The procedure for tongue tie revision (frenotomy) is relatively quick, and it can significantly help your baby develop and grow because it makes it easier to breastfeed, and to speak. Here’s what to expect from the procedure.
Preparing for Tongue Tie Revision
It’s not necessary to do anything to prepare for the procedure. We will use numbing medication during the procedure, and the use of a laser means that there is actually very little discomfort anyway. But if you do want to give your child some acetaminophen (Tylenol) about 30-60 minutes before the procedure, that can help. Follow the dosage on the packaging, using the dropper or syringe that came with the medication. Typical dosing for acetaminophen with 160 mg per 5 mL, a common concentration, is:
- 6-11 lbs 1.25 mL
- 12-17 lbs 2.5 mL
- 18-23 lbs 3.75 mL
- 24-35 lbs 5 mL
For children over the age of six months, ibuprofen is also an option. Consult with your pediatrician and check the dosing on the label. You can also talk to your pediatrician about other methods to reduce discomfort.
At Our Office
The actual procedure is very easy on your child, and we work hard to make it as easy as possible. We have done this many times, and we know the ways to ensure minimum discomfort and stress. For this procedure, general anesthesia is not necessary, and because it has risks, we won’t use it. Instead, we will use topical numbing cream. This works very quickly. For older and larger children (typically over 12 months), we may supplement with an injection of anesthesia to ensure the entire area is adequately numbed (topical cream may only work on the surface).
For safety reasons, we are not allowed to have you in the treatment room. We will carry your baby to and from the treatment room. Your baby will be away from you for just about three minutes, of which the actual laser treatment takes half a minute or less.
Crying and fussing are common during and after the procedure. You can soothe your baby in any manner that works, including breastfeeding or bottlefeeding in our office. We won’t rush you out–you can stay until both you and your baby have recovered and feel comfortable leaving. We will be happy to answer any further questions you may have at this time.
Tongue tie revision has a very good success rate, but an important part of success is how you handle recovery. First, watch for complications, and contact us if you notice uncontrolled bleeding, your baby fails to nurse or take a bottle, or there’s a fever of 101.5° F or greater.
Oral wounds tend to contract as they heal, and there will be a tendency for the two sides of the wound to want to heal together. To ensure the healing we want, it’s important to perform stretches of the treated area.
Your baby will likely experience discomfort during stretches. You can use acetaminophen or ibuprofen as above, but we recommend a non-numbing teething gel, which will help your baby feel comfortable during stretches. Apply the gel to your finger before performing the stretches.
Stretches should be performed four times a day for the first three weeks, then taper off during the fourth week.
Wash your hands well before stretches. You don’t have to wear gloves, though it may be advisable if you have sharp nails.
Upper Lip Stretches: Begin with the upper lip, if treated. Insert your finger under the upper lip, pushing upward until you encounter resistance. Sweep side to side for several seconds to keep the two parts separated so that they won’t reattach.
Tongue Stretches: Tongue stretches are more complicated, though they’re easier if your baby has started to cry in response to the upper lip stretches. Put both index fingers into your baby’s mouth. It’s easiest to insert one index finger first, using it to stretch the cheek, allowing for the second one. Put both index fingers under the tongue and lift it upward. Hold it as high as it will go for about 1-2 seconds. Do this twice.
Next, prop the tongue up with one finger and use the other finger to massage the area where the tongue meets the bottom of the mouth using a circular motion for several seconds.
Finally, turn your finger sideways and run the side of your finger along the entire length of the treated area, starting under the front of the tongue, moving backward toward the point where the tongue and floor of the mouth meet, then coming forward along the floor of the mouth. Do this twice in the treated area, then perform a similar motion on the floor of the mouth on either side of the treated area.
Sucking exercises help your child develop a good sucking response. They also help encourage positive associations with you that counteract the some of the negative sensations associated with stretching.
Start by rubbing your baby’s lower gumline from side to side. Your child’s tongue will naturally follow, and will develop stronger side-to-side motions.
Next, let your child suck your finger into their mouth. Then slowly pull your finger back out against the force of suction. Let them pull it back in and then pull it out several times before letting your child suck on your finger while you apply gentle pressure to the palate. After a short while, turn your finger around and gently press down on the tongue and massage it.
A follow-up with your lactation consultant can also help ensure your baby is able to nurse comfortably.