Associated Risks to the tongue tie procedure:
Any known risks will be explained on the day of assessment, and although this is not an exhaustive list; it will be disclosed to enable the parent to make an informed decision. These include:
Most babies do not show signs of pain following the tongue tie division procedure. A few may be 'miserable' for a few days. On rare occasions your baby may particularly unsettled and possibly not feed. Pain relief can be prescribed if this is the case, and in those over 8 weeks old paracetamol may be considered. Whilst this is stressful for you and baby at the time it shouldn't last too long and is considered temporary. For those babies, it may take up to 48 hours for your baby to settle, you are encouraged to contact me, monitor nappy output/signs of dehydration, and if breastfeeding: protect your supply through expressing. At your division appointment you will be given an 'aftercare' sheet, some calming measures for you to try are listed there. Most babies have no issues with pain following the frenulotomy but from experience a few do, but some babies do sleep through the procedure and your infant's response unfortunately can not be predicted.
Other Oral Structures
There is an associated risk that within the vacinity of the mouth I may divide something other than frenulum. Rest assured, I have not done this before, but as the scissors are blunt-ended and curved, they do not have the capacity to do anything sinister-and treatment would be controlling any blood loss.
Research indicates that one baby in a thousand babies will bleed for longer than expected. The bleeding normally settles with wound compression with no further treatment required or long term effects on your baby. Excess and or prolonged bleeding is rare (1:400), and your practitioner is skilled and equipped for such events. Please remain calm and allow your practitioner to contribute to stemming the blood loss. If there is excessive blood loss I may use compression or a specialist dressings to stem it. The Current bleeding guidance will be adhered to as per the Association of Tongue Tie Practitioners guidelines, and can be accessed here:
There have been reported cases of bleeding which has occurred some time after tongue tie division, usually on the same day when the baby has returned home. If this occurs, the bleeding is usually very light and is triggered by strenuous crying (resulting in the tongue lifting and disturbing the wound) or when the wound is disturbed during feeding, particularly if caught by a bottle teat, dummy, or the tip of a nipple shield (1:300).
At the end of your appointment, I talk you through what to do in this event and I provide you with the Association of Tongue Tie Practitioners 'Aftercare after frenulotomy' sheet, who have worked closely with a surgical Neonatal Consultant to provide guidance for further bleeding. I recommend these are kept with your child at all times until the wound is completely healed (approximately 2 weeks).
Of 10,000 babies who were followed up post procedure by a local practitioner; only one had an infection that needed treating with antibiotics, and continued to breastfeed through this experience. Infection is associated with a fever/high temperature with a wound that is not healing ; if you feel that the wound is infected, please see your GP to consider oral antibiotics and review. I am happy to review the wound/view any pictures you can send me as occasionally infection is assumed when it is not. However, I can not diagnose a wound infection based on a picture.
Nursing Strike/ Feeding Aversion
Occasionally, post procedure, a baby may refuse to feed. I believe this may be because the wound site itself is inflamed (inflammation is 1 of 4 stages of the wound healing process) and maybe uncomfortable. If this happens with your baby there are ways to help your baby feed. The main point to remember is that this is a temporary phase and the most important thing is that your baby gets nutrition and calories until your baby is ready to feed again. Please contact me if you feel this is happening so I can support you.
Reformation (sometimes phrased Reattachment/Regrowth)
In some babies the frenulum may reform . You may notice changes in the way your baby feeds perhaps similar to your previous experience. A further frenulotomy may be considered. Current research indicates that around 1-4% of initial divisions can reform. It is also thought there could be hidden frenulum which is brought forward with improved tongue movement, or scar formation (or a combination of both elements).
As with all medical procedures, there are no guarantees. Experience and research suggests there is likely to be an improvement with feeding, and whilst optimum feeding efficiency is the aim, no-one can promise this. However, if following a thorough tongue function & motility assessment I felt that your infant would not gain anything from a frenulotomy procedure, a division would not be the suggested treatment. As an IBCLC (gold standard in lactation care) and an Infant feeding specialist, I would further support you on your feeding journey with a feeding plan to help address any challenges you or your infant may be facing.
© DIANA WARREN IBCLC, RGN