Exercises:
- Doing the exercises as instructed allows for proper healing by reducing the risk of reattachment and therefore the need for the procedure to be repeated.
- These exercises must be done at least 5 times a day for 3 weeks. Be sure to perform the stretches at least every 5 hours. If your baby sleeps more than 5 hours at a time you will need to wake them to perform the stretches.
- Wear gloves or use clean hands. Make sure your fingernails are short.
- Doing the stretches may make your baby worried if every time you try to put your fingers in their mouth is to do stretches and massages. To help avoid this oral aversion we recommend putting your fingers in their mouth several times a day with breast milk or sugar water on your finger. This gives your baby a positive experience with your fingers along with the stretches and massages.
- A small amount of Coconut Oil on the finger during the massages can help make the massages more effective.
- If your baby received a frenotomy under the tongue be sure to give your baby plenty of tummy-time. Tummy-time will help stretch the muscles in the neck and under the tongue.
- Start 5 hours after the procedure. Perform every 4-5 hours.
- Lay your baby on their back with their head towards you, and feet pointing away.
- Pull lip up to the tip of nose and hold for 5 seconds.
- 5 rubs at fold with light to moderate pressure (vertically)
- With fingers under the tongue, pull tongue up to the roof of the mouth and hold for 5 seconds.
- 5 rubs at fold with light to moderate pressure (vertically)
There may be a few drops of blood as the area stretches but this is normal. In the unlikely event that bleeding continues, use gauze to apply pressure on the surgical site.
If a frenotomy was done under the upper the lip you may notice swelling on the upper lip on days 1-3. If this occurs it is within the range of normal. Let our office know if your baby is running a fever over 101 degrees or if the treatment site is very red and inflamed.