What is a frenotomy?

A frenotomy or frenectomy is a procedure used to correct a congenital condition in which the lingual (tongue) or labial (upper lip) frenulum is too tight, causing restrictions in movement that can cause significant difficulty with breastfeeding, and in some instances, other health problems like dental decay or spacing, speech difficulties and digestive issues. When it affects the lingual frenulum, this condition is commonly called a tongue tie (the medical term is ankyloglossia).  Approximately 5% of the population has this condition, so your lactation consultant or doctor may feel that a procedure is warranted to improve symptoms.

 

How to prepare for the procedure

The best way to prepare for the procedure is to have the medications that you will need on hand so you can focus on your child following the procedure.

Tylenol - You do not need to give any medication prior to the procedure. Dosage: Using the dropper in the manufacturer's packaging. This can be given every 6-8 hours after the procedure. The concentration of Tylenol should be the 160mg/5mL dosage. Some places may sell a concentrated form at 80mg/0.8mL - this is not the one I want you to use.

  • 6-11 pounds - 1.25mL
  • 12-17 pounds - 2.5mL
  • 18-23 pounds - 3.75mL 
  • 24-35 pounds - 5mL

For children 6 months of age or older, you may use ibuprofen instead (or with Tylenol). Please follow the dosing instructions on the package.

You may use whatever works for your family. This includes homeopathic remedies like arnica or Rescue Remedy, or nothing at all. Because numbing medicine is used during the procedure, and because the laser itself has some analgesic properties, not everyone needs a medication beforehand. 

 

SUCKING EXERCISES

It's important to remember that you need to show your child that not everything that you are going to do to the mouth is associated with pain. Additionally, babies can have disorganized or weak sucking patterns that can benefit from exercises. Starting these exercises from the moment you make your appointment can speed up your recovery after the procedure. The following exercises are simple and can be done to improve suck quality. Aim for 4x/day leading up to the day of your procedure.

  1. Slowly rub the lower gumline from side to side and your baby's tongue will follow your finger. This will help strengthen the lateral movements of the tongue.
  2. Let your child suck on your finger and do a tug-of-war, slowly trying to pull your finger out while they try to suck it back in. This strengthens the tongue itself. This can also be done with a pacifier.
  3. Let your child suck your finger and apply gentle pressure to the palate, and then roll your finger over and gently press down on the tongue and stroke the middle of the tongue. Alternatively, once the baby starts to suck on your finger, just press down with the back of your nail into the tongue. This usually interrupts the sucking motion while the baby pushes back against you.
  4. With one index finger inside the baby's cheek, use your thumb outside the cheek to massage the cheeks on either side to help lessen the tension.