Tongue-tie in my baby... can be treated. Mom, please don't worry.

This small frenulum is found in all normal children, but most are not severely attached and therefore do not require surgery. Only infants with moderate to severe tongue-tie cause tongue attachment problems and should receive treatment as soon as possible.

Tongue-tie and Your Baby’s First Surgery

Tongue-tie revision surgery is a minor procedure that can be done in several ways, such as using small sterile scissors to snip the frenulum (snip), electrocauterization, laser, or plasma light applied to the tongue frenulum area. For infants, the doctor will use a local anesthetic that is safe and has no side effects. The surgery takes only 1-2 minutes, does not require tongue retractors, causes no bruising, and only minimal bleeding. The doctor will have the infant bite on gauze to stop the bleeding for about 10-30 minutes, similar to biting gauze after a tooth extraction at the dentist. However, if the mother chooses electrocautery, laser, or plasma surgery, there will be very little or no bleeding. For safety, the doctor will have the infant bite on gauze to fully stop the bleeding for about 0-15 minutes. After surgery, the baby can breastfeed immediately and can go home the same day.

If the tongue-tie is severe, surgery is recommended within 12-72 hours after birth to prevent jaundice in the infant. If surgery is not possible, feeding by spoon/cup, feeding tube, or bottle feeding may be necessary initially. However, bottle feeding from birth can cause the baby to become bottle-dependent and less willing to breastfeed. For moderate tongue-tie, in some infants, the frenulum may stretch on its own within 1-2 weeks if the mother’s nipples are normal. In this case, follow-up appointments can be scheduled. If it does not stretch on its own, surgery should be performed because surgery is the only way to fix the root cause of the problem.

For older children under 7 years old, frenulum snipping may require general anesthesia, either without intubation or with intubation. The doctor will use electrocautery to perform the surgery, which takes about 1-5 minutes. Recovery takes 2-4 hours, and the child can go home the same day.

For older children who can open their mouths wide and stay still (7 years and older), the doctor will use local anesthesia combined with electrocautery. The surgery takes about 1-5 minutes, requires no recovery time, and the child can go home immediately.

What Will Your Baby’s Wound Look Like?

The wound will look like a sore you get when you bite your lip or cheek. It will be a white, clear sore similar to a canker sore. The tongue-tie wound will heal on its own without needing antibiotics. Initially, the wound will have a white-yellow scab (different from skin scabs which are black-red). This is not pus. Please do not try to pick or peel off this scab (thicker frenulum types produce more scabs than thinner ones). Within 2-4 weeks, the scab will fall off or fade away on its own, leaving a clear white scar that will gradually fade as the child grows.

Symptoms to Watch Out For

After tongue-tie surgery, if your baby shows any of these symptoms, do not panic. Perform the following first aid immediately:

• Infant regurgitation

Common in infants who have just breastfed before surgery. It is recommended to stop feeding the baby at least 30 minutes before surgery. If regurgitation occurs, immediately place the infant on their side to reduce the risk of milk aspiration into the lungs.

• Rebleeding at the wound

This is very rare and occurs when the blood clot covering the wound dislodges too early. Usually, it stops on its own, but if it does not, have the mother fold a diaper corner 2-4 times, moisten it with drinking water, and place it over the tongue for the baby to suck on to stop the bleeding. If bleeding does not stop within 10 minutes, return to the hospital. On the first day after surgery, slight blood mixed with saliva may be seen, which is blood remaining in the cheek pouch during surgery.

• Complications from general anesthesia

Such as bronchospasm. If the child requires general anesthesia, this complication may occur, especially in children with hyperreactive airways, asthma, or a history of bronchodilator use. Parents should inform the doctor of these conditions. If the child has symptoms such as a cold, cough, runny nose, or fever on the day of surgery, consult the anesthesiologist or postpone the surgery for at least 2 weeks.

• Reattachment (synergia)

Occurs when the tongue is not moved enough due to habit, causing the wound to heal back to its original state. Mothers can help prevent or reduce reattachment by:

• For infants, gently sweep the finger every 3-5 hours in the following 3 directions, 3 times each:
  • Position 1: Insert finger and sweep the tongue side to side
  • Position 2: Insert finger for the baby to suck, then pull out to move the tongue forward
  • Position 3: Hold both sides of the chin and move to exercise swallowing muscles
• For older children, practice sticking out the tongue to lick the upper lip. It is recommended to lick cold ice cream to reduce pain and may apply honey or syrup to encourage the child to stick out the tongue and lick. Also, practice the child’s speech with sounds /s/ /d/ /t/ /th/ /n/ /r/ /l/. Generally, voice changes can be seen at least 4-6 months after surgery. The older the child, the harder it is to relearn speech.

If parents suspect their child may have tongue-tie, they can schedule a consultation with a doctor for examination and treatment.