Benefits of treatment
Not all tongue-ties require treatment, however if it is affecting feeding then treatment earlier rather than later is recommended.
By releasing the frenulum, it has been shown to:
- Decrease nipple pain
- Improve babies latch
- Enable baby to transfer milk more effectively
- Improve weight gain, sleep patterns
- Enable babies to be more settled, less windy
- Lower the occurrence of blocked ducts and mastitis
- Improve overall feelings about breastfeeding
Infants with ankyloglossia, (tongue-tie), mainly experience breastfeeding difficulties, including poor latching, irritability while breastfeeding, and failure to thrive.
However, older children and adults with ankyloglossia may experience mechanical limitations, like difficulty eating ice cream, licking their lips, and kissing. Restricted tongue mobility may complicate the pronunciation of certain letters; however, the link between ankyloglossia and speech disorders remains controversial. Furthermore, the role of tongue-tie in mandibular development, malocclusion, and gingival recession is still unclear.
Risks of treatment
Complications of frenotomy are rare and it is a low risk procedure. Parents should still be aware of the following risks:
Bleeding: Posterior Tongue ties are expected to bleed more than anterior ties as the incision is made deeper into the tissue layers which contain more blood vessels. Vitamin K administration is essential for baby prior to the procedure and you should inform the treatment provider of any blood clotting disorders in the family. Immediately after the procedure you may notice some blood on your nipple after feeding and again after the first few stretching exercises. This is normal.
Pain/swelling: Most babies do not require analgesia to cope with this treatment, however, some may require paracetamol in the first day following treatment. Breastfeeding immediately and as often as wanted 24-48 hours after the procedure will provide very good pain relief for baby. In some cases Upper lip tie release can cause some swelling under the lip. This usually resolves within 48 hours.
Infection/Ulceration: With any surgical procedure there is always a risk of infection. Frequent breastfeeding decreases the risk of infection as breastmilk has antibacterial properties. It should be ensured that anything that goes into baby’s mouth in the first few weeks after treatment is sterile and that fingers used to perform the post care exercises are washed well with soap and water. Infection rates in Tairāwhiti are currently 0%
Damage to the tongue, gum or submandibular ducts: although extremely rare, this is a possibility.
The tongue re-joins or continues deeper: It is possible for scar tissue to form and for the tissue to heal back together again. This is why it is very important to follow through with the post care exercises and stretching to ensure the wound heals separately. If baby has an anterior tie it is possible that the restriction goes further back under the tongue, in both cases it may mean that further treatment may be required.
It has no effect or it takes time to notice changes in feeding: It is possible that the tie is not the sole cause of feeding issues and improvements are not seen despite a release. Baby may need time to re-learn how to suck/feed correctly as well as for the swelling to reduce and healing to complete. Your baby may need further suck training and other therapies.
Feeding aversion: In rare cases, mostly with laser treatment, babies have developed oral aversion. Refusal to feed from breast and/or bottle. This is very rare and has passed in all but one case. If this occurs try to feed baby via a spoon, offer the breast as much as possible with frequent skin to skin contact until baby returns to the breast.