Frenotomy (Tongue-Tie Procedure in Infants)

What is a frenotomy?

A frenotomy, also called a lingual frenotomy, can be a quick, in-office procedure that treats tongue-tie in infants. Tongue-tie (or ankyloglossia) is a condition that limits how well your baby can move their tongue. It sometimes causes breastfeeding (chestfeeding) difficulties.

Adjusting your breastfeeding position or your baby’s latch often helps. So, not all babies with a lingual frenulum need a frenotomy. But some babies benefit from this procedure to help their tongue function as it should.

When it’s necessary, healthcare providers recommend doing a frenotomy early in a baby’s life, typically within their first month. A pediatrician and lactation consultant will evaluate your situation and help you decide if a frenotomy is right for your baby.

What conditions are treated with a frenotomy?

Healthcare providers view frenotomy as the gold standard for treating tongue-tie (ankyloglossia) in infants if it’s causing a painful latch, latching difficulties or milk transfer difficulties.

Research doesn’t show an association between tongue-tie and speech disorders. Older children with tongue-ties and speech problems haven’t shown benefit from frenotomies, but rather from speech therapy.

You have multiple frenula (plural form of frenulum) in your mouth. Each one connects different structures inside your mouth (like your upper lip and upper gum). The only frenulum currently recommended to cut due to breastfeeding issues is the lingual frenulum under the tongue.

How should I prepare for this procedure?

Before your baby has a frenotomy, a pediatrician will give them a thorough physical exam. They’ll look for all possible causes of breastfeeding difficulties. These include:

• Disorders affecting their nervous system.
• Conditions affecting the anatomy of their head or mouth.

This exam is important because treating tongue-tie won’t be enough to help if other factors are affecting your baby’s ability to breastfeed. If your pediatrician determines tongue-tie is the main concern, they’ll work with a lactation consultant to help you find solutions. For example, changing your breastfeeding position or adjusting your baby’s latch may help.

But if your baby still can’t breastfeed, then your providers will talk to you about a frenotomy and what it involves. They’ll make sure you’re comfortable with the decision and explain the benefits and risks to you.

What happens during a frenotomy?

During a frenotomy, a healthcare provider (typically a clinician trained in performing frenotomies such as a pediatrician, ENT physician or breastfeeding medicine physician) makes a small cut in your baby’s lingual frenulum. This is the fold of tissue that connects the bottom of your baby’s tongue to the floor of their mouth. Cutting this tissue allows your baby to move their tongue more freely.

The traditional method for a frenotomy uses scissors to cut (release) this tissue. This is the gold standard. However, some providers use other methods, like lasers. Researchers continue to compare the benefits and drawbacks of these various methods.

Infants don’t need anesthesia in any form for this procedure. Some healthcare providers recommend using oral sucrose (a sugar solution) before the procedure to help your baby feel more comfortable. Most babies are comforted after with feeding.

Frenotomies typically take place in a provider’s office or a hospital setting.

How long does this procedure take?

A frenotomy that uses scissors is a short procedure. It only takes about one minute, on average. This is the conventional and more common method. A frenotomy that uses lasers may take a little longer.

What happens after a frenotomy?

Healthcare providers recommend feeding your baby right after the procedure ends. Doing so helps comfort your baby and stop any bleeding.

There’s currently no evidence to support stretching or massaging the wound after the procedure to help recovery. Some parents notice an immediate improvement in pain and transfer of milk and some notice an improvement over one to two weeks after the procedure. Some infants require additional speech therapy assistance to gain full movement of their tongue.

What are the benefits of this procedure?

Possible benefits of a frenotomy include:

• Helping your baby breastfeed more effectively.
• Reducing pain or discomfort you feel from breastfeeding.

It’s hard to predict whether your baby will have improved breastfeeding after this procedure. That’s because many different factors affect how well a baby breastfeeds. Researchers continue to look into the short- and long-term benefits of a frenotomy for babies and nursing parents.

What are the risks or complications of this procedure?

A frenotomy is generally very safe. Rarely, a frenotomy can cause:

• Bleeding.
• Infection.
• Scarring.
• Feeding aversion.
• Injury to the saliva ducts or nerves in your baby’s mouth.

What can I expect for recovery?

Your provider will tell you when you should bring your baby back for a follow-up after the frenotomy. At this follow-up, your provider will:

• Check for any complications.
• Ask how breastfeeding is going and discuss any difficulties.
• Offer help with breastfeeding, as needed.

When should I call my healthcare provider?

Call your pediatrician or lactation consultant if you:

• Have any pain or discomfort with breastfeeding.
• Believe your child has tongue-tie or another issue affecting their ability to latch.
• Notice signs of complications (like bleeding or infection) in your baby after a frenotomy.
• Have any questions or concerns about breastfeeding, tongue-tie or your baby’s treatment plan.