What To Expect Before, During & After A Tongue Tie Release

No one wants to hear that their newborn needs to have a corrective procedure of any kind, no matter how quick or simple it is. But, if perhaps you’re experiencing feeding challenges and your pediatrician has diagnosed your baby with a tongue tie, it’s possible that the idea of having that tongue tie released is a welcome one, but what does that entail and what is the recovery like?

When my baby was born, nursing didn’t seem like a challenge for us right away. He nursed eagerly, and my milk came in before we left the hospital. However, I experienced some discomfort, particularly on one side, and a lactation consultant suggested I try a nipple shield to keep it from getting worse. After a few days at home, we wondered if maybe this baby wasn’t getting what he needed during his lengthy 45-minute feedings. A ‘weigh-feed-weigh’ session with lactation support confirmed that our son was not transferring much milk during his feeds. “He probably stops because he’s tired, not because he’s full,” the lactation consultant told me. The next day, our pediatrician recommended a tongue tie clip. Within a day, nursing was much easier and his milk-transferring abilities had massively improved.

However, in recent years many pediatricians have pointed out that tongue ties are being corrected at a rate that may be far greater than is necessary. When I asked Dr. Anna Messner, M.D., Division Chief, Otolaryngology and Head & Neck Surgery at Texas Children's Hospital, about my experience, she called ours “not an uncommon story” and agreed it should’ve been done. “Prolonged feedings, like you describe, is sign that there is a problem with the latch,” says Messner. “It doesn't mean the baby is necessarily tongue tied, but that the latch is probably not good if the baby is taking an hour to feed. That should not happen. Most babies should take 10 to 15 minutes to feed.” Still, she urges families to work closely with their pediatrician before making any decisions about having a tongue tie release. Here’s everything families should know about this prodecure, from what to expect before, during and after.

What is a frenotomy on a baby?

The medical word for a tongue tie is ankyloglossia and literally translates to “tethered tongue.” “‘Ankylo’ means ‘to tether’ and ‘glossia’ means ‘tongue,’” she explains. While tongue ties can range from very mild to quite severe, the diagnosis refers to having limited tongue mobility caused by a restrictive lingual frenulum. ‘Lingual’ is a medical term meaning anything having to do with the tongue, Messner explains, while “the frenulum is a fold of the mucosa, or the lining of the mouth and the tongue.”

For a frenotomy, or tongue tie release, patients generally do not need general anesthesia and the procedure does not need to be done in an operating room, Messner assures. Parents can expect that the procedure will be over very quickly, and can be done in a clinical setting, meaning (very likely) in your pediatrician’s office. Your baby’s comfort should be a huge consideration for whoever performs the procedure — most likely a pediatrician — and Messner says that to keep your baby feeling safe and comforted, most practitioners will:

1. Have the baby in a cozy swaddle during the tongue tie release.
2. Offer the baby sugar water immediately before the tongue tie clip, because sugar water has been found to be a pain control option for newborn babies. “We have special sterile sugar water that’s used in the newborn nurseries whenever the child has to have a painful procedure.”

In my own experience, the procedure was over almost before I realized it had begun, and the pediatrician offered us the option of staying in the room, or stepping outside in case it was upsetting for us to watch. As Messner explains, the word “clip” is apt, as that’s essentially what the whole procedure is: “we cut the frenulum with sterile scissors, and then have the baby immediately feed right afterwards, either from breast or bottle. Then, there’s usually a little bit of bleeding which stops within a couple of minutes.”

How do I know if my baby needs tongue tie surgery?

It’s essential to seek out guidance from trusted health care professionals, and don’t be afraid to seek out second opinions, says Messner. It’s likely that tongue tie release does help with certain breastfeeding struggles depending on the severity of the tie, but breastfeeding difficulties can be multifaceted and hard to get to the bottom of. Despite the fact that a tongue tie release is a relatively minor procedure, if your child does not really need one, it’s of course best not to have it done, she adds. “Some people will get referred to a pediatric dentist, and they’re great but they don't understand necessarily all the other things that can be affecting breastfeeding or affecting babies,” Messner says. “I encourage families, before they proceed with any procedure, to just check in with their pediatrician, see what they think is best.”

Do I need to do tongue tie exercises? How to help your baby recover

The good news is that you don't really need to do anything special after your baby’s tongue tie is released. The babies can feed normally, Messner reassures. It used to be standard that parents were told to do frequent stretches and oral exercises to keep the tongue tie from scarring over. But, that’s no longer considered the conventional wisdom. “You do not want to do those exercises where you rub under the tongue or lift the tongue — there is no need to do that,” Messner says. “Some babies will have a white patch underneath the tongue, but that will go away within about a week.”

How soon can nursing parents expect feeding sessions to improve after a tongue tie release?

This will vary parent-to-parent, but on a personal note, we experienced near-immediate improvement. And indeed, Messner agrees that some parents will notice the difference immediately, often noticing that that their baby’s latch suddenly feels different and more comfortable. Other parents may take a few days to experience a sense of improvement, because their breasts are so sore from the poor latch.

Either way, if a tongue tie release is recommended by your family’s pediatrician, not only should it be a swift and relatively easy procedure, it should offer quick improvement.

Studies cited:

Borowitz, S.M., (2023) What is tongue-tie and does it interfere with breast-feeding? – a brief review. Pediatric Gastroenterology, Hepatology and Nutrition https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10167863/

Harrison, D., Beggs, S., (2012) Sucrose for Procedural Pain Management in Infants. Pediatrics, https://publications.aap.org/pediatrics/article-abstract/130/5/918/32407/Sucrose-for-Procedural-Pain-Management-in-Infants?redirectedFrom=fulltext

Experts:

Dr. Anna H. Messner, MD, FACS, FAAP, Division Chief, Otolaryngology/Head & Neck Surgery at Texas Children's Hospital