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PRE AND POST FRENOTOMY CARE:   WHY THERAPY AND LACTATION?

What does therapy before and after a release procedure do?  Why does my provider want me to see a therapist before a release, isn't the procedure going to fix everything?

If you go into a release procedure expecting a "quick fix" for feeding problems, you may be disappointed.  

Feeding problems are often very complex.  While there are some babies who respond well immediately after a procedure and don't need much help, most others require some additional support to get feeding on track.  Frenotomy is best with a team approach.  For more information about about how pre-frenotomy therapy may benefit you and your child, click here.


The feeding therapist evaluates oral function, body alignment, and other factors that may be impacting feeding.  If you are scheduled to have a frenotomy, requirements for aftercare are reviewed and taught.  Regardless, strategies to improve oral motor skills and overall function are covered.  By working on building new muscle memory and improving function before a procedure, your baby may pick up on new patterns faster afterward.  If your child is older and anxiety may play a role in cooperation with aftercare, working with your child so he/she is accustomed to oral care prior to the frenotomy is very helpful.  Therapy after  a frenotomy focuses on improving oral motor skills, including coordination, strength, and endurance, along with guidance on wound management.

If you are breastfeeding, a lactation assessment is strongly recommended before a frenotomy.  There are numerous issues related to milk supply, transfer at the breast, nipple pain, etc that may not be related to a tongue tie.  Some symptoms of tongue tie can overlap with symptoms related to other issues, so it's possible a frenotomy won't "fix" the problem if the tie wasn't the true cause.  It is important to look at the "big picture" to resolve breastfeeding problems.  A release procedure is only one part of the puzzle, even for tied infants, and most therapists are not trained in breastfeeding assessment and management.  A skilled lactation professional is the best person to evaluate breastfeeding difficulties.  

At Flourish, you get both feeding/oral motor therapy and lactation assessment, in one location.

Even if you are not breastfeeding, a feeding evaluation before a frenotomy is a good idea, to ensure you are addressing issues beyond a tie that are impacting feeding performance.  A feeding therapist with training in feeding/oral motor treatment is the best person to evaluate oral function and feeding.  Tongue tie is considered a "functional diagnosis" and release should not be recommended based on appearance of the tie alone, without considering how the child is functioning. It is important to note that infant feeding is a subspecialty of feeding therapy.  You want to be sure the therapist seeing your baby has infant specific training.

A good therapist will give you an individualized, custom tailored home program to meet your needs and your baby's needs, while considering your individual circumstances.  There are a lot of "suck training" exercises out there, but intervention is most effective if used carefully to target priority areas.  Harm may be done by doing too much, too fast, risking aversion with feeding.  I am careful to give families home programs with a "less is more" approach, slowly adding on home activities as they are appropriate, while doing all we can to stabilize and improve feeding even without surgical intervention.  

My goal is to provide customized guidance in the most baby-friendly manner possible, to reduce any risk of oral aversion/feeding aversion and minimize stress on families while working through a feeding issue.

What if I am not sure I want a frenotomy for my baby?

A therapy/lactation assessment is a great place to start to help with that decision.

Frenotomy is always elective, and sometimes the decision of whether to do a release is not easy.  Families face a lot of conflicting information about ties from various people, from peers to medical professionals.  My job is to provide you information about what is impacting your baby's feeding, and what your options are to address those things.  As a therapist and lactation consultant, I can weigh in on both "baby issues" and "mom issues."

A therapist and/or lactation professional can give you numerous conservative strategies to manage feeding issues that do not involve surgical release.  This can help bring clarity to the decision about whether or not the release is absolutely necessary.

For professionals interested in learning more about TOTS and the role of therapy/lactation in managing these issues, I have also created a continuing education course available on the Lactation OT website, geared to therapists working with tongue tied infants.  For more information, click here.

Some signs/symptoms that indicate tethered oral tissues may be impacting feeding:

Breastfeeding:

  • Consistently painful or shallow latch, despite working on technique and positions

  • Clicking when sucking, air intake, reflux

  • Falling asleep quickly at the breast

  • Baby always seems hungry; excessively frequent feedings

  • Lip blisters and poor lip flange

Bottle feeding

  • Clicking when sucking

  • Spilling from corners of mouth when drinking

  • Excess air intake when feeding

  • Feedings take in excess of 30 minutes

Older children:

  • Gagging and vomiting when attempting to manage foods, even though seems interested in food

  • Difficulty chewing

  • Seems to swallow foods whole

  • Constipation (related to poor chewing) or other GI difficulties

  • Pushes foods in mouth with chewing or seems to move head a lot when attempting to chew

  • Spits foods out frequently

  • Prefers soft/mushy foods

  • Protrudes or thrusts tongue when chewing or swallowing