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This experience is a personal one, but it’s one I would have loved to read to help me weigh the pros and cons of the frenectomy procedure. I acknowledge frenectomies often work out for families well, and hope everyone can respect the information I share to the contrary whether or not it reflects their own experience.

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Our first daughter had a mild tongue tie at birth which our pediatrician deemed unnecessary to revise. At the time I didn’t know much about tongue ties anyway, so I was relieved to hear this.

Our second daughter also had a tongue tie. Having breastfed our first daughter for 18 months and knowing what a good latch felt like, it was clear to me something was different and it was confirmed by multiple people – physical therapists, pediatrician, midwife, lactation consultants – that she had a very restrictive tongue tie.

My gut mama instinct told me the tongue tie revision process would lead to a breastfeeding aversion, and later you’ll find my gut was right.

At six weeks old, we had seen a physical therapist, lactation consultants, two pediatricians and a few midwives regarding our daughter’s tie. It was plain to the eye that she the tie was severe, and the pinching I felt during nursing was not a good sign six weeks in. In addition, our girl wasn’t quite staying on the weight trajectory that our pediatrician wanted her to, though she never lost weight. Those two things coupled together led us to schedule a tongue tie revision, otherwise known as a frenectomy.

We booked an appointment with a well known pediatrician in our area who performed a laser tongue tie revision for our daughter. Wound aftercare included tissue stretches and mobility exercises under the tongue for six weeks, four to six times per day. These stretches are the American standard of care for frenectomy to prevent the tie from reattaching to the base of the mouth. More on that later…

The first night, we expected our daughter to experience a higher level of pain so we had plenty of natural remedies prepped, while also expecting latching to go smoothly as was shared by the pediatrician during post-procedure instructions.

She didn’t latch well at all. In fact, she didn’t latch for12 hours after the procedure, a very rough 12 hours. It was 12 hours of nonstop crying, thrashing, complete and utter discomfort.

It is important to note her age again here. Our daughter was six weeks old at the time of her frenectomy, which by any standard is older than average. She had established feeding patterns and preferences already, and was now too sore and mad to care about nursing. I felt absolutely horrible for allowing the procedure, especially because in the back of my mind a breastfeeding aversion was a huge possibility which all of the providers we saw said was extremely rare and uncommon.

After those initial 12 hours, she finally latched at 1:00am but only nursed on one side, and for a mere two minutes. Something bigger was definitely going on, but I continued the prescribed course starting the wound stretches and praying this would work out. I, being the type A person I am, endeavored to be timely in my approach to the stretches in her mouth, thinking, “There is no way are are doing that procedure again! We have to do these stretches so the tie doesn’t reattach…!”

SPOILER ALERT: All those tongue stretches caused a negative association with nursing.

When completing tongue stretches six times a day with an infant, you are almost always stretching inside their mouth before a feed or just after a feed – that’s just how often babies of this age nurse. With around the clock nursing and stretching, she quickly linked mouth pain with feeding time. In other words, “Mommy stretching under my tongue hurts, and I nurse with mommy around the time that she stretches my tongue, so I don’t want to nurse anymore.”

Another component of the American standard of care for frenectomy is purposeful reopening of the tongue revision wound. You read correctly…yikes! Her tongue wound was reopened once by the pediatrician’s office that performed her revision and another by the lactation consultant I was seeing weekly. Both times, she was enraged and the increased pain in her mouth pushed her further and further away from breastfeeding.

Three weeks post-procedure, and our sweet girl had given up nursing altogether. Just the sight of my boob caused her distress, pushing me away, crying, and throwing herself backwards. Little-by-little, she dropped nursing sessions in the day and eventually overnight, leading me to offer bottles of pumped breastmilk in replacement.

From nine weeks of age until now at seven months old, I am an exclusively pumping mama and she is the bottle queen. It has worked out, but the whole deal was less than ideal.

Now, the takeaways: What would I do differently? You better believe I am sooo here to share a few.

1. Choose a doctor who performs scissor tongue tie revisions, not laser.

Laser is a very new technique with frenectomy. We can’t really tell how far the laser has cut the tissue under the tongue, because it is a laser. With a scissor, you can tell exactly how far tissue is cut, and yes, the scissor has to be sterile to be safe, but it is an age-old practice without risk of deeper tissue damage than is necessary.

2. Avoid the prescribed stretches at all costs.

The tongue stretches can (and do) encourage breastfeeding aversions. In the United States, mothers religiously stretch the wound because they are told the tongue tissue will reattach if they do not. However, other countries, including most notably the UK, tell parents to keep their hands away from baby’s mouth because any attempt to stretch can cause infection and is actually telling the body to create more scar tissue under the tongue as a healing mechanism against the manual stretching, which is the “reattachment of tissue” American doctors say must be avoided by stretching. Basically, you can cause the tissue regrowth you wish to avoid by stretching… If you push on an open wound, your body’s natural reaction is to flood that area with restorative cells to build back the tissues. Same if you cut yourself open on a sharp object, your body wants to fix that cut and mend it quickly by scabbing over. When I heard this concept related to frenectomy, it blew my mind, and if I have to do this again with a future child, I will not touch inside their mouth post-procedure. Breastfeeding is the perfect recovery tool for frenectomy because it teaches the tongue to be used the way the tongue needs to be used in the mouth, which is by expressing breastmilk.

3. Don’t put too much weight into weight percentile curves.

A child who is gaining weight may not gain weight at the same rate as the average child in the United States on a weight percentile curve. I wish I would have known that sooner. I should not compare my child’s growth to another child’s growth, not even her older sister. Her sister was a much different baby, born a different weight with growth at a different rate. Both are healthy developmentally, reaching milestones in due time. One of the best growth factors to examine is infant head circumference, which tells you the brain is growing well! Compare your baby to your baby; rather than compare apples to oranges, compare apples to apples.

The title of this post is tongue-tied and speechless, and perhaps you’re thinking now, “Cassie, you don’t seem so devoid of speech on this topic…” While I have a lot to say, I will tell you in those hard days when I was trying to figure it all out, I wanted to read this sort of an honest story from another mom. I sought like-for-like experiences out after the fact, and they exist in plenty. Breastfeeding aversions are not as uncommon as many think, despite what your provider may share with you. Mothers are trusting that their pediatricians know best, assuming the provider follows up with every family who has undergone infant frenectomy and therefore knows aversions to be uncommon. But providers are busy, and they just haven’t done that follow up work. Perhaps a firsthand experience like ours gives a different perspective at the very least, and at most, provides empathy to those with the same experience as us.

Mama Knows Best Top Tips:
What to Ask Your Pediatrician Before Frenectomy

• “What are my options?” Check on the different procedure instruments available. Be sure to know whether the pediatrician uses traditional pharmaceutical numbing agents, or if instead herbal remedies are available to help with active and post-procedure pain.
• “What outcomes have you seen in patients who do and do not perform stretches in real life?” What is the pediatrician’s overall philosophy with the tongue stretches post-procedure? Ask about the “Sleeping Posture Tongue Hold” and whether they believe that can take place of invasive stretches (this hold technique is the one “stretch” I’d consider for a future baby with frenectomy and doesn’t involve your fingers in their mouth at all). Are there circumstances the pediatrician doesn’t recommend wound reopening?
• “Do you follow up with families post-procedure for statistical results indicators?” It would be well-worth your while to see if the pediatrician has tracked rates of breastfeeding aversion, issues with oral or facial sensitivities, and how often reattachment is truly occurring with patients who do and do not stretch the wounds post-procedure.