TONGUE TIE PROCEDURE
What does the procedure involve?
A frenotomy or a tongue tie release is a procedure whereby this thin membrane is snipped to release the tongue to improve the problems associated with tongue tie. This is a simple procedure which takes only a few seconds. This can be done with scissors or laser. This procedure is performed by Dr Quigley by scissors release. Occasionally if the membrane is very tight or thick ( with a risk of bleeding) she will recommend that it is released by laser and will provide details of where this can be performed.
Dr Quigley will discuss the feeding issues with the parents before examining the baby. If the baby has a tongue tie and will benefit from release, Dr Quigley will explain in detail the risks and benefits of the procedure. The baby is given either topical sucrose +- local anaesthetic before being swaddled. The membrane is then snipped with scissors and the baby is returned immediately to mum for a feed. The baby will cry for a few seconds but usually settle very quickly when fed.
Mothers attending with babies are encouraged to breast feed after the procedure as a source of comfort for the baby. Improvements with latching can also be assessed at this stage, and any questions/issues can be discussed. If the baby is bottle fed, a bottle feed is given to the baby. This also helps with any bleeding that might occur. It is better if the baby is slightly hungry ( or due a feed) before the procedure, this is to ensure they feed afterwards.
If the baby is over 8 weeks old, it is advised to give Calpol 2.5ml 30mins prior to the procedure to help with pain relief.
Risks with this procedure:
- Crying- usually a few seconds
- Bleeding- usually a few drops to approximately a teaspoonful.
- Infection- 1/10,000
- Reattachment (when the membrane grows back)
- Local nerve damage/Salivary gland damage
Tongue Tie Aftercare
Your baby may be out of sorts on the day of the procedure. Regular feeds, skin to skin with mum and paracetamol can be of benefit. The doctor will advise you of correct dose based on the baby’s weight.
The risk that the tongue tie may grow back or ‘reattach’ is approximately 4% from limited research studies. The signs that this may be happening are an initial improvement then followed by a return of symptoms usually after a 2-3-week period. Recent research suggests that there is no evidence for deep massage of the wound to prevent reattachment. This involves massaging under the baby’s tongue with a finger and stretching the wound. Many parents find this upsetting and difficult to perform and it is not tolerated by babies. If a baby tolerates a gentle massage under the tongue this can be performed to try and slightly reduce the risk of reattachment, but the risk reduction is very small. If you feel the tongue tie has reattached, the baby can be reassessed and a decision to re release the tongue tie again can be made after careful consideration.
Some mothers notice an immediate improvement in their symptoms, while in others it can take longer to notice. It is important to follow up with an IBCLC (lactation consultant) or local breastfeeding support group. While the tongue tie may be taken care of, it is still so important to pay close attention to latch and positioning, and an IBCLC can help with this.