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The Do's & Don'ts of Lip/Tongue Tie Release Procedures for Babies - your guide from an experienced IBCLC & Paediatric Oral Myofunctional Therapist

Kellie Eason, Advanced Practice IBCLC. BHSc. (Nursing), Post. Grad. Dip in Midwifery

MILK...early parenting support, Melbourne, Australia



Cute baby with thumb in mouth
The Do's & Don'ts of Lip/Tongue Tie Release for Babies

Lip and tongue tie release procedures for babies are delicate and require careful consideration to ensure the best outcomes for your baby's well-being. Here are some do's and don'ts from an experienced IBCLC and Pediatric Oral Myofunctional Therapist to guide you:


DON'T PROCEED WITH THE PROCEDURE IF YOUR BABY IS NOT EXPERIENCING FEEDING DIFFICULTIES

Tongue tie release is only indicated in babies who have feeding difficulties, such as difficulty latching onto a breast or bottle, taking in too much air, milk spilling from the mouth, or swallowing difficulties.


Seek advice from a tie-savvy IBCLC if you suspect that your baby has a lip or tongue tie, as feeding issues may not be apparent to you but are noticeable to a professional with clinical expertise.


Lip or Tongue tie release can be done under general anaesthesia for children over the age of two if there are other related issues, such as speech or dental problems.


DON'T PROCEED WITH THE PROCEDURE IF YOUR BABY HAS LOW MUSCLE TONE

Babies with low muscle tone are at risk of surgical airway obstruction, as the tongue falls back into the airway, making it unsafe to perform the procedure. Additionally, these babies may experience worsening feeding issues after lip/tongue tie surgery because their lack of muscle tone is inadequate to support their feeding posture.


If your baby has low muscle tone, consider engaging oral myofunctional and infant feeding therapies to improve muscle tone and safely prepare your baby for surgery, if necessary.


DON'T PROCEED WITH THE PROCEDURE IF YOUR BABY HAS PIERRE ROBIN SEQUENCE

Pierre Robin sequence is a rare condition (1 in 8,500 to 14,000 births) that involves three airway features: a narrow or high hard palate, a heavily recessed jaw, and a tongue that sits further back than usual.


Tongue tie release is unsafe for these babies because following surgery, as the tongue can occlude the airway.


It is crucial to have your IBCLC to not only be tie-savvy, but have clinical expertise in Paediatrics to be able to assess, detect and refer any issues to a doctor for further evaluation.


DON'T PROCEED WITH THE PROCEDURE IF YOUR BABY HAS DIFFICULTY WITH REGULATION

Regulation difficulties often worsen following lip/tongue tie release procedures.


There is a real risk of feeding refusal and poor weight gains with this procedure if your baby has regulation difficulties.


It is essential to see an IBCLC for assessment before any oral surgical procedure to determine therapeutic strategies to support your baby in better regulating and preparing them to cope with the demands of surgery, resulting in better outcomes and avoiding complications.


DON'T DO THE PROCEDURE IF YOU ARE NOT IN THE RIGHT HEADSPACE

Your baby always depends on you to model as much calm and regulation as possible, especially during times of high stress. If you are not in the right headspace, you are unlikely to cope with the procedure, which increases the chances of poor postoperative outcomes, such as reattachment, worsening feeding issues, and the need for repeat procedures.


Delaying or Avoiding a Procedure: Alternative SolutionsThink carefully before undergoing a procedure, as there may be other options available to you. For example, if you have an experienced IBCLC, they can provide personalized feeding and lactation strategies to help you and your baby.


With the right support and plans in place, many babies with oral ties can breast/bottle feed without major issues and continue to thrive.


DO PRE-SURGICAL PREPARATION

Tie-savvy IBCLCs will assess your baby's need, suitability, and safety for oral surgery and will prepare you and your baby for surgery through education, massage, oral stretches, and oral motor therapy.


This is no different to seeing a Physiotherapist prior to having Orthopaedic Surgery.


Pre-surgical preparation turns what could be a stressful and painful experience for your baby into a much calmer one.


DO SEE AN IBCLC WITHIN 1-2 DAYS FOLLOWING THE PROCEDURE

Your baby’s lip and tongue will be at their most mobile as they tighten the most rapidly over the first few days of healing. After lip and tongue ties are cut, babies lose sensation with their tongue and face/mouth muscles. Additionally, the lip and tongue muscles become floppy after surgery.


Babies usually behave as though they can't feel their tongue and don't know what to do with it, causing frustration and some temporary regression in feeding.


Seeing an IBCLC soon after the procedure is vital to help your baby latch and feed effectively from the start, minimize your baby's distress and discomfort, and keep your baby's tongue moving.


DO EXPECT TO SEE AN IBCLC APPROXIMATELY WEEKLY FOR 4-6 WEEKS AFTER THE PROCEDURE


This is no different to visiting a surgeon on a regular basis following surgery for dressings or any other aftercare needed.


If your baby's tongue isn't encouraged to effectively move following the procedure, the chances of the wound reattaching and surgery needing to be repeated are increased. Your lactation can be impacted if breastfeeding, as your baby's oral motor function is not yet effective enough to stimulate milk production.


Healing and recovery following lip/tongue tie surgery is not linear or easy.


The first two weeks are the most challenging as the superficial wounds heal, and your baby adjusts to the aftercare.


The next four weeks are for monitoring and providing therapies to support ongoing oral motor function as the deeper wounds tighten to close.


The highest risk of reattachment is within the first four weeks, and if there is scar tissue that mimics reattachment of the oral ties, massage can be introduced to soften and create suppleness within the wounds, further minimizing the risk of scar formation and the need for repeat procedures.


Full or close to full oral motor function is usually expected to return within 4-6 weeks.

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Hi, thanks for stopping by!

At MILK early parenting support, I strive to be your go-to source for all your parenting needs – from pre-birth to post-birth. I'm a passionate and experienced International Board Certified Lactation Consultant (IBCLC). I love empowering expectant and new parents with all the knowledge and support they need to make the right decisions for their family.

Whether it’s helping you find the best feeding and sleeping strategies, or ensuring that your baby is getting the nutrition they need for optimal growth, I'm here to make sure that you and your baby get the best start in life.

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