Will Tongue Tie Release Fix All Breastfeeding Challenges ?

One of the most complex questions and, honestly, a dilemma, is when a parent asks me if they “should” have  their infant’s tongue or lip tie released, a procedure known as frenotomy.

They want to know if it will be worth it, if it will solve their problems, and if it is really going to make a difference for their infant. These are great and necessary questions. Sometimes I wish I had my crystal ball to see into the future for these families and tell them for sure, but this isn't always predictable, and it certainly may not be a quick fix. 

Over the years, I have honed my skills at discerning which infants will benefit the most. In this article I will four questions to to consider before releasing tongue and lip tie. 

1. Are you sure there is a tongue tie or lip tie? 

Now, this may seem obvious, but in practice, it's not. Every baby has frenum. But not every frenum is restricted. A visit to a pediatric dentist, or other provider who can perform the surgery to release the frenum is not typically the best evaluation for knowing if there is a tongue or lip tie. Of course there are exceptions, but most medical providers are not performing a functional evaluation of  breastfeeding. The IBCLC is usually the best professional  to determine if there is a restriction that is causing problems with the movements that affect breastfeeding. An SLP is helpful for babies with complex feeding challenges, or are bottle fed. 

2. Is there anything else going on that may be preventing breastfeeding success? 

I could write a book about breastfeeding challenges, and perhaps some day I will. For now, I'll share a few  that need to be considered: Low milk supply, parent depression or exhaustion, maternal anatomy, infant anatomy beyond the mouth, recovering from c-section or difficult labor, traumatic birth, separation of mother and baby, such as a NICU admission or maternal health concern, need for supplemental bottles. Other challenges include lack of experience or support in understanding how to breastfeed which can include how to hold a baby for best latch, how often to feed a baby, and how to recognize feeding cues

Any of these complex situations can interfere with the initiation and continuation of breastfeeding and if possible, should be addressed before considering frenotomy. 

3. Are the parents prepared for frenotomy?

Preparation is key for success. This includes knowing what the procedure will be like, practicing exercises and stretches before the procedure, having a plan in place for pain management if infant seems uncomfortable, and having a written care plan for the night of the frenotomy, and the days and weeks following. This is not something to do and then ask, "now what?" Or to have done when you have no time to devote to the aftercare. The aftercare - stretches and exercises - in many cases - are just as important as the procedure itself.  

4. Is the infant being treated with a team approach?

No, this isn’t baseball, my favorite sport, but this is a medical procedure that requires a holistic assessment and recovery plan. Who is on the  team? My "A" team, my ideal recommendation for breastfeeding infants is an IBCLC, possibly an SLP, a bodyworker, a provider for frenotomy, and then rinse and repeat until you are on your way to reaching your goals. Of course, the front line team members for assessment are Nurses, Midwives, Doulas, Doctors, PAs, etc.

Some Quick definitions: Who are bodyworkers? chiropractors, Osteopaths, Physical Therapists, Occupational Therapists, massage therapists, CST providers, etc.  Who are the medical providers for frenotomy? That may depend on your location, but most often it’s a pediatric dentist. If you'd like information on the team approach, check out Season 1 Episode 2 of the Tongue Tie Experts Podcast. It's all about the team approach to tongue tie treatment. 

No one wants an unnecessary procedure

Whether you are a parent, deciding for your own baby, or a tongue tie team member guiding the decision for fenotomy with the families who come to you for guidance, I hope that this information has provided help and insight. 

Frenotomy is not a procedure to rush into. We all want the most successful outcomes for our own babies and for the patients in our care. 

For professionals interested in learning the protocols that insure your patients will be prepared for frenotomy, check out the Professional’s Guide to Tongue Tie in the Breastfeeding Infant. It’s all included there, including handouts for your patients. The course provides 4 L-cerps and membership in a community for continued support, learning and networking.