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Who intervene in a Tongue-tied release?

"It is NOT just a cut."

I keep telling this to parents when they're about to go through a frenectomy (tongue-tied release) process.

"Don't expect your baby's latching problems will disappear right after the procedure."

Your baby needs to re-learn how to use his tongue.

Just imagine you broke a leg and you had to wear a cast for three weeks. After the doctor removes the cast, you must go through physical therapy to strengthen that leg. Now, with the tongue happens the same. The tight frenulum under the tongue restricts your baby's tongue mobility, and that weakens this important muscle. In other words, after the frenectomy, you're giving your baby the tools; now we have to teach him how to use them. That's why in this process, all these specialists must intervene and work together in beautiful gear to help your baby to reach his tongue's full mobility.

The IBCLC: The lactation specialist is usually the first one to recognize the oral restriction. She'll guide parents through the process of release and identify the other specialists. In addition to that, she makes sure that:

- Mother's milk supply is adequate.

- Mother's able to position the baby for a deep latch, and she knows how to recognize a nutritive sucking.

- Baby's placed in a comfortable position.

- Parents are doing the stretches in the right way.

- And she'll show parents re-habilitation exercises to strengthen the oral muscles.

The Bodyworker: Chiropractors, osteopaths, physical therapists, craniosacral therapists, or orofacial myologists are different disciplines that work through a variety of techniques to help the baby liberate body tensions and strength all the muscles (not just the ones in the mouth). Tongue-tie babies tend to suffer from body tensions that prevent them from breastfeeding comfortably. For this reason, a baby who's about to go through a frenectomy should be taken for an evaluation at one of these specialists. These techniques are gentle in newborns and should be performed by a professional with plenty of experience with pediatric population.

The Pediatric Dentist or ENT: These professionals will perform the frenectomy (or release). They have the skills and license to do this kind of procedure. Either by laser or clipping, make sure he has enough experience with tongue-tied babies. Not all ENTs or pediatric dentists have experience with tongue ties. It's essential to look for a professional with enough practice and knowledge in this particular field. Your IBCLC can help you find the right one for you in your location.

After the procedure, the provider should send a baby home with detailed indications for pain management and stretching exercises. These exercises are not fun for the baby, but they're meant to avoid re-attachment of the recently separated tissue. The provider should take the time to teach parents the proper techniques and let them practice them in the office until they feel comfortable doing it at home. Follow-ups are also crucial in this process.

Once the frenectomy is done, parents should keep working with the IBCLC and bodyworkers for optimal results. Usually, a few more sessions at each are all it's needed.

If the baby's breastfeeding or parents are looking to bring him back to the breast, they should follow up with the IBCLC 2-3 days after the procedure and until lactation is fully established. The pediatrician should also be informed of the procedure, and the IBCLC should send him a detailed report on her findings.

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