Services for 3 to 6 month old infants
We offer a different pathway of care for 3-6 month olds. This is because it can be harder to facilitate an infant of this age group to change the way they feed. Their compensatory movement patterns are more established and their newborn reflexes which help with feeding are now integrated. This means most will benefit from having a feeding therapy appointment ahead of surgery so we optimise their chances of transitioning their feeding to normal movement patterns post-op.
It also will give you a chance to learn and practice aftercare ahead of the procedure and for your baby to become accustomed to having their mouth touched.
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 treatment plan and options will be discussed.
1. Consultation
We will go through your baby’s history with you, examine your baby and then discuss the findings of both.
Where feeding therapy is required, as described above, this will be at a separate appointment.
If surgery is required then this can be completed as either a frenectomy or functional frenuloplasty. We will advise you as to which pathway we think is best for your child.
If proceeding with frenectomy then the information below will be relevant
Pathway A – Frenectomy
A – 2. Frenectomy
One of our Healthcare Assistants will bring your baby through to the procedure room. Due to laser safety guidelines and for the best care of your baby, parents remain in their consultation room. Your baby will be swaddled and laser safety goggles put on them. The doctor will use some local anaesthetic gel to numb the area to be treated and then the tie(s) will be released using a CO2 laser. Babies sometimes dislike being swaddled or are hungry, but are usually then settled when they return to you, around 10 minutes after they were taken for their procedure.
A – 3. Feeding
Your baby can feed after the procedure and we will assist you with this. If you are breastfeeding you will have an IBCLC help you. If you are bottle feeding we may suggest trying a different bottle and we have a range here in the clinic to find the one that is going to work best for your baby to optimise their oral function.
A – 4. Aftercare
To achieve the best result from a tongue tie release we need to follow an aftercare programme. In order to optimise the healing of the surgical site, as well as change how your baby sucks, we need to teach an optimal resting posture of the tongue and teach you some massage to ensure we don’t have any reattachment of the released tissues. A member of our team will go through all this with you, including some bodywork exercises, so that you are confident in the care you are providing at home over the coming weeks.
A – 5. Follow-up
We invite all parents to bring back their baby during the week following surgery for a member of the team to check the surgical site (Diamond check).
We also ask that you email us photos or videos of the diamond every 48hrs for one week following the procedure so we can monitor this healing process for you.
Should you wish for any further feeding support or therapy you are very welcome to make an appointment at any time. There are additional fees for Lactation support and reviews
Are There Any Side Effects?
With the use of a CO2 laser, there is usually little to no bleeding.
Rarely, because of an aberrant blood vessel near the frenulum, we can get a more significant bleed. If this occurs we control the bleeding with one or two absorbable sutures which do not affect the healing of the surgical site. We do not use silver nitrate to control bleeding, which is often the first line of choice, as this can cause a chemical burn.
The greatest complication is reattachment or sub-optimal healing which is why we have an aftercare program in place.
We also offer the option of using conscious sedation and absorbable sutures for older babies. Please see the information for functional frenuloplasty below.
Pathway B – Functional Frenuloplasty
B – 2. Pre-operative Feeding Therapy
At the initial therapy appointment, we will assess your child’s oral function in order to make a therapy plan for the weeks leading up to surgery. A structural restriction will have a functional consequence so we will work with you to come up with fun and functional ideas to help your child learn normal movement patterns to replace any compensatory adaptations they may have developed.
This plan can then be monitored through in-clinic visits, Zoom-type consultations or video and email reviews as best suit the family and child.
B – 3. Functional frenuloplasty under conscious sedation
This step is the surgery for the Tongue/Lip Tie.
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 period of time after, we will have them monitored using an ICU-grade monitoring system. For a child-friendly approach, we use EMLA numbing cream applied to the skin 40 minutes ahead of inserting the cannula for IV access. Your child will only be taken to the procedure room following the administration of the first dose of sedation so they will not be aware of having been apart from you during the surgery.
As your child is conscious during surgery we are able to elicit tongue movements and assess tone, so we are able to 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 then 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.
B – 4. Post-op Feeding 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 can be done through a combination of clinic visits or Zoom-type consultations.
B -5 Post-op follow-up appointment
We will see you back at 6 weeks to check on healing