THE RISKS OF NOT ATTAINING A PRE FRENECTOMY FEEDING & CHILD HEALTH ASSESSMENT

Kellie Eason RN, RM, IBCLC

Kellie is a Nurse, Midwife and International Board Certified Lactation Consultant in private practice, with over 25 years experience.  
She has a special interest in providing personalised support for families with complex infant feeding issues as well as Gentle Sleep & Settling Solutions for Newborns to 3 Year Olds.   
Working collaboratively with holistic practitioners at Osteo 4 Kids & Adults in Preston, & Family Tree Health in Briar Hill, Melbourne, Kellie also supports families via in home & Skype/FaceTime Consultations.

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After consulting over 6000 families in 4 years & seeing so many adverse effects as a result of failure to attain
pre-frenectomy feeding & child health assessments, I thought I would share this advice with the intent of helping others.

TONGUE OR LIP TIE SURGERY IS NOT INDICATED FOR ALL INFANTS WITH LIP & TONGUE TIES

• Unless you have expertise in this area, you are not qualified to assess or diagnose lip & tongue ties
• Tongue & lip ties are not the only causes of infant feeding problems -  this needs to be assessed, managed & supported by an expert in the field such as an IBCLC, Speech Pathologist of Infant Feeding Therapist with advanced training in the area
• Many other causes of feeding issues can mimic infants with symptoms of tongue & lip ties
• Even though some infants are assessed as having lip or tongue ties, they may be poor candidates for surgery & alternative management strategies need to be addressed

NOT ALL INFANTS THAT HAVE LIP/TONGUE TIES NEED SURGERY

• Many other causes of feeding issues can mimic the infants with tongue & lip ties
• Infants can continue to feed successfully with tongue & lip ties, whereas there are some that cannot continue to feed successfully without the surgery

TONGUE/LIP TIE SURGERY SOMETIMES DOES NOT WORK

• If the surgery was performed unnecessarily because the tongue/lip tie was not the primary cause of the feeding issues, it will simply not work - this needs to be excluded by pre surgical feeding/child health assessment
• There are often multiple contributing factors to an infants feeding issues & if these are not addressed, the surgery will simply not deliver the desired outcome
• If parents/carers do not comply with post frenectomy care, they run a real risk of the tongue/lip reattaching & the surgery may need to be repeated

 

• I have seen & advocated for many infants needing tongue/lip tie surgery of which it has both been highly beneficial & successful.
• I have seen way too many infants that have had tongue/lip tie surgery where it has been highly unbeneficial & unsuccessful.

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WITHOUT A PRE-FRENECTOMY FEEDING & HEALTH ASSESSMENT, YOU RUN AN INCREASED RISK OF:

• A failed procedure that fails to address your concerns
• Your child going through an unnecessarily painful procedure
• A procedure associated with potential health risks such as feeding refusal, oral aversion, hospital admission with nasogastric tube feeding & failed breastfeeding,
• Infant and maternal mental health concerns such as postnatal anxiety, depression, poor sleep & settling

MAIN POINTS FOR YOU TO CONSIDER...

1. Tongue/lip tie surgery is associated with significant benefits when expertly assessed as being necessary
2. Ensuring your child has a pre-frenectomy feeding/health assessment & ongoing post procedure rehabilitation, ensures optimal success & outcomes
3. Tongue/lip tie surgery involves a total 4 month healing period of which the first 4 weeks hold the highest risk of poor healing and recovery 
4. Your infant’s rehabilitation team will often need to include an expert IBCLC, Speech Pathologist, Infant Feeding Therapist & Bodyworker (ie. Paediatric Osteopath, Chiropractor, Physiotherapist) is needed for a minimum of one month after the procedure
5. If you are unable to commit to complying with the pre-rehabilitation & post rehabilitation care involved, DO NOT consider this surgical procedure

HERE’S A TYPICAL CASE EXAMPLE OF WHAT I SEE, WHEN INFANTS HAVE THE PROCEDURE WITHOUT ATTAINING A PRE FRENECTOMY FEEDING & CHILD HEALTH ASSESSMENT

Crying, desperate mum can no longer cope with her fussing, poorly feeding baby, she may have had a history of low milk supply, recurrent mastitis, nipple damage.  She seeks advice from friends & social media, proceeding to a referral from her GP to a tongue/lip tie surgical provider...

Baby has tongue/lip tie surgery...

Baby’s feeding and behaviour regresses, with their health & wellbeing further compromised...this is not what mum expected.  Mother & baby get admitted to mother baby unit under Psychiatric, & Paediatrician care.

Mother & baby unit staff can only provide limited assistance because the child is in pain - baby screams out for mum while strange staff cuddle baby whilst she has dinner.  Mum gets more stressed because this simply isn't working.

The whole family is struggling with stress at home because mum isn't coping & things have gotten way worse before they have even gotten better....

This cycle continues for another 2 weeks, but each day feels like a year for this poor mum.  Her baby picks up on her stress, which makes things worse.

Mum’s mental health deteriorates as she feels guilty that the procedure didn’t fix her baby’s fussiness & feeding problems.

Mum’s milk supply, nipple damage, mastitis is an ongoing issue - making her feel even worse, just more complications to deal with....

Mum & baby return to lip/tongue tie surgeon for review appointments to find that wound has reattached & upon questioning, mum has been procrastinating the dreaded "stretches" or fails to do the stretches effectively because she can't handle hearing & seeing her baby in distress.

Surgeon has to re-stretch the wound open again which is more painful than the procedure itself.
There is still another 3 weeks of this journey to be continued

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HERE’S A TYPICAL CASE EXAMPLE OF WHAT I SEE, WHEN INFANTS HAVE THE PRE-PROCEDURAL ASSESSMENTS WITH POST SURGICAL REHABILITATION

1. Assessments reveal that there is an infant with postural/mobility strains that contribute to intra oral tension - referral made to Bodyworker for these to be assessed & addressed.  If mum has low milk supply or mastitis, she may be referred to GP for supportive care.  Mother also provided with strategies & techniques to faciliate infant mobility & introduced infant intra oral exercises, breastfeeding & lactation strategies, whilst preventing mastitis until repeat review with myself
2. At review with myself- feeding improves without surgical intervention, ongoing advice/support given, repeat review organised to ensure no regression of feeding issues
3. At second review - feeding continues on normal healthy trajectory & discharged from my care
4. If at initial review, feeding/lactation issues deteriorate  & if safe to proceed, a referral will be made for surgical Ax of lip/tongue ties with a plan of ongoing intra oral exercises and massage to desensitise baby to procedure and post surgical exercises. Parents are realistically informed of what to expect from surgical assessment & onwards
5. During the 4 week recovery, ongoing support & repeat assessments with rehab team of surgeon, myself, & bodyworker.  Maternal & infant stress is kept at a minimum because both mother & baby are prepared & desensitised to the stressful process.  Also no unnecessary referrals have been made with excellent outcomes because every step of care is considered to benefit the health, safety & wellbeing of the mother, baby & their family

I'm really keen to hear about your own stories with regard to experiences with your child with a tongue/lip tie whether it was surgically treated or not.  What were you pleased about? Would you do anything differently next time around?