Well, who would have thought I’d ever write that headline? Not me, that’s for sure.
When my daughter was two weeks old, she was diagnosed with a class III upper lip tie (this blog has a great discussion of upper lip ties) (ULT) and type 3 posterior tongue tie (PTT). We were experiencing nursing problems and I was told she might benefit from an elective procedure called a frenotomy to surgically clip, or sever, the ties. I flat-out refused. In my mind, she didn’t need it. She was gaining weight like crazy. She looked like a little sumo wrestler. I was in minimal discomfort during nursing (okay…. To be clear, the first few weeks were excruciating. But eventually, the pain leveled off and became more of an irritation rather than toe-curling torture; it was tolerable….or so I thought).
Flash Forward a Year and a Half
A year and a half after that initial diagnosis, I changed my mind.
*record screeches to a halt*
What? Why the change of heart?
Well… here’s what happened: I’d had a year and a half to rethink my initial decision — to do research, consult with experts, read personal anecdotes of other families with tongue- and lip-tied children, to observe my own kids — to live with the consequences of untreated ties.
After much deliberation and soul-searching, I finally decided to have BOTH my kids undergo this surgery. We opted for what’s called a laser frenectomy.
What Changed My Mind
My daughter’s symptoms:
- Her lower front incisors began leaning in towards her tongue and getting a lot of tartar build-up behind them.
- Her upper central incisors developed plaque regularly; we could not brush efficiently in between her teeth because the frenulum was in the way.
- Nursing, while tolerable, was never perfect (I developed recurring milk blisters, plugged ducts, and near episodes of mastitis; I always had irritation during feeds and afterwards, my nipples always looked slanted, like a brand-new tube of lipstick).
- She did/does not chew her food enough; I always find large chunks of undigested food in her poop — even soft stuff, like avocados.
My son’s symptoms:
- When he was an infant, he was a marathon nurser. No kidding. He would latch on for 45 minutes straight; unlatch for 15 minutes, and want to latch on again and repeat the cycle… all. day. long.
- He projectile vomited after every feed. (I cry when I think of all the milk that was wasted!)
- I experienced recurring plugged ducts, insufficient emptying of milk, engorgement.
- After starting solids, he would gag whenever he ate, even soft foods like avocados.
- He had a super sensitive gag reflex — he vomited whenever he coughed from illness or physical exertion (including laughing or light running).
- He ate much too quickly, swallowed lots of air, preferred to wash foods down with some sort of liquid. Displayed a “pot belly” because of all the air swallowed and improper digestion.
- He had infrequent bowel movements. When he was exclusively breastfed as an infant, his world record was 18 days without a poop. Everyone said that must be because my milk was so “pure.” While I wanted to desperately believe that theory, I always had a niggling hunch that something was wrong. When he began solids, he’d go 3 or 4 days without pooping, and then when it finally came, it was always with much crying and effort. And I had tried *everything* to ease his discomfort — prune juice, pears, loads of vitamin C, loads of liquids, greens, coconut and olive oils, mangoes, etc.
- He was unable to produce certain sounds during speech, especially “r,” “s,” “sh,” and “ch.” He couldn’t even say his own name until he was about 5 years old. He would resort to spelling it out instead of saying it and felt sad and frustrated that he couldn’t say his own name.
The Chosen One
I wasn’t going to take my kids to just any local laser-happy doc (most dentists have NO CLUE how to properly diagnose lip or tongue ties). In the end, we chose Dr. James Jesse in San Bernardino to be our laser frenectomy provider. He was recommended to us by Dr. Larry Kotlow, arguably the world’s foremost expert on all things tongue/lip tie. He (and many others) declared Dr. Jesse to be THE laser frenectomy authority on the West coast.
My son went first. He was nearly 7 years old at the time. All in all, he took everything in stride. First was the topical numbing gel. We waited a couple of minutes for that to take effect. He drooled some and said he really didn’t like not feeling his lips. Then came the Ridiculously Huge Needle Filled with Local Anesthetic. That was probably the hardest part. He squirmed at the shots (2 in his upper lip frenulum and, if I recall correctly — it’s now starting to become a hazy memory — for me, not him! — and 2 in his lingual frenulum). After a minute or two, Dr. Jesse began lasering. The actual lasering portion of the procedure probably took less than 5 minutes total for both the ULT and TT. When he was finished, I gave my son a popsicle that we had brought from home in a cooler. It melted en route, so it was more like an Icee, but he took it gratefully.
My daughter, 19 months old at the time, went next. I had to lie down in the exam chair, embracing her in a “mama bear hug.” Her head was on my left shoulder and while I held her torso and arms, an assistant held her head still, and yet another assistant held her legs still. Dr. Jesse opened her mouth with one hand while the other hand maneuvered the laser. The procedure lasted about 15 minutes. I won’t lie to you. It was probably the longest 15 minutes ever. She cried the entire time. From the moment the numbing gel went on to when we were finished. At one point, she began mimicking the doctor and nurses with a distraught and prolonged “say Ahhhhh!” By the time the procedure was over, she and I were sweating buckets.
The Aftermath – Pain Management
Pseudo-crunchy mom that I am, I was bound and determined NOT to use any pharmaceuticals for pain management. Homeopathics were my go-to. Here’s what I bought: Arnica, Staphysagria, Aconite, and Hypericum (all Hylands brand; but I didn’t use any of them). In the end, I wound up using a custom “Post Tongue Tie Release” tincture from my IBCLC that contained the aforementioned remedies, as well as Rescue Remedy for Kids (glycerin-based).
My daughter seemed to respond well to the homeopathic tincture, RR, and TONS of nursing. She also enjoyed coconut popsicles and ice cold fresh coconut water to “numb” her mouth. My son, however, seemed to be in more pain (despite frequent self-servings of fruit popsicles and chocolate ice cream!), so I did give him a couple of doses of Tylenol to take the edge off.
The Aftermath – Stretches/Massages/Craniosacral Therapy/Orofacial Myology
Dr. Jesse advised us to do upper lip stretches (pulling the upper lip all the way up to the nose 3x every waking hour for a week) and said that NO stretches or massages of any kind were needed for under the tongue. In his professional opinion, he believed that both my kids were old enough that their normal tongue mobility during talking and eating was enough movement to discourage any “reattachment” of the wound site.
I wasn’t convinced. I had read many, many articles (by The Medical Experts) and personal accounts which insisted that frequent and even “assertive” stretches and massages were required to prevent the ties from coming back.
So, I implemented my own stretching/massage routine. Every day, six times a day, for TWO weeks, I would sweep across my kids’ frenectomy wound sites with a gloved finger, using a bit of extra virgin coconut oil as a soothing lubricant. I’d sweep under the lip horizontally three times. Then I’d sweep under the tongue — three times horizontally, three times vertically — right over the diamond-shaped wound. In the first week, I used little to no pressure, just lightly grazing over the sites. In the second week, I applied a firmer pressure, similar to using a rubber eraser — somewhat firm, but not what I’d call aggressive.
Let me be clear. These were the most traumatic two weeks I’ve ever experienced as a parent. Ever. I thoroughly hated myself for what I was doing to my kids (they cried every single time; and I’m pretty sure they hated me, too), but I kept doing it because I thought it was the right thing to do. I thought the alternative was doing NO stretches/massages but risking reattachment and having to go in for surgery again. That was not a viable option. I could NOT put my children through this whole ordeal only to go back to the square one and start it all over again. No way.
So I persevered. And so did they. At the three week mark, I reduced the massages to three times a day. My kids were mostly healed and no longer vehemently protested the massages (there was still some whining, but none of the sobbing that ensued during the first two weeks). During this time, my son resumed lip and tongue exercises recommended by his orofacial myologist to help the wounds heal properly (without reattaching), as well as encourage new muscle movement. At the four week mark, I stopped the massages/stretches altogether.
My son and daughter have also had craniosacral therapy sessions (pre- and post-surgery) to help loosen any residual mouth, jaw, and neck tightness to encourage the newly released oral muscles to learn how to move and function properly.
Did/do the Stretches/Massages Prevent Reattachment?
I wish, wish, wish I had the answer to this. I don’t. Only time will tell.
There’s a lot of conflicting advice regarding frenectomy aftercare. Some docs recommend stretching and massaging the wound sites, many times a day for two, sometimes three, weeks. Some docs recommend doing nothing at all.
I found this lack of solid protocol maddening. It frustrated me to read one expert’s advice about how massages were absolutely required to prevent reattachment, but then read about how reattachment still happens despite following those recommendations. On the flip side, I’d read stories about how parents did nothing, and their kids healed fantastically anyway. It’s enough to make me scream! There definitely needs be some Properly Designed Research Studies (I’ll leave that to the science-y, statistically minded types) to suss all this out once and for all.
We are now at the five week mark. My son continues to do his orofacial exercises, and my daughter tries to imitate him. She also voluntarily and enthusiastically lifts up her own upper lip and likes to wag her tongue around, basically being a silly toddler.
In my non-medical expert opinion, I think that my son’s upper lip frenulum has grown back some (not all, just some). Dr. Jesse says it looks totally normal — most of the restrictive tissue has been removed, and my son now has a more “normal” -looking and -functioning frenulum. I still think that my son has some tightness under his tongue. The “webbing” you see (in the first photo of this post) is greatly reduced, but there’s still some there. I think that he may need to have the “floor” of his mouth revised. I still am researching this, but I believe that lasering is done below the salivary glands to release any tight tissue there. He still has some speech issues and we will most likely seek the help of a speech therapist soon.
On the up side, my daughter’s upper lip looks fantastic. The frenulum that went in between her teeth is completely gone. There a little frenulum tissue way high up, but it no longer gets in the way when we brush, and she is MUCH more amenable to letting us brush there now. And when she smiles, you can see all of her top teeth (before surgery, her upper lip would conceal most of her upper teeth when she smiled). She also is able to open her mouth much wider than before, and that is good news for us, in terms of nursing. She does sometimes revert back to a more shallow latch, and humping the back of her tongue while nursing (so irritating!), but I’m continuing to encourage a deeper latch. As for her lingual frenulum… well, she won’t really let me in there for a good look. At the two week mark, I was convinced that I felt tight frenulum tissue (where there wasn’t any immediately post-op) whenever I ran my finger under her tongue. Without getting a good look, however, I can’t really say for sure.
Of course, the only one who will be able to give any actionable, professional insight and advice is our provider, Dr. Jesse. He has been very supportive and responsive to all my obsessive, imploring emails, and has said that we can come back for a follow-up to see how things have healed and see how we should move forward. I just may do that. (The only caveat being that he’s a couple hours’ drive from us, so if we do discover that additional lasering is needed, we need to be mentally, emotionally, and logistically prepared for that scenario. If that, indeed, turns out to be the case, I’m not sure I want to do it again so soon….)
My big takeaway: Laser frenectomy is not a magic bullet, not an overnight magical solution. While I have read wonderful stories of nursing babies suddenly achieving The Perfect Latch and kids being able to touch their noses with their tongues after revision, that’s not been our experience….But it’s early yet.
Overall, I feel good about our decision to choose frenectomies for our kids. There seem to be some tangible benefits already, and I’m optimistic that with more time and diligence (especially on the part of our kids), we will see further improvement.
Below are my older posts, in case you are interested in the evolution of my attitude towards tongue and lip ties and frenectomies.
Websites/Resources that Helped Me Think All This Through
Dr. Alison Hazelbaker’s book Tongue Tie
Frenectomy Today (a well-written, detailed personal account of tongue and lip tie)
Tongue Tie Babies Support Group on Facebook (the parents and medical professionals on this board offer an incredible wealth of information, support, and compassion)
Your turn! What’s your take on the whole tongue-tie issue? Did you or are you breastfeeding a child with a tongue- or lip-tie? Are you choosing to clip/laser? Why or why not? If you chose to have the procedure done, did/do you notice a difference? What advice or words of wisdom would you give to a parent just starting out on this long, winding tongue/lip tie journey?