Making a list. Checking it twice.
A frenotomy/frenectomy (tongue tie release) is a fairly simple surgery as far as surgeries go. But it is more than just a tiny snip.
The practitioner could have a variety of scholarly degrees. They might be a pediatrician, a dentist, or an otolaryngologist (Ear, Nose, Throat doctor). They could even be a certified nurse midwife or other specialized nurse practitioner. (This is not an all inclusive list).
It doesn’t really matter what degree they hold as long as the procedure is within their scope AND they understand the impact that any tethered oral tissue (TOTs) has on a person. The second part is key.
The List
So why is my list microscopic? I will only recommend someone who understands ties. There are 2 providers in my area that I know understand the implications of a tongue tie. They understand why a full release with a diamond shaped wound is important. They give instructions to help avoid reattachment. They understand that the act of breastfeeding is important and that “just switch to bottle feeding” is not a good answer to resolve breastfeeding problems.
Latching to the breast optimizes the shape and muscle development of the mouth, the face, the head. With optimal shape and a fully mobile tongue babies can flourish. They can breastfeed efficiently. They can use both sides of their body equally well. They can swallow food without choking. They can sleep deeply (with a closed mouth) and wake up well rested. They can breathe through their nose. They can crawl on all fours evenly. They can have better fine motor skills. The list goes on.
If a family chooses to hold off on the procedure, these doctors will cheer them on AND make sure they understand what to watch for in the future. For some babies, a lingual frenulum will go to the tip of their tongue and breastfeeding is progressing beautifully. Well, no reason for a frenotomy due to feeding complications. Perhaps mom has an oversupply and no nipple pain. Great! But it would be nice to know what to look for in the future if something pops up. Healthcare practitioners should always give you the “reasons to return” list…after any visit.
How to find a practitioner
It can be tricky to find someone in your area who is well-known for their frenotomies. Some questions to ask when you are trying to find a “TOTs savvy” provider:
Do you release a posterior tie? What does the wound look like after the procedure?
This shows you who the knowledgeable providers (and their staff) are. If a practitioner scoffs that a posterior tie isn’t a real thing, run away.
If there is no wound after the procedure, move on to the next provider. A complete release of a tie is typically a diamond shape wound. It is generally recommended to provide some sort of active wound management, often called “massage”, under the tongue.
Do I need to see any other healthcare providers before the procedure?
Yes. The answer should be yes.
An IBCLC for a breastfeeding baby. An IBCLC, SLP or OT for a bottle feeding baby. (yes, IBCLCs help with bottle feeding too!)
A body worker.
Why? Body work before a procedure can relax tight muscles and fascia, specifically under the tongue.
Relaxed muscles allow restrictive tissue to be visualized better, thus improving the outcome of the surgery.
You should also be working with these people after a frenotomy. The frenotomy itself is only part of the process.
Do you use numbing medicine?
The intensity of pain a baby feels with a frenotomy depends on the type of tool used for the procedure. Babies are sentient beings. Numbing medicine can be used safely for a painless procedure if needed for the type of equipment used.
General anesthesia is not required for a child requiring only a frenotomy (though it’s obviously a great option if you’re having tonsils/adenoids out in addition to a frenotomy)
Do you require follow up? When?
A surgeon who does not require follow up of some kind has no idea if their procedures are effective or not.
Follow up appointments allow the provider to assess their work and parents to ask questions (write your questions down!) about post-procedure care.
What sort of exercises and therapists do you recommend I work with?
If the answer is “none” or “no one” think twice before letting them operate on your child.
Success of the procedure requires some sort of oral therapy in addition to surgery.
International Board Certified Lactation Consultant, occupational therapist, speech language pathologist (preferably an SLP-COM (certified orofacial myologist)). These are appropriate feeding specialties to work with.
Body work: craniosacral therapy, chiropractic, osteopathy, massage (just a few examples)
I’m also more than happy to help you find a TOTs savvy practitioner in your area. Feel free to email me! If you’d like more information about tongue ties (or manual therapies) visit my links page. This is where I keep my recommendations for baby stuff.
ETA: Body work is a controversial topic between the pediatric community and lactation consultants. I have seen it work well for many babies but not all parents choose this therapy. That’s ok! It is a recommendation, not a requirement. If you have questions or concerns about the various forms of body work, I suggest locating someone near you and asking for a chat. Meet the practitioner. Ask lots of questions. Mull it over before making a decision either way. Choose what works for your family based on information gathering and research rather than on fear.
updated 2/17/2020