The medical term for tongue tie is ankyloglossia. It’s a fancy word that describes a simple concept. Picture your baby with his or her mouth wide open, tongue curled back so you can see the bottom of the tongue. There’s a “cord” running down the center of the bottom of the tongue. That’s a ligament that attaches the tongue to the bottom of the mouth. It’s called a lingual frenum or frenulum. When the frenulum is too short and/or too thick, it “ties” the tongue to the floor of the mouth. This restricts tongue motion, impairs tongue mobility and can cause a host of functional and developmental problems for the tongue tied baby. A simple analogy is a baby being born with webbed fingers or toes– this child will have to learn to use their body differently to make up for the lack of normal function and may have lifelong repercussions.
Infants typically do not require any type of sedation for a frenectomy. Your baby will be swaddled, protective eyewear placed, and either one or two assistants will keep your baby safe and still. Keep in mind that the laser is very precise and controlled, and is very safe even on a crying infant.
For older babies and children, each situation is evaluated on a case by case depending on symptoms, urgency, physical and emotional well being of your child. For older children we may use a combination of laughing gas, a movie, and numbing.
As a general rule, for newborns less than 2 weeks old no anesthetic is used. We find that the procedure can be performed so quickly that the risks outweigh the benefits of numbing. For infants 2 weeks and older, we use a topical numbing cream that is custom formulated and safe for babies. We only use this for lip ties as placing numbing under the tongue causes difficulty nursing afterwards. For older babies and children we may use a combination of topical local anesthetic along with an injection, if needed.
The short answer is yes! During your appointment we will thoroughly discuss, demonstrate, and give written instructions on home care as we have found it is critical for the success of the frenectomy.
First and foremost, it is important to understand that every baby is different. On average, the younger the baby is, the less we see fussiness. For the average baby one can expect a couple days of fussiness or soreness. At first, feeding can be disorganized because of the tongue’s new range of motion. Until the soreness goes away and the tongue strengthens, this is normal and part of the rehabilitation process. Dr. Green works closely with lactation consultants, speech therapists, and myofunctional therapists to make sure we have all hands on deck in the care and rehabilitation of your baby.
There are no restrictions, and in fact, we recommend nursing/feeding right after! Nursing and skin to skin will help relax and soothe your baby. We have private rooms so you can take your time.
When there is a restriction in the normal range of motion of the tongue, it is often first identified in infancy during breastfeeding. Red flags ( link to signs and symptoms) are raised that something isn’t right. Sometimes babies are able to compensate extremely well or the mother may have an oversupply that masks inefficient nursing. Bottle feeding does not require the same mechanics and is generally easier for the baby, which may contribute to undiagnosed tongue ties at cause feeding or speech issues in older children. There are so many factors surrounding proper diagnosis ( link to team approach) which is why it is so very important to have a team approach and a comprehensive evaluation by a specialist such as an International Board Certified Lactation Consultant (IBCLC) or Speech language pathologist (SLP) prior to meeting with Dr. Green.