Tongue Tie FAQ

A frenulum (plural: frenula) is a piece of soft tissue that anchors one part of the body to another. Midline frenula develop beneath the tongue and the lips during the first trimester as the face begins to take shape, tethering the tongue to the floor of the mouth and the lips to the gums.

A sophisticated look at the interface between baby’s mouth and mother’s breast may determine that the tongue and lips are anchored in a manner that interferes with breastfeeding. When someone who is knowledgable and experienced makes this diagnosis, frenectomy is likely to be helpful. There are no negative long-term effects from releasing the lingual or labial frenulum. 

Your Pediatrician is an invaluable resource, and will be advocating for your child long after you’re done nursing, but most Pediatricians simply aren’t trained to identify tongue-tie. If you don’t know the criteria for diagnosis, you also can’t rule it out. On the other hand, Lactation Consultants are specifically trained to identify numerous breastfeeding problems, including tongue-tie.

Having done several hundred releases with scissors, I can do an accurate release very quickly—in seconds rather than minutes—and parents are able to stay in the room from start to finish. An added bonus is that because we have lower overhead, we can afford to accept payment from your insurance.

Absolutely. We use lidocaine (similar to Novocaine®), just like the dentist. It stings for a few seconds, and then your baby rests comfortably in your arms until the local anesthesia has fully set in. 

Certainly. I’ll take a thorough history and do a detailed exam, so I can counsel you, offer insight, and answer your questions. I strive to be open and honest about potential benefits, potential risks, and unknowns, using relatable terms that you can understand. If need be, you can usually schedule the procedure one or two days later.

For frenectomy, you can expect to spend about two hours in the office. 

After check-in and vitals, I’ll do a lap exam and a digital suck exam, and I'll observing the latch to confirm the procedure is needed. Then I’ll counsel you and answer questions before the actual release. 

First, we inject a numbing agent beneath the tongue and/or lip. This takes about 30 seconds. Then you’ll hold your baby for half an hour while the numbing takes full effect. The actual release takes about a minute. You’re welcome to stay in the room with us from start to finish, or you may step out at any time. 

Absolutely. We don’t need an empty stomach in order to do this procedure safely and well, and a baby who is satiated will be much more calm and is more likely to nurse well after the release. Don’t intentionally overfill the stomach, but the last thing we want during the procedure is a ravenously hungry baby. 

Please feed your baby right after the procedure. Once you’re done feeding you’re free to check-out, but if you have any questions, we’ll be happy to come and talk to you.  Be sure to take our post-frenectomy handout, which tells you things to look out for and how much Tylenol to give;  reviews how to contact us after-hours; and reminds you to start the stretches after your first feeding at home. 

Actually, they’re really easy to perform, they only take a few seconds, and, most babies don’t seem to mind them. We recommend doing these simple stretches after you feed, six times a day, for one month. We’ll show you how to do them in the office, but the basic idea is to lift the tongue from the floor of the mouth and to retract the upper lip away from the gums.

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(I love this question, because when I show parents how simple the stretches are, they're almost always pleasantly surprised. -KJR)

The most challenging side effect is that lips and tongues heal incredibly quickly, and if you don’t reinforce the new range of movement, the tissue will reconnect in a matter of days and you’ll be back where you started. The stretches you’ll do at home (see above) are as important as the release itself. We almost never encounter infections or bleeding.

Some babies need Tylenol for a day or two, but many babies don’t seem to experience any pain. When they’re fed they’re happy, and when they’re hungry they cry as if they’re in pain—just like they did before the procedure.

We definitely want your baby to take in calories as soon as we’re done. About half of babies will nurse well, right after the release—impressive, considering they have new anatomy and they’re still numb.  About half will need a bottle. 

We recommend that moms schedule an appointment with their Lactation Consultant a day or two after the release.  

Some babies with an especially tight frenulum won’t be able hold the tongue against the upper front teeth and they will have trouble pronouncing certain letters (classically L, S, and T). However, many of them won’t have an issue, and the “looser” frenula that don’t end right at the tip of the tongue almost never have a problem.  Generally speaking,  breast-feeding is the main reason you might want to release an infant’s tongue-tie; articulation issues later in life are not. 

For the procedure, you'll need the following

• Blanket for swaddling

• Diapers

• A change of clothes for the baby

• If your baby is taking bottles:

  • Enough formula or expressed breastmilk to last 3 hours. 

  • Bottle, nipples.

• If you’re pumping: A breast pump