The first indication of restricted oral tissue is usually breastfeeding dysfunction. Assessment by an experienced IBCLC is imperative in order to review breastfeeding function, rule out other known challenges, and guide the breastfeeding dyad in optimizing latch, positioning, and routines impacting both milk supply and the nursing relationship.
The IBCLC should provide anticipatory guidance and referrals regarding further evaluation and treatment by manual therapists, bodyworkers, and appropriate medical and dental practitioners in the community.
To complement work with an IBCLC, parents are encouraged to work with manual therapists and bodyworkers experienced with challenges to breastfeeding, including tongue tie.
When poor latch persists, resulting in nipple pain, tissue degradation, compromised milk supply, milk transfer issues, slow weight gain or failure to thrive, lingual frenotomy by an experienced practitioner should be considered.
Currently, breastfeeding difficulty is the only scientifically proven indication for neonatal lingual frenotomy. Treatment for tongue tie in bottle fed infants with feeding problems or in infants in order to prevent speech and articulation problems or suboptimal airway development bears further study.
The simplest way of performing the procedure is by using a pair of sterile scissors. For a video clip of scissor release, click here (Knox I. Tongue tie and frenotomy in breastfeeding newborn. NeoReviews. 2010;11.ISSUE 9). Recently, laser devices are used. Obviously, these devices are much more expensive. For a video clip of laser release, click here. While clinical reports mount regarding positive outcomes of laser release, research is needed to compare the efficacy of laser with scissors and other tools such as electrocautery.
Frenotomy is safe and with the use of scissors, does not require pharmaceutical analgesia (Ovental A, Marom R, Botzer E, Batscha N, Dollberg S. Using topical benzocaine before lingual frenotomy did not reduce crying and should be discouraged. Acta Paediatr. 2014;103:780-2). However, some practitioners offer various forms of pain relief based on their clinical experience.
In addition, many practitioners are releasing lip-ties and reporting good clinical outcomes. There are a limited number of reports in the literature to date associating lip-tie with breastfeeding difficulties, none of which present level A or B evidence. There are no reports of longterm follow up or of complications after lip-tie frenotomy. Some practitioners are also releasing buccal ties and reporting good clinical outcomes. IATP strongly encourages research in these areas.