Shira Johnson, IBCLC
Getting a tongue tie release? How to prepare...
Preparation and Aftercare for Frenectomy
Shira Johnson, IBCLC Shira Johnson Lactation LLC
Frenectomy or frenotomy refers to the minor surgical procedure to release restricted/tethered frenula (connective tissues) in the mouth, commonly referred to as tongue tie, lip tie, and/or cheek (buccal) ties.
This procedure is often done with a laser, but can be done with scissors or scalpel.
Ties (also known as oral restrictions or tethered oral tissue) restrict or limit the mobility and range of motion of the tongue and other parts of the mouth, commonly resulting in feeding difficulty, pain/discomfort (for baby and/or nursing parent).
Ties can be hard for many providers to recognize, and are very frequently underdiagnosed or misdiagnosed.
HOW to prepare for a frenectomy?
Preparation includes oral exercises and bodywork, and can take anywhere from a few days to several weeks, depending on baby’s mouth, body and temperament.
Good frenectomy prep includes:
1) ORAL EXERCISES – Taught by a specially trained IBCLC lactation consultant, SLP or
other provider who specializes in infant oral function (not all IBCLC or SLPs do!)
The amount of time/work necessary varies for each baby, depending on their anatomy & oral function prior to release.
These exercises help teach the mouth a new way of moving:
a. Increases coordination of various tongue/mouth movements
b. Strengthens weak or underdeveloped muscles
c. Supports “neuromuscular retraining” - a fancy term to describe the activation & interaction of muscles and nerves, “turning on” muscles & nerves that may not have been utilized much yet (due to physical restriction or tension). Touch and movement stimulates formation of new neural pathways, and encourages learning for new (more functional) patterns of movement
d. Baby has the benefit of getting familiar with, & developing positive associations with, doing oral exercises, having parents’ hands in their mouth. If they’re familiar and comfortable with this BEFORE having the procedure, they are less likely to associate the aftercare with a traumatic experience or soreness in their mouth
e. Helps prevent reattachment of ties! The more MOVEMENT we can achieve in the mouth prior to release, the less likely it is for ties to reform or reattach. After frenectomy, a new frenulum will grow in its place. It will grow into the space that it has, which is greater with more exercises and movement. The goal is for the new frenulum to be longer and/or more stretchy than the restricted one!
2) BODYWORK – i.e. Craniosacral therapy, chiropractic, PT, osteopathy, etc.
A skilled pediatric bodyworker can work gently with baby’s body to:
a. Release tension caused by the physical ties (fascia in the body is connected from tongue to toes! A tongue tie can cause fascial tension elsewhere in the body)
b. Help unwind dysfunctional habits caused by the physical restrictions themselves, and by baby working to compensate for those restrictions (e.g. if a baby’s tongue struggles to move well, they may compensate with jaw, lips, shoulders, etc.)
c. (This is an important one!) Bodywork can help to calm and regulate baby’s nervous system. This actually matters a lot, because being in a calm state is better for learning new skills (mouth movements), and generally results in a smoother recovery, as opposed to a baby who tends to be in more in a high-alert “fight/flight” state who may be very upset by having a procedure or pain. Going into a medical procedure can be scary and uncomfortable, for adults and babies alike. Having a calmer nervous system going in can result in a better overall experience, and is less likely to trigger a trauma response from baby! Starting the frenectomy journey with a calmer nervous system can minimize or eliminate certain challenges
** IN ADDITION TO PROFESSIONAL BODYWORK, doing body exercises/movement at home can also be very supportive of optimizing oral function:
o TummyTime Method
o Rhythmic Movements -also including bouncing, rocking, etc. (can also help calm nervous system and minimize pain)
o Minimal use of baby “containers” i.e. car seats, swings, etc.
WHY do we need to prepare for a frenectomy anyway?
How important is it?
WHAT exactly are we preparing??
o Babies who have done some good preparation before their release procedure tend to have better outcomes, as far as faster improvement and less upset after the procedure
o In my experience as an IBCLC, having worked with hundreds of tongue-tied babies before and after frenectomy, I have observed that babies who do good preparation prior to release are generally less upset by the procedure, and improve much more quickly afterwards
o When we rush into releasing ties without preparing, we run the risk of baby not having adequate coordination or strength to move their tongue well with its new wider range of motion
o Preparation generally helps babies to not be so upset/triggered by the procedure itself, or by the temporary soreness with recovery
o Good prep significantly reduces the risk of feeding or oral aversion after release! Aversion is rare, but it is a concern that some parents & providers have. Good preparation practically eliminates this concern.
> Some babies need more preparation than others:
o Babies whose tongues are strong and moving a lot might need less prep than a baby who has low oral muscle tone or whose tongue isn’t moving much.
o Babies who tend to be very easygoing, calm, & easily-soothed generally need less prep time than babies who are a little more high-strung, fussy, on the more “high-needs” end of the spectrum of baby temperaments. Fussier babies (babies with “colic” symptoms, for example), typically benefit from a bit more prep time.
o Additionally, babies with more physical or structural issues (e.g. traumatic birth, muscle tension, torticollis, skull asymmetry/misshaping, etc.) typically benefit from a bit more prep time. Frenectomy procedures/outcomes are typically more successful when baby’s body is less tense and more symmetrical.