Services for 3 to 6 month old infants
NEW PATHWAY OF CARE FROM DECEMBER 2023
We do things differently in our clinic compared to other services for babies with tongue tie. We do not offer surgery on a first appointment as we do not believe that this is in the best interest of your baby, nor is it in keeping with current international best practice for the treatment of tongue tie.
The pathway of care for 3-6 month olds is different from the 0-12 week olds. This is because it can be harder to facilitate an infant of this age group to change how they feed. Their compensatory movement patterns are more established and their newborn reflexes which help with feeding are now integrated.
A baby who has a tongue tie will have had to adapt to this anatomical/structural restriction from before they were born. They will therefore have developed compensations to feed which in turn causes tension patterns in their body; for example, you may have noticed they turn their head one way more than the other or they tend to keep their hands fisted a lot of the time.
To help your baby transition to a normal feeding pattern, using the muscles in the way they were intended and to build up sufficient stamina, is going to take time and help from you. We therefore need to show you how to do this, and your baby will find this process following surgery much easier if they are prepared ahead of time.
This means they will benefit from having feeding support / feeding therapy appointment(s) ahead of surgery to optimise their chances of transitioning their feeding to normal movement patterns after surgery.
The initial appointment will be a consultation to assess if there are tethered oral tissues (Tongue, Lip or Buccal ties) and assess your child’s feeding. A recommended treatment plan will be discussed with you.
One of our feeding specialists, International Board Certified Lactation Consultants (IBCLC), will assess how your baby is feeding to review how their function is. They will be looking at whether your baby is moving their tongue to create suction to extract milk. Alternatively, they may be using tongue or lip compression/tongue thrusting or jaw dropping to achieve milk transfer. They will also observe how your baby paces themselves when feeding. They will assess latch and position and suggest changes to optimise this if you are breastfeeding. If you are bottle feeding they may suggest a change in bottle type and/or flow rate.
We will examine your baby and then discuss the findings of both this and the feeding assessment. A recommended treatment plan will be drawn up to best prepare for surgery, if this is required. Surgery will be performed on a different day.
This will be at separate appointments from the initial evaluation.
If required, this will be at a separate appointment from the initial evaluation.
Surgery – Functional frenuloplasty under conscious sedation
This step is the surgery for the Tongue/Lip/Buccal Tie(s).
For this, we use conscious sedation. This means that although your child will be breathing for themselves they will be unaware of what is going on and have no memory of the procedure. They are kept comfortable by numbing the base of the tongue using local anaesthetic. Throughout the procedure and for a while after, we will have them monitored using an ICU-grade monitoring system. Your child will only be taken to the procedure room following the administration of the first dose of sedation (intranasal midazolam) so they will not be aware of having been apart from you during the surgery.
As your child is conscious during surgery we can elicit tongue movements and they have normal tone in the muscles, so we can more precisely gauge how much fibrous tissue needs to be released for optimal function whilst creating minimal inflammation during the healing process. Both doctor and physiotherapist work together in surgery ensuring all tension has been released under the tongue. This is what differentiates a functional frenuloplasty from a tongue tie release under general anaesthetic as with this method the patient is fully unconscious and muscles flaccid.
The surgical site is held together using absorbable sutures so that there is no need for any active wound management post-operatively, minimising inflammation and discomfort.
Post-op Feeding Support/Therapy
The work you will have been doing pre-op is continued and monitored so that we obtain optimal healing of the surgical suture line. Again this will be done through in-clinic visits.
Post-op follow-up appointment
We will see you back at 6 weeks to check on healing.