Your Appointment

This page covers what happens when you come in, and what happens afterwards. If you are still working out whether your baby has a tongue tie at all, start with what an assessment involves.

A consultation comes first

A consultation is required before any tongue or lip tie release. This appointment allows Dr Helen to complete a comprehensive assessment and determine whether treatment is recommended and appropriate.

Where a release is supported by your IBCLC, it can often be done at the same appointment. Where it is not, a second appointment may be needed, depending on what the consultation finds. We will not promise a release in advance, because the assessment is what decides it. If Dr Helen suggests waiting, that is not a refusal to help — it is usually because something else will help more first, and we will tell you what that is.

Working with an IBCLC

Input from an IBCLC — an International Board Certified Lactation Consultant — is critical to improved function after a release. The procedure removes a physical restriction. It does not, by itself, change how a baby has learned to feed.

A baby who has been feeding around a restriction has usually built a compensating pattern, and that pattern does not disappear when the restriction does. Re-learning is the work, and an IBCLC is the person who does that work with you. It matters most for babies who are older at the time of release, because the pattern is the more established.

Seeing an IBCLC beforehand is worth doing for its own sake, and it also matters practically: where a release is supported by your IBCLC, it can often be done at the same appointment rather than a second one. If you do not already have one, we can refer you, or you can find a local IBCLC through the Lactation Consultants of Australia and New Zealand directory.

Factors other than lip and tongue tie may contribute to feeding difficulties, and results cannot be guaranteed.

Before your appointment

Please complete the Patient Information Form at least 48 hours before your appointment. It takes about ten minutes and it is what Dr Helen reads before she meets you.

To help your visit run smoothly and comfortably, please:

Arrive on time.
Bring a comfortable swaddle or wrap to assist with feeding.
Bring any feeding aids you currently use (e.g. nipple shield, bottles).
Avoid feeding your baby for 2 hours prior to the appointment.
Bring your child’s Personal Health Record (Red Book) if you’d like the appointment documented (optional).
Consider freezing breastmilk in small portions to use for soothing after the procedure.
Bring another adult if siblings will be attending so they can be supervised.

What a release involves

Between 0 and 6 months, the primary purpose of a lingual or labial frenotomy is to aid breastfeeding and maternal discomfort, and in many instances to prevent future problems that may be associated with tethered lip or tongue tissues.

Lingual frenotomy is a minor surgical procedure that involves clipping the band of tissue that holds the midline of the underside of the tongue. When this band is too tight or too short, normal tongue movement is restricted. The treatment may:

Allow the tongue to move in a greater range of motion
Improve breastfeeding comfort
Improve breastfeeding efficiency
Reduce the future of speech difficulties

Labial frenotomy frees the lip attachment from the gums. When this attachment is too tight or too short, proper lip movement and flexibility is restricted. The treatment may:

Allow adequate lip flair to improve nursing effectiveness
Reduce the pockets on either side of the frenum to prevent food trapping
Give the upper lip more freedom of movement for speech sounds

There is always a possibility that an additional revision may be required when your child is older.

Afterwards

You are welcome to stay and feed here afterwards, for as long as you need.

Settling and feeding

About half of all babies will settle quickly and feed normally after the procedure, showing little or no side effects. As with vaccinations, some may be a bit clingy, grumpy, or unhappy for a day or two. Reluctance to feed is often reported in the first hours, but most will feed normally within 24 to 36 hours.

Most babies will show an improvement in breastfeeding immediately. However, it is normal that the baby needs to re-learn breastfeeding, and the mum may also need to learn new techniques of feeding. Typically, the older the baby is when the tie is released, the more established incorrect feeding techniques are, and the longer it takes for the baby to re-learn feeding.

Rarely, a baby may be unhappy or upset, and slow to feed for several days. Usually, gradual improvement in feeding will occur over 5 to 10 days. Feeding with a syringe or bottle for up to one week has been reported. If in doubt, it is best to consult your lactation consultant or child health nurse for support. It is important that fluid and nutrient intake is maintained. If you are concerned that your baby is becoming dehydrated, consult your GP, or 13 HEALTH (13 43 25 84).

It is strongly advisable to seek advice and follow-up from your lactation consultant or child health nurse after the tongue or lip tie release. While newborns may start latching properly almost right away, for babies that have already established incorrect feeding techniques a release is not a quick fix, but just one step in the process. It is also important to understand that not all breastfeeding problems are caused by tongue or lip tie, and there might be other reasons as well that require attention after the tie has been released.

Pain relief

Have plenty of skin to skin contact with your baby. This will calm and reassure the baby and helps with any clinginess and grumpiness. You can even take a warm bath with baby and try latching your baby whilst in the bath. Baby wearing is also a great way to keep the baby close to you while staying mobile.

If your baby appears to be in pain, you can tuck some frozen breastmilk chips under the tongue or lip where it can slowly melt. You may also consider giving paracetamol (always check the label for correct use, the dosage should be based on your baby’s weight, not age).

Exercises

The best exercise for the tongue is breastfeeding. For breastfeeding babies under the age of 3 months, sucking issues related to tongue tie often resolve after the tongue tie is released, with no other intervention needed. Babies with a disorganised or weak sucking pattern may benefit from the below exercises. Always remember to wash your hands prior to starting the exercises.

To get baby to open their mouth, run your finger gently from the nose down to the mouth.
Pop your finger in baby’s mouth and push gently down on the tongue for a few seconds, and release. Repeat 4 or 5 times.
Keeping your finger inside the mouth, slowly play a tug of war with your baby, by slowly pulling your finger out and let them try suck it back in. Repeat for about 30 seconds.
Slowly run your finger along the lower gum line from side to side, and your baby’s tongue will start to follow. This helps strengthen the sideways, or lateral, movements of the tongue.
Run a finger from one side of the upper gum line, across the palate, and back again to encourage baby’s tongue to follow your fingertip.

Stretches

The benefit of stretches after tongue and lip tie releases is unproven, and opinions differ on the issue. There is no scientific evidence that stretches prevent reattachment. The theory is that it can help prevent scar tissue contracting and restricting the tongue or lip again.

Wounds being repeatedly stretched open, to the point of bleeding, causes the baby pain and distress. This can result in a baby becoming so averse to having anything in or near the mouth, that they refuse to nurse or eat, or become upset any time a finger, breast, or bottle approaches the mouth. With this in mind, it is advised to avoid aggressive stretching or upsetting your baby. Keep it light, calm and soothing. If your baby is upset, don’t force the issue.

If you choose to do stretches, below are a couple of simple examples. These are easiest to do with baby’s head in your lap, and feet pointing away from you. Wash your hands well prior to starting these stretches, and ensure your nails are short. 2-3 times a day for 2-3 weeks is enough. Some babies will associate the stretches with nursing/feeding, so if possible, try to avoid stretches immediately before nursing/feeding. Instead, after performing the stretches, make funny faces, blow raspberries, anything that makes your baby giggle and change their emotions quickly.

For lip tie release: Using a straight index finger, sweep the lip up to the nose, then gently sweep from side to side for 1-2 seconds.
For tongue tie release: Pop both index fingers under the tongue on either side, behind the wound, and lift up, and hold for 1-2 seconds. Being too far forward will only lift the tip of the tongue.

If you feel your baby is in pain, place the breastmilk chips under the tongue or lip to help soothe the areas.

Possible complications

Bleeding. Bleeding is usually minimal immediately after the tongue tie release. The action of sucking will put pressure on the wound, and is the most comfortable and effective method to stop the bleeding. When baby refuses to feed or is unable to latch, bleeding may persist a bit longer. Allowing baby to suck on a clean finger can help to stop bleeding in a few minutes.

There may be some dark streaks in your baby’s nappy in the 24 hours after the procedure. This is from the small amount of blood that your baby may have swallowed during the procedure, and is expected. If blood persists in your baby’s nappy, or if you are concerned, contact your General Practitioner.

Ulceration. The wound can often turn white and form a patch that resembles a mouth ulcer. This is part of normal wound healing, and usually occurs within 48 hours and disappears within one to two weeks.

Infection. Infection is extremely rare. However, it is prudent to ensure anything entering your baby’s mouth is sterilised or clean for about a week after the procedure. This includes dummies, pacifiers, bottle teats, and fingers.

Recurrence. About 5% to 10% of babies experience some level of recurrence. There are multiple theories on the sources of recurrence, ranging from incomplete division, edges healing together, scarring, or revealing of deeper fibres after the release. Reducing the risk of recurrence is therefore highly controversial, as well as very emotive. Multiple procedures are never ideal for the baby. There is no consensus, nor any published data that supports any type of wound management. Due to lack of scientific evidence for or against stretches, as well as the risk of oral aversion, only gentle exercising of the tongue is advised.

If you are worried about your baby at any point afterwards, ring us on 3398 5886 rather than waiting for your next appointment.

Fees

We will give you the fee for a consultation, and for a release, when you book — and again in your confirmation email, so you have it in writing before you come.

The consultation and any release are charged separately, whether they happen at the one appointment or at two.

Payment is required on the day of the appointment. An itemised receipt will be provided so you can claim.

If you are claiming with a private health fund, rebates vary between funds and individual policies. Ring us on 3398 5886 and we will give you the item numbers, so you can check with your own fund before you come.