Frequently Asked Questions

Tongue and lip ties can be perplexing problems and can be associated with a variety of signs and symptoms. We are frequently asked questions (FAQs) about symptoms, the treatment procedure, and what to expect after the procedure. We have collected the various FAQs, that we have been asked over the years, and have provided the answers in the three sections below. Each section has various sub-sections you can click through at the top. 

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Please feel free to browse these sections. Clicking on each question will reveal the answer(s). You can also query each section by using the search tool for specific keywords or phrases. If you still have questions after going through these FAQs, please feel free to contact us.

All About Ties

Common Symptoms

What are common signs and symptoms of tongue tie?

For breastfeeding babies: Most moms will complain of breastfeeding difficulties including painful feeding sessions, cracked and possibly bleeding nipples, and babies being fussy at the breast. This is because, in many cases, the baby is unable to latch well enough to drain the breasts. This lack of milk transfer is related to the limited ability of the tongue to lift, lateralize and extend, which are precisely the movements that are necessary to create a proper latch. Babies tend to eat frequently for long periods of time (30-45 minutes), may show poor weight gain, or reflux symptoms, or be overly gassy. Some babies may have swallowing difficulties and /or have associated torticollis. For older infants: you might see issues with additional problems with feeding. Babies might have a hard time transitioning to solids, they may gag/ choke on pureed foods, puffs or wafers. They may not want to try new textures of foods. Some infants can still experience reflux, or have a lack of good sleeping habits as evidenced by by waking frequently at night. Some may have difficulty transitioning to sippy cups. For toddlers: you might notice that all or many of the above symptoms were present when they were growing up, and now that your child is growing he / she may experience difficulty articulating certain sounds. Toddlers will also continue to be hesitant on trying new textures of foods. Kids at this age can start to show symptoms of hyperactivity or other behavioral problems due to lack of proper sleep cycles. Some toddlers or young kids with will be very noisy breathers as well. For additional details check out the signs & symptoms page



Can colic, excessive gas, fussiness, or extended feedings improve after a procedure?

Several studies have shown that a frenectomy procedure usually helps improve feeding difficulties. Some of these difficulties may include: colic like symptoms, air intake, and excessive fussiness and shorter feeds. Although we cannot guarantee that the procedure will be 100% successful for all babies, in most cases many babies feed better right after a procedure and continue to improve because their tongue is no longer working against the resistance of a tight lingual frenulum. Breastfeeding babies tend to improve after a short period of time, as the muscles that were restricted must learn to work in a new way. Former muscle memory fades as the tongue becomes stronger and utilizes its new, full range of motion. Careful attention to the details of good positioning and latch as well as working with an IBCLC and/or Myofascial/CST specialists can enhance this process.



Do high palates cause similar difficulties in feeding? How long does it take high palates to flatten out?

High palates are commonly associated with tongue ties because of embryonic developmental processes. Having a high palate may contribute to poor suction and ineffective coordination between the tongue and lips. Athough there are no studies that have evaluated how long it may take for palates to flatten out, but clinically we have seen that a good percentage of them flatten out over time. We also, very commonly, see that children with tongue ties need orthodontic work and palate expanders.



My child has thrush, clicks when feeding, and I have severe nipple pain - could it be related to tongue tie?

"My PCP informed me that they did not find any significant impairment of my child’s tongue and did not recommend the procedure. However, my older children had tongue ties which improved after the procedures in the past. Hence, I am unsure if my current issues with breastfeeding my little one are due to the tie or thrush. Any advice?" Clicking in itself is not a problem, but it can be a sign of a problem. The presence of thrush may be resposible for some of these issues. We recommend visiting your PCP to check for a possible thrush. If your child is being treated for thrush, we recommend either dropping the medication in his / her mouth or rubbing it with a towel and/or cotton swab. If child’s tongue has good range of motion, it may be their latch is a bit off and on top of the thrush, they are not doing a great job at sucking. So, this can definitely be a contributing factor. Often milk residue seen on the tongue, because of a tongue tie and high palate can be falsely diagnosed as thrush and will not respond to any treatment, as it truly is not thrush. It would be a good idea to get in touch with an IBCLC to work on latching and continuing the treatment as suggested by your PCP. We will be happy to evaluate the problem and guide you. If we see the presence of milk residue due to high palate and tongue tie, appearing as thrush, we can recommend appropriate treatment steps for it.



General Info

What is a tongue tie?

Tongue tie (TT) is a small band of mucous membrane (a frenulum) and / or a fibrous tissue that connects the middle part of the tongue to the bottom part of the mouth. Some children are born with fusion (either partially or completely) of the tongue to the bottom of the mouth. People often refer to this abnormality as being "tongue-tied." The technical name for tongue-tie is ankyloglossia.



What problems can a tongue tie cause?

Tongue-tie can cause restriction of movement of the tongue which can cause various problems throughout a human’s lifespan. In babies it can cause problems with breastfeeding and / or bottle feeding because the tongue is restricted in its natural movement of sucking and transferring of milk from the breast or the bottle. With breastfeeding it can often cause nipple pain, latch problems, and poor weight gain amongst many other symptoms. Different problems may also occur later in life, such as speech problems, dental complications and breathing problems.



What are some considerations for releasing a chlid's tongue tie?

Thre are a number of signs and symptoms which can be relieved or significantly improved by clipping of the tongue-tie (also called “frenotomy or frenectomy). It is a safe and effective treatment for tongue ties and several studies have shown that it usually helps improve breast feeding in babies. The procedure can also help with issues related to speech, breathing/sleeping, and/or dental complications.



What does a tongue tie release procedure involve?

Frenectomy (also referred to as the "procedure" for tongue tie), is done at the bedside in our office and entails the following steps and possible risks. For Infants: The baby is restrained in a papoose board and then given local anesthesia prior to the procedure to numb the site. The tongue tie tissue (frenum) under the tongue of the infant’s mouth is then cauterized using a laser. The procedure itself is very brief and the infant can go straight onto the breast afterwards (or bottle as the case may be). Many mothers feel less nipple pain and a better latch almost immediately. After the procedure, no special care (other than exercises) is needed, though most infants may feel pain for 1-3 days, which is resolved with Tylenol and/or Arnica (a homeopathic treatment). For older children: The child is restrained in a papoose board or made to lie on a table (depending on their age) and given a local anesthesia prior to the procedure to numb the site. The tongue tie tissue (frenum) under the tongue is, then, cauterized using a laser. The procedure itself is very brief and the child is taken straight back to the parents. After the procedure, no special care (other than exercises) is needed, though most children may feel pain for 1-3 days, which is resolved with Ibuprofen (Motrin or Advil) for children older than 6 months of age, Acetaminophen (Tylenol) and/or Arnica (a homeopathic treatment). Risks: Although it is a minor procedure, as with any surgical intervention, it does have some risks, including but not limited to, infection, bleeding, pain, allergic reactions, temporary numbness, injury to the mouth, or reattachment.



Up to what age do you do tongue and lip tie releases?

Here at Agave, we release tongue and lip ties up to age 18.



Can you recommend books about tongue tie? How can I further research them?

There are many informative articles, abstracts, and reviews in scientific literature about tongue ties. To find material such as this, try searching Google Scholar (or other academic search engines) for keywords such as “lingual frenectomy”, “ankyloglossia”, or “tight lingual frenulum”. A very good book that we recommend is “Tongue Tied,” by Richard Baxter, DMD. Dr. Agarwal has written the Foreword for this book. Many families, rather than reading scientific articles or authoritative texts like the book above, gather information on tongue ties from Facebook support groups and friends. There is value discussing issues like tongue ties in these “mommy communities”. However, such conversations lack the scientific rigor associated with clinical investigation and experience. In fact, many of these Facebook groups are hijacked by a few very vocal responders who advertise their biased viewpoints as the truth. These opinions are often not clinically sound. We strongly recommend that you seek the opinion of professionals who are well-versed and have experience in the diagnosis and management of issues related to tongue ties. You can also click on the 'For Health Professionals' tab on our website, in order to view the research we have listed on tongue and lip ties.



Speech

Are speech delays related to tongue tie, or could it be just a developmental thing?

This could be a mixture of both. Does the child try to say the word, but it just doesn’t come out well, or are they just babbling in their own language? Tongue ties usually inhibit the child from making certain sounds since the tongue can’t move appropriately, but it doesn’t delay the actual use of words. However, if you are concerned, you should definitely see if your PCP can refer you for a formal speech evaluation which can help to assess if the child just has minor language quirks, or if there is an issue that is causing the sounds to not come out correctly.



My child was diagnosed with a tongue/lip tie at our consultation; however, we were told to obtain an official speech evaluation prior to having the procedure done. Can issues with muffled words and tongue tie improve through speech therapy?

Obtaining an formal speech evaluation allows you to see whether or not the child’s speech is delayed, or physically restricted by the tie. Also speech evaluation and therapy is very important because the procedure itself is only one part of the picture. Being able to use the tongue properly depends on retraining the tongue and oral muscles to make correct sounds. Hence, helping the tongue move and participating in speech therapy, can enhance the success of the procedure. Furthermore, working with a speech therapist can help if there are sensory issues, and also with post procedure exercises.



Upper Lip Ties

Can you tell me about the upper lip tie procedure? Is it similar to the tongue tie procedure?

The upper lip tie procedure is typically done just like the tongue tie. Recovery is typically much less painful than the tongue, because there is more movement of the tongue with oral function than the upper lip. Exercises are also easier because you have to lift and separate the lip from the jaw, and do not have to deal with the jaws. There are many babies, toddlers, and young children with upper lip ties that experience no issues. This is why we recommend you watch and wait if it is not causing any symptoms at the time of the tongue procedure or until there is a medical issue before having a procedure done. If your child is still experiencing some issues, feel free to schedule a Consult Appointment with us at (480) 585-5200. Or email us at tonguetie@agavepediatrics.com.



Can a tongue tie procedure and an upper lip tie procedure be done on the same day? If so, what are the pros and cons?

Keeping in accord with ‘The Agave Approach’, we are conservative and minimalists. We want to give you the highest chances of achieving your goal, with the minimal intervention. If the procedures are done at the same, this will cause more pain for the child, as well as the necessity for more exercises to be done (both tongue tie and upper lip tie require their own post-procedure exercises), which may make keeping up with them more difficult. We have seen in our experience that both procedures do not need to be done at the same time for improvement of symptoms. Hence, we like to perform one procedure at a time, usually starting with the tongue tie. The majority of expected improvement in symptoms can be achieved by performing the tongue tie procedure only. After the tongue tie procedure, we schedule a two-week follow up appointment. This appointment is to evaluate healing and symptoms improvement as well as determine whether there is a need for additional treatment, which may include a redo of the tongue tie, or an upper lip tie procedure. In certain clinical or social situation we do suggest performing both procedures at the same time, especially in older children. Please note that we are NOT opposed to doing both procedures at the same visit. In our vast clinical experience, we just have not seen the need to do them together as a routine. Roughly 50% of children will end up needing both the procedures, while the other 50% will not need the lip tie to be done. There is no real way for us to predict whether your child is going to need the upper lip tie procedure or not, just yet. We are involved in research to answer this question, but do not have any results just yet.



Why is Dr. Agarwal hesitant about doing both procedures together?

Most babies have a tight lip tie in addition to their tongue tie. In our experience, not all babies will need the upper lip released (one study noted that almost 100% of babies have a degree of upper Lip Tie, which makes it a part of the normal anatomy). Many of the symptoms that are causing the difficulty with feeding can be eliminated by just performing the tongue release. So, performing one procedure initially and seeing how things improve before adding another, to the recovery process, seems prudent and clinically sound. Also, some babies are sensitive and can sometimes have a difficult time relearning to eat after the tongue release, adding two painful areas can slightly increase the chances of oral aversion, reattachment, and longer difficulties with breast feeding. Hence per the “Agave Approach” of “do no harm”, it seems to be the best practice to perform one procedure earlier and then reevaluating. The intent is not to do, or not to do the procedure, but to ensure success with the symptoms that your child is experiencing. We have been able to achieve this by spacing the procedures, and hence this is our recommendation. Although every case is different, and Dr. Agarwal will weigh the risks for each patient and decide with the family the best approach.



What are the indications for getting both procedures together?

This is an excellent and frequently asked question. Over the years, we have discovered that there is no absolute way of knowing whether a child is going to need only a tongue tie release, or both the lip and tongue tie release. In our office, we usually suggest doing the tongue first, especially with breastfeeding, because it addresses 80% of symptoms in most babies. Afterwards, 50% of families will go ahead with the upper lip procedure while others have complete resolution of their symptoms and do not need it. Clinically, there is no way to predict if symptoms will be improved with either of the procedures. We have done scientific research on this and the results are inconclusive as to if they should be done together or if TT should be done first. We also take many other considerations which include risk vs benefit, particular clinical or social situations, etc. This situation is best addressed at the time of the consult. We do not suggest automatically performing both procedures at the same time.



What is tongue tie recovery like compared to lip tie recovery?

The recovery after a lip tie procedure is usually easier on the babies compared to the tongue tie procedure. This is because by the time the babies have had the lip tie procedure done, they have already had the tongue tie release done. Because of this, they might have some kind of comfort/familiarity with the exercises that were previously used. Also, the movement of the upper lip is less compared to the movement of the lip, hence there is less pain. The pain management remains the same, as pain lasts on average for 3-4 days. Very rarely, some parents have reported more discomfort after the lip tie as opposed to having more pain after the tongue tie



Should my child get an upper lip tie procedure for dental reasons?

Research has shown that issues can arise from an ULT in regards to poor seal on the breast and/or bottle, dental hygiene, and spacing of teeth. If you are still breast or bottle feeding your child, take notice to whether or not your child has difficulty with flanging their upper lip, where it seems that they suck the upper lip in while feeding. Symptoms may include: popping on and off breast or bottle and/or parent needs to adjust child’s latch frequently during feeds, etc. If your child has had their tongue tie released, and is still showing symptoms of a shallow latch, they may benefit from an ULT procedure. As your child’s teeth begin to come in, some with an ULT present may show a significant spacing in between their upper two front teeth. Although, a gap can close as the mouth grows and more teeth come in which push the teeth together. With older children, some might begin experiencing pain with brushing their teeth secondary to an ULT. This could eventually lead the child to not want to brush their teeth and develop dental caries or deposition. If your child has this spacing in between their teeth and/or starts/continues with pain with brushing of teeth, they may benefit from ULT procedure.



The Procedure

Pre-Procedure

My child has their consultation tomorrow. Any advice/suggestions before the appointment?

From the time you schedule a consultation appointment with a provider to your final follow-up appointment, you and your child will be cared for with the utmost skill and compassion by each of our specialists! Prior to your Consult Appointment, we recommend writing a list of questions you may have and make sure you get those answered at your visit. During the Consult, we discuss the procedure and the indication in-depth and you will be given a significant amount of information and you can ask all your questions. Sometimes this information can be a lot for the families and hence we suggest that you do as much reading prior to the appointment. There is a lot of ‘misinformation’ on the internet also, and you may want to ask your questions rather than solely relying on opinions expressed on the net. Please arrive at least 15 minutes prior to your scheduled appointment time. Consults are done in a holistic manner and include a symptomatic and anatomical diagnosis of tongue-tie by one of our certified nurse practitioners or Dr. Agarwal. Your child will be thoroughly examined with additional attention to the structure and function of their oral cavity including the characteristics of the tongue; attachment of the frenulum; muscular tightness; and, a complete physical examination including the midline assessment of the baby’s spine and diaper area. They will also discuss the risks and benefits of the procedure, as well as what the aftercare involves. While you are considering the procedure, we recommend that you begin doing the Pre-Procedure Playful Exercises (under “Pain Management” tab) to help your child get familiar with having your fingers in their mouth several times a day. Parent education about the procedure is an important component of our program. Your preparation is a necessary and important part of your baby’s treatment process and healing! The ‘Agave Approach’ allows time for parents to absorb information and receive ongoing support as treatment is undertaken. Our aim is to make you comfortable with the procedure and after care, before the procedure day, hence after your consult appointment, we encourage you to watch our videos again and take your time to make your decision. You may come up with more questions, which we will be happy to answer on the day of the procedure.



What should I expect on the procedure day? Should I bring anything?

On procedure day, please remember that your child can eat up to 30 minutes before your scheduled procedure (this includes: breastfeeding and bottle feeding for infants, and any food or drink for older patients). After that, please refrain from breastfeeding/bottle feeding and any food or drink. For infants 12 months or younger, you may also bring a receiving blanket for your baby to be wrapped in for the procedure. The familiarity of their own blanket can be comforting. Please understand that most babies do cry because they don’t like being held still. This is temporary, and your baby will be returned quickly to your waiting arms! For older children a blanket, their favorite toy or something that comforts the child is also helpful. Dr. Agarwal will review and answer any questions you have BEFORE the procedure. The procedure will be completed by Dr. Agarwal. He and/or our staff IBCLC will also demonstrate the Post-Frenectomy Wound Care Exercises for you. The use of a Class IV Laser instrument by a skilled, trained provider results in a safe treatment. As a medical office, we are governed by OSHA safety standards; and we have safety protocols in place to reduce or eliminate the risk of injury due to accidents. In keeping with our safety protocols, parents are not allowed in the procedure room.



Why do we have a consult, procedure, then follow-up?

Agave Pediatrics, under the direction of Dr Agarwal, is one of the leading specialists in the country in the management of tongue and lip ties. We have developed a standard of practice that is now followed by other practitioners too. Tongue / lip tie releases are considered surgical procedures, and while the procedure itself is very quick, there still needs to be a full assessment of your baby or child prior to performing any surgical procedure. This standard of practice of having a consult done by one of our very knowledgeable practitioners to fully assess your child, assess their symptoms related to the tie is necessary to fully assess the function of the tongue and lip, and to discuss the entire procedure and the after care. We want all of our parents to be completely informed of why or why not the procedure is indicated, risks and benefits, and take the time to answer any questions. You then have the ability to go home and make sure you are comfortable proceeding with a surgical procedure and your appointment is scheduled. You then come back for a follow up, just like you would any surgical procedure to make sure things have healed well, and to make sure symptoms have improved. While we know it can be a very stressful time having a baby who is struggling to breast feed, or feed in general, we want to make sure we are providing procedures safely and each baby or child is looked at from all angles, not just their tie. We have done research at Agave pediatrics, which has clearly showed that doing the procedure after a consultation significantly decreases maternal anxiety. Parental anxiety is one of the most common reasons for failure of successful outcomes after the procedure. By decreasing the anxiety by separating the consult and procedure, we have been able to reach success in symptom improvement in a large majority of our patients. Having said the above, in certain situations we offer same day Consult and Procedure, because every situation is unique and we try to individualize our care.



What is the best age to get the procedure done?

The ideal age for the procedure is when you start seeing problems associated with limitations in tongue movement. Specifically in breast feeding babies, if there are issues associated with breast feeding, research done at Agave (and corroborated with other studies) have shown that a procedure done within the first couple of weeks is most effective in improving the symptoms. Having said this, it is extremely important that there is a clear functional impairment established by your provider, before the procedure. For the breastfeeding dyad it is also important that the baby have a lactation consultant, and body worker before the procedure because often enough, these interventions may mitigate the need for this procedure. We are particular about establishing a need for the procedure by doing a thorough evaluation as this increases the chances for improvement after the procedure. It is important to make sure that children who benefit from the procedure get it done at the right time. At Agave, we do not suggest getting elective procedures.



I have been told by an IBCLC that if I do not get an immediate frenectomy/procedure, my breastfeeding will not take off. Is this true?

This is a major difference of opinion in practice between Agave and other offices. We strongly believe in a thorough evaluation which may take a couple of days for appointment rather than an immediate frenectomy without a thorough evaluation or established need for frenectomy. We do not suggest that frenectomy be performed until the milk supply has been established and we know that the tongue tie is causing impairment in transfer of milk. We have done research at Agave which shows that the appearance of the tongue is not a measure of the severity of the tongue tie or the need to do the procedure as soon as possible. We do suggest the procedure be done quickly once the diagnosis has been established by demonstration of impairment of function. One of the biggest determinants of breast feeding success after frenectomy, is the presence of improved maternal milk production. Doing the procedure right away often increases maternal anxiety to an extent that it can reduce milk production. We strongly believe that early on, measures should be taken to decrease maternal anxiety, and increase maternal comfort/milk production by making sure the family is fully informed. Utilization of breast pumping is also very important early on, so that the mother continues to produce breast milk and has good success when the baby is ready to transfer the milk, post-procedure. We have shown that a consult/procedure will answers all questions and this decreases anxiety and thus increases milk production which makes the procedure more successful. Having said this, there are definitely exceptions to the rule where we have suggested very early frenectomies, especially for families who have been through this before and have a level of comfort for the procedure. Every family and child is different and deserves an individual evaluation for their particular spectrum of clinical symptoms.



Why does my baby need to be 1 month old or have had a Vitamin K shot before the procedure?

We require the Vitamin K shot to be administered prior to a frenectomy procedure to avoid preventable bleeding. At birth, many newborns do not have adequate levels of Vitamin K in their body. Vitamin K is a hormone which is required for blood clotting. As the baby grows, the bacteria in the baby’s gut produces Vitamin K. Over time it is absorbed and normal levels are established in the body. As a frenectomy is a surgical procedure, there is a possibility of bleeding associated with it. Bleeding associated with tongue tie may happen because of anomalous veins, which uncommonly occur in the area; or from the deficiency of Vitamin K. As previously stated, we are typically able to prevent this bleeding with the Vitamin K injection given to all babies at least 12 hours before the procedure. Thus, we can ensure that any bleeding which occurs is not from Vitamin K deficiency. Many of our families prefer to do oral Vitamin K as opposed to injectable Vitamin K. However, it is well established in the scientific community that injectable Vitamin K prevents the often debilitating intracerebral late onset hemorrhagic disease of the newborn. Studies over the years have not established the bioavailability of oral Vitamin K; therefore, we require our babies to have received this injection prior to the procedure because we are also concerned about the overall health of the child. There is only scant evidence which is able to identify when Vitamin K levels in the body are normalized; but, the evidence suggests that it normalizes by 2 weeks to 2 months of age. At Agave Pediatrics, we have chosen the median time for this to be about a month.



Day of Procedure

What will I experience on the day of the procedure?

On the day of the appointment, please arrive at your designated time. You can feed your baby upto 30 minutes (or earlier) prior to your appointment, but please do not in the office. You can feed the baby immediately after the procedure. Dr. Agarwal will come in and see you and the baby, the medical staff that assists with the procedures will take the baby into the treatment room and get the baby swaddled. Dr. Agarwal will inject a small amount of numbing medicine (lidocaine) into the area being treated for release by laser. The laser is used for ~10-20 seconds and then the same medical staff brings your baby right back to you. Dr. Agarwal will come back to see you and answer any questions. He will show you how the tongue moves and let you know how the procedure went.You will be encouraged to feed the baby immediately after the procedure. They will also discuss the risks and benefits of the procedure, as well as what the aftercare involves. While you are considering the procedure, we recommend that you begin doing the Pre-Procedure Playful Exercises (under “Pain Management” tab) to help your child get familiar with having your fingers in their mouth several times a day. Parent education about the procedure is an important component of our program. Your preparation is a necessary and important part of your baby’s treatment process and healing! The ‘Agave Approach’ allows time for parents to absorb information and receive ongoing support as treatment is undertaken. Our aim is to make you comfortable with the procedure and after care, before the procedure day, hence after your consult appointment, we encourage you to watch our videos again and take your time to make your decision. You may come up with more questions, which we will be happy to answer on the day of the procedure.



Am I allowed in the procedure room with my child?

It is a very short procedure and the baby is only away from the parents for 5-10 minutes. You child will never be alone, as there are always at least 2 people with them the entire time. We do our level best to comfort the baby by swaddling them as needed, giving them a pacifier (if that’s what the baby wants), singing to the baby, and ensuring they are as comfortable as possible. In the past, we have allowed parents to be in the room for the procedure. However, at this time we do not allow parents to be there. In the past, parents have stated that it is very emotionally trying for them to see the procedure. Some moms have even worried that they might lose their milk supply because they were so stressed out. We have also had parents who have said that they have felt dizzy. We then had to take care of them before we could perform the procedure. This unnecessarily delayed the procedure and caused extra stress on the baby and the parents. For older children, we have consistently noted that children are more compliant with our instruction when parents are not present for the procedure. We ask that they keep their mouth open for 45-60 seconds. This period of time is open much longer when parents are present because the children are distracted and unable to follow instructions.



Why is silver nitrate sometimes used during the procedure? Does this change the recovery time?

The lingual and labial frenulum areas where we work usually do not have any veins. Hence, these procedures are almost always blood-less (except for very mild ooze). However, your baby may have an anomalous vein in the area and that can bleed during the procedure. Bleeding is very rare during the procedure, for any reason if this does happen, we have been using silver nitrate sticks to cause local cauterization to help bleeding. This has helped in almost 100% of the cases. After the procedure if silver nitrate has been used, you will see a black and grey area at the site. This should be of no cause for concern. The black area will slough off in the next couple of days. If there has been bleeding and silver nitrate has been used, we advise parents to defer from exercises for the next 24 hours. After that you can start regular exercises. We have not seen any increased incidents of bleeding with the exercises after silver nitrate has been used. Silver nitrate itself does not cause any pain, and though we always recommend good pain control, in our clinical experience we have not known children to need extra pain management after it is used.



What is the worst case scenario if I don't get the procedure done?

The diagnosis of tongue tie is dependent on functional deficit. As this entity is relatively newly described and has not been treated in the recent past, there are many adults (and their family members) who have tongue ties. Over the years, these individuals have learned to compensate for the dysfunction (limitation of tongue movement) associated with tongue ties. In other words, people often grow out of the symptoms that their tongue ties cause. With the body of evidence and experience that we have now, we suggest that the release be taken care of at the time of diagnosis. In the same way, do not recommend that a tongue tie be electively released in the absence of symptoms. Human bodies are amazing machines and compensate for many major issues, including limitation of the tongue movement. Many children with tongue ties may have manifestations associated with tongue ties appear at different stages of development from children to adulthood. Literature is still coming in about the effect of tongue ties in adults which include speech, dental, and feeding issues.



Can my baby be given immunizations after the procedure? If so, when?

Your baby can receive immunizations at any time after the procedure. Additional fussiness may occur; however, it is generally temporary.



After The Procedure

General Questions

How should I prepare for recovery after the procedure?

Initially, your child’s mouth will be numb at the site of the procedure. This will last for approximately 2- 4 hours. Please prepare to ease your child’s discomfort by having pain medication on hand. Stay ahead of pain for the first day, using Tylenol and/or Arnica (and Ibuprofen for children older than 6 months of age) as needed. We recommend having at least 2 of the 3 medications as above, on hand so that you are already prepared on procedure day! If you have traveled a distance of a couple of hours, please consider bringing Tylenol or Ibuprofen (depending on what is appropriate for your child) so that you can give a first dose before traveling home. You can time the medications, so they will be at peak effect for the therapy sessions. Also make sure to not skip the stretches after the procedure has been done, as these are essential to prevent reattachment of the tie(s).



When can I do the post procedure exercises?

You may start these exercises 6-8 hours after the revision, unless given different instructions by Dr. Agarwal. If there is any bleeding after the procedure, Dr. Agarwal may have to use silver nitrate locally to control it and you will be instructed to not do exercises for at least the next 24 hours.



Can I breastfeed or give my child a pacifier after the procedure?

Of course! You may feed your baby directly after the procedure and give them a pacifier if needed. If you are bottle feeding, have your bottle ready post-procedure. After the procedure, our staff IBCLC will guide you to a Lactation Room. Our Staff IBCLC can also demonstrate the exercises if needed. Pain management and wound care will be reviewed with you, as well. You will be encouraged to feed while onsite so that baby is as comfortable as possible for the trip home. Older children can be given their regular diets after the procedure. Cold foods and beverages, ice creams and popsicles are particularly comforting to children as they temporarily numb the area.



Should we use coconut oil after the procedure?

After a tongue and/or lip tie revision, we do not recommend using coconut oil because this may cause faster healing of the tissue and the tongue tie might re-attach. In addition, the application of coconut oil requires you to go onto the wound, but we want you to go AROUND the wound when dealing with the tongue tie site. In the past we were suggesting the use of coconut oil on the wound and one of our older videos on exercises still has it there, but since we have not found this practice to be useful and do not suggest that anymore.



How long before the white patch of skin under the tongue/lip stops looking so prominent? What is the white stuff?

Right after the procedure, the wound is going to look slightly reddish and may have a very small amount of bleeding which can be seen as pink saliva. Very often, you cannot even see the wound because there is no bleeding and the red color associated with the procedure is minimal. However, starting the next day or so, you will start seeing the wound covered with a whitish or yellowish membrane. If your child is significantly jaundiced, this film may appear almost look fluorescent yellow or even sometimes slightly greenish. This is the healing tissue of the body which you would see covering any kind of oral ulcer. This area usually looks like a diamond and serves as a good landmark for where to stretch the wound. Sometimes during the stretching exercises, there may be minimal bleeding, but other than this, bleeding almost never seen. You don't need to go over the wound to remove the white tissue. But if you happen to go over it, either on accident or during exercises, the whitish film may slough off and you will see a clean looking wound below it with a whitish base. Do not panic, this is normal. Over the next 4-5 days, the white diamond tissue will start getting smaller. If it starts looking like a straight horizontal line you will know there is some reattachment happening, You should do more stretching to keep the diamond shape. By about the 7th or 8th day, the film usually sloughs off and you will start seeing light, pink area below the tongue. What we want to see is a diamond shape, though lesser in size. You still need to do exercises after the wound is not seen and takes the color of the normal mucosa. This can happen anywhere between 10 days to 3 weeks.



Is my child's personality going to be affected by the procedure? Are they going to be miserable during the healing process?

This is a really good question. In the first 3-4 days after the procedure the baby may show signs of pain and discomfort. We suggest aggressive pain management with appropriate medications and other modalities including skin to skin contact, soothing activities like baths, breast feeding, singing and cooing, gentle touch, and light swaddling. This seems to work very well for the majority of the babies. Many families do not want to use any medications for pain and that is an option. However, depending on your child’s affect, we suggest that if the child seems to be in pain, medication should be administered so that we minimize the chances of breast aversion or later feeding difficulties. Pain associated with the procedure is a normal phenomenon and does not mean that there is a complication or infection. Once the pain associated with the procedure subsides the babies usually get much happier as they are able to feed better. Every child is different and some do not need any medications, while some need around the clock medications for the first 3-4 days. There is no way to see beforehand which category the baby will fall into. Pain after the 5th day is unusual. If they seem to be in significant discomfort after the 5th day we suggest you call the frenectomy provider and get the child evaluated. We have often seen that when parents change feeding patterns from exclusive to exclusive breast and the babies do not adapt well and the frustration the baby expresses may be perceived as pain. The baby will continue to have some discomfort with the exercises for the remaining 6 weeks, but should not be in frank pain and shouldn’t need any medications except if the wound has been reopened for any reason. It is very important that parents be emotionally ready to handle the baby’s pain as we have often seen that parents react negatively to the perceived pain in the baby and in turn, will stop doing exercises. This results in increased chances of reattachment. It is extremely important that parents are aware of, and comfortable with the pain management strategies after the procedure. It is very interesting that in a large percentage of cases babies who were perceived as fussy and clicky pre-procedure over the long run become very happy and amiable afterwards. This is a frequently noted observation in our practice.



My child had the procedure a few days ago, but has started becoming more fussy today and resisting the exercises. Is this normal?

Yes, this can still happen because the nerve endings are still irritated. For most children, the first 24- 48 hours are the hardest, however after day 3, the discomfort usually begins to subside as the inflammation starts decreasing. Staying on top of pain management is very important. Call if you are still having to use Acetaminophen or Ibuprofen 4 times/ day, past 3 days, as we may need to change the after-care instructions. After the first 3 days, we still suggest giving the pain medication for the pain, (Tylenol, Arnica, Ibuprofen), but only as needed.



My pediatrician and my family does not know about tongue/lip ties. What can I do to help other parents and babies avoid going through what I had to go through?

Advocacy is a very important part of our tongue tie program. The connection between a mother and the maternal community is extremely strong and invaluable. We suggest that you reach out to other mothers through social media mom groups, friends, and family and share your experience. This does not mean judging your pediatrician (as they have not been trained for handling tongue ties). Sharing the information is vital, in this day and age you can become an agent of change and help many other mothers to breast feed or help children to improve their speech. You can also talk to your pediatrician and share your story with them. We have been very fortunate already from moms sharing their stories with the community. In the past years, some of the fiercest critics of Agave have become some of our strongest supporters. We often ask mothers for testimonials, attendance to summits/lectures because they are able to share their personal experience with the audience. If you would like to help out with this, please reach out and let us know. It can be very important for other providers and mothers to hear your story.



Exercises

Any tips/tricks on how to get my child's tongue up to stretch the wound?

Build on the skills you developed by doing the pre-procedure exercises. If the child has already experienced the exercises before the procedure they are more likely to negatively react to having your fingers in their mouths for exercises. Remember to start with clean, well-rinsed hands. Try to make this a playful routine so that you are effectively stretching the tissue and child’s discomfort is kept to a minimum. These exercises do not take a long time to do; however, they should be done consistently to avoid re-attachment. If your child prefers cold temperatures, you can try freezing teethers or using narrow cylindrical shaped ice cubes wrapped in gauze (like breast milk popsicles). Try to position your child in a way that’s most comfortable for them and you, while giving you access into their mouth. You can position your baby on a stable surface, such as your lap or a changing table so that you can see into baby’s mouth. If helpful, place a rolled up hand towel or receiving blanket behind their neck to help their head flex back, making it easier to see the inside of their mouth. The goal of these exercises is to keep the wound from reattaching. This can usually be achieved through activities that involve elevating the tongue, protruding it (while the mouth is open, versus only sticking it out while lips are still closed) and moving it from side to side.



Can my child sleep through the night without stretches and pain control or should I wake them up?

Preferably the stretches should be done around the clock in spaced out intervals, but we do not want to wake a sleeping baby if we can let them go an extra hour or two. If your baby sleeps 6-7 hours at night, just do a good session prior to sleeping, and as soon as they wake up. It should be noted that many parents have reported to us that the easiest time to do the exercises is when the child is sleeping. Keep in mind that also without waking up for stretches they are not having any pain control at night and might be in a bit more pain when you do the stretches first thing in the morning. We do not suggest waking the child up for pain med if they are sleeping comfortably.



After 6 weeks of exercises, should I keep doing them?

In the human body, healing tissue changes in appearance over a long time. In our experience we have seen that there is a decrease in incidence of reattachment when the exercises are done for 6 weeks. However there is a finite chance that there will still be reorganization of the wound and this attachment may happen. We often see wounds that look like they have reattachment, but over the next several months improve considerable and the movement of the tongue improves. This can go in the opposite direction as well. Wound healing is not a static process, it is dynamic.



My child won't suck on a pacifier or on my finger. How do I do the suck training?

Many babies do not perform “non-nutritive sucking”. A baby won't suck on something they do not find comforting. While some babies won't function without a pacifier in their mouths. If you can try a drop of breast milk on your finger and see if they will suck that way and then try a little tug here and there, it will be beneficial. If your baby won’t suck or just gives up when you start to tug, that is ok, just keep trying.



What tips are there for doing exercises with my toddler?

The best behavioral technique that works for toddlers is that they are easily distractible. A lot of parents are able to play with the child and get them distracted while performing the exercises. Also make sure that the child has adequate pain control on board, because if they exercises are hurting a lot it will be more difficult for parents to distract the child. The exercises can be done is a very playful manner in which the child can be asked to imitate the parents when moving the tongue around. Another game to play to see if the child can lick (peanut butter, jelly, etc. by moving their tongue from side-to-side. For pain management, you can try giving your child colder foods like ice cream or a popsicle. This may incentivize them to cooperate and provide pain relief at the same time.



What tips are there for doing exercises with an older child?

If you have not had the procedure done yet, try to do the exercises 3-5 times a day before the procedure, to allow the child to get used to the exercises and having your hands in their mouth. Start when your child is quiet and non-agitated. Talk them through the exercises. You can have them do the exercises on you for fun and to build more trust and familiarity with them. Using a mirror may provide a visual cue for some children and create an additional element of fun as well. We advise to try doing the stretches while your child is sitting up, like in a bouncer, swing or car seat. This can help make getting the tongue up easier. If your child becomes distressed or upset, please respect their cues and stop the exercises. Make sure to provide comfort and console them. Building trust with your child is very important to avoid oral aversion before or after the procedure! We understand that toddlers and older children can make this process more challenging. Just do your best! For pain management, you can try giving your child colder foods like ice cream or a popsicle. This may help relieve pain near the tongue/lip tie site.



Pain Meds

How long should I expect my child to be in pain?

Proactive pain management is very important. For most babies, the first 24 hours are the hardest. After Day 3, the discomfort subsides considerably. Some babies don’t seem bothered much at all, and others can be fussier than usual for the first 5 days or so.



When should I start pain medication at home?

Each baby metabolizes the numbing medicine (lidocaine) differently so starting pain control before your little one is in a lot of pain is very important. Starting Tylenol (or Ibuprofen or Arnica) within the first few hours of being at home is recommended. Also, keeping on top of dosing will be very beneficial to making sure this transition goes as smoothly as it can. If your baby is at the peak of pain before control medication is started, it can become very difficult to get him / her calmed down enough to eat. So, staying on top of pain is very important.



How soon after the procedure should I give my child pain medication?

For most babies, the first 24-48 hours are the hardest. Staying on top of pain management is very important. We suggest that you may start giving pain medication 2 to 2.5 hours after the procedure. If you have traveled a distance of a couple of hours, please consider bringing Tylenol or Ibuprofen (depending on what is appropriate for your child) so that you can give a first dose before traveling home.



What is Arnica? Where can I get Arnica 30 C?

Arnica 30 C is a homeopathic treatment that can be used for pain relief. There are several formulations of Arnica on the market, but we highly suggest purchasing Arnica 30 C (aka: Arnica ‘Montana’ 30 C). You can purchase this medication at Sprouts, Whole Foods, or Amazon. To use Arnica: Take 10 pellets and dissolve it in 1 to 2 tablespoons of water or breast milk. You may have to manually disintegrate the pills if they do not dissolve. Once made, the solution is good for 24 hours. Once you are able to get the Arnica to dissolve: Give 10 drops of that liquid as needed. For fussiness or inflammation, it can be given every 30 minutes to 1 hour until child is calmed. For preventative use, give once every 3-4 hours or at the time the Tylenol is given. No dosage and effectiveness correlation has been established, and hence the use of Arnica depends on how the child is responding. Arnica can be given every 30 min for up to 5 times, and these can be repeated 2-3 times/ day. Though we have found Arnica to be very useful in taking the edge off the pain, Tylenol/ Ibuprofen provide much better pain relief and Arnica should be used only as an adjunctive medication. Many parents have been able to use just Arnica for good pain control, but that is rare.



Are there any other natural pain relievers I can use?

At this time we do not recommend any other natural pain relief options, but feel free to consult with a naturopath for more information.



Would infant Orajel be useful after the procedure?

After a tongue and/or lip tie revision, we do not recommend using an Orajel for pain relief as that formulation has been taken off the market for the potential complication of causing methemoglobinemia. Instead of Orajel, we suggest the use of Tylenol or Ibuprofen (for children > 6 months old) and the dosage is based on your child’s age and weight. Additionally Arnica 30 C, (a homeopathic remedy) can be helpful.



Is Tylenol safe to use if I suspect my child has the MTHFR genetic mutation?

Many parents are now suspecting this genetic mutation in their babies and concern is starting to spread with social media . If you have concerns, please address them with your provider or pediatrician prior to this appointment. MTHFR is an enzyme. In instances when mutations in MTHFR cause the enzyme activity to be severely impaired, it can lead to elevated level of an amino acid called homocysteine. Buildup of this amino acid may increase the risk of blood clotting and heart disease. With what we know about the MTHFR gene mutations, acetaminophen metabolism is not affected by this enzyme. At Agave, we have a minimalistic approach and prefer not to use any medications, if we do not have to. We do not recommend routine use of pain killers. However if you still have concerns, please discuss them with your health care provider.



Symptoms After Procedure

Is lip swelling after the procedure normal?

This is completely normal because the lip is a soft tissue with limited space, hence injection of local anaesthetic may cause swelling, and as the tissue heals there may be further swelling. Most lip swelling goes down in 2-3 days.



I suspect my child is developing breastfeeding aversion. What should I do?

Breast aversion is a rare occurrence after frenectomy. With the present protocol of the exercises at Agave Pediatrics we have not seen many cases of breast aversion. However it is seen in babies who are already at risk for breast aversion. Such babies may have been poor feeders, or had failure to thrive, or other sensory issues. It can also be sometimes seen secondary to extremely vigorous exercises or poor pain control. If you do believe that your child is facing breast aversion, the first thing you should do is to see an IBCLC who can help you truly diagnose it. If breast aversion is clinically disgnosed, we suggest you decrease the exercises to a minimum, increase pain control, and increase non-nutritive nurturing activities with your baby, such as skin to skin contact. It is very important that the nutrition of the baby is given due importance as this may sometime require bottle feeding, syringe feeding, and in extreme cases, tube feedings.



I see a little growth under the tongue after the procedure. What is that?

Sometimes after the procedure, you may see a granuloma at the site of the wound. This may be consistent with the destruction of a small salivary gland or sometimes hypertrophy of the tissues from exercising it too vigorously. If you see such a growth, we recommend that you bring it to our attention. This is a rare occurrence and in our experience, it generally does not need any further treatment. It usually goes away in a couple weeks to months.



My child has been drooling a lot since the procedure. Is that normal?

Any injury inside the mouth increases saliva production. This is because saliva has healing and anti-inflammatory properties. This is a normal response and should not cause any concern. Interestingly, in many older children who have problems with excessive drooling (due to the inability of the tongue to direct the saliva for swallowing) it is remarkably reduced after the procedure.



My child had the TT/ULT procedure but still has gas/reflux. Is this normal? What should I do?

Yes, this is normal and something that happens after the procedure. This is usually due to your little one being able to suck stronger. Try giving your child gas drops and gripe water to help decrease her gas and reflux, as well as lots of burping during feeds and after feeds, as needed. Also, if you have a carrier, you can use that to help with comfort and decreasing the reflux, as well. If you haven't already, we would also suggest working with a chiropractor/myofunctional specialist. Experts believe myofascial/craniosacral/chiropractic work helps babies latch after a frenectomy. They believe this will help with compensations for when the tongue or lip was not functioning properly. This includes a high tone or low tone suck, clenched jaw, biting, feeding better on one side over the other, and other issues like torticollis. If she is really uncomfortable, you can give her a nice warm bath, or even get in the bathtub with her and feed her that way. We recommend doing this when you have a helper at home so they can help getting in and or if the tub. If this is happening after a TT release and does not improve even after 10-14 days after the procedure, please bring this issue up at the follow up appointment. Your child may need an upper lip tie frenectomy also. Even after the lip tie is released, the muscles might be tight around the mouth and could still be affecting her seal. This may take strengthening of the muscles and process of learning. We suggest continuing the exercises and continued follow up with a myofunctional therapist or craniosacral specialist.



My child had a procedure done but is still clicking. Is this normal?

The clicking itself is not an issue - this just means that the tongue is either still weak, might still have a little restriction, or there is air intake. If everything is going well, the child is eating fine, and isn't overly gassy or having issues with reflux, just be patient and keep up the stretches. The clicking is more of a symptom of the problem than a problem by itself!



Prior to getting the procedure done, I had pain with breastfeeding. These symptoms went away right after the procedure but are now starting to return. What should I do?

If you haven't already, we would recommend working with an IBCLC to help you, and give you specific suck training exercises to try and improve your nipple pain. If you believe the ties may have reattached, ask an IBCLC to evaluate the milk production and milk transfer. If the ties have slightly reattached, they may need to be opened up. If this is early enough in the process, some extra pressure will open the wound, (it might bleed a little, and that's okay, just breastfeed your baby afterwards), but if you think it is anything more than that, please contact our office. Keep in mind that some reattachment is expected but we want to minimize it as much as we can and get functional improvement. Some IBCLCs feel comfortable in stretching and opening the wound. You may want to check this with your IBCLC. If symptoms are still not improving, schedule a visit with one of our nurse practitioners or Dr. Agarwal for further evaluation and treatment options.



Reattachment

At our follow-up we were informed of mild reattachment. When would we consider getting it revised?

We see a lot of anxiety associated with 'reattachment'. When any tissue heals, there is fibrous tissue laid in between the two sides of the wound, which bridges the gap, and it later remodels itself. This happens after tongue tie surgery also. After the TT procedure, the increase in the movement of the tongue (after cutting the thick tie tissue) causes improvement in the symptoms. We expect this improvement to continue, hoping that it heals with new fibrous tissue which is not as tight. In the meantime the muscles also get initiated. Hence we recommend start working with myofunctional therapy even before the procedure is performed and definitely after the procedure. This forms the basis of initial and continued improvement after the tongue tie procedure. As the wound heals, if the symptoms have improved, there is NO need to consider it to be a 'reattachment' even though it may look like the frenum has grown back. Very simply stated, the diagnosis of tongue tie in the first place is dependent on the symptom complex and movement of the tongue, and the diagnosis of reattachment is also dependent on the same. The appearance of the frenum is only a secondary issue. Anatomical 'reattachment' is acceptable to an extent, as long as there is functional improvement. In this circumstance the procedure DEFINITELY does not need to be repeated. If the symptoms have improved, let us not consider reattachment to be a bad word. Hopefully, we have been able to alleviate some concerns.



I am worried about reattachment. Can I post pictures or Skype and get feedback?

Pictorial representation is only a fair representation to diagnose TTs or reattachment after the procedure. Per our ‘Agave Approach’ we refrain from making judgements or evaluating just by looking at pictures, as this can be completely misleading and may make you believe that the baby may need another procedure (when they do not), or missing reattachment and the necessity of performing an additional procedure. Pictures though speak a thousand words, they do not take the place of an in-person evaluation. We are not offering evaluations by Skype remotely.



My child had a procedure done a few days ago.The site is white - does that mean it is infected?

Within 24 hours or so of the procedure, a white diamond shape will be seen at the wound site. This is normal healing tissue, not a sign of infection. You may want to take a picture of this for size reference. (If your child is crying and their tongue is raised, it is fairly quick to get a picture before comforting them!) It is important that you try to maintain the diamond shape with the exercises, until it is completely healed. The edges of the white diamond should stay sharp. If the diamond is shrunken or not even from one side compared to the other, there may be reattachment happening. You will likely be able to release it yourself with your fingers. You may want to give your baby some medication for discomfort if you need to do a firmer exercise to open it up. Some re-attachment is expected, but minimizing it is important for overall improvement. Only do this if you feel reattachment! We want to avoid irritating the wound if possible. Early on there should not be any tissue stopping your finger like a “speed bump” in the fold area. Later in the healing process a small ‘speed bump’ is normal, however it should be much smaller than what your child had before the procedure.



Why does reattachment occur? Could it happen if I am not doing the exercises right?

Reattachment occurs due to the babies’ normal healing process. We can decrease the rate of reattachment by proper exercise. It should be known that it is not possible to prevent all reattachment with exercises as we have seen it occur with or without exercises. However, the incidence is significantly decreased with proper exercise. Hence we strongly recommend them. If your baby has reattachment, it is not an indication that your technique was faulty or you are “not a good parent”. Please make sure that you learn the technique well and do it as prescribed. There are many ways of exercising the wound. The most important and fundamental things which decrease chance of reattachment are stretching the wound and making the tongue move. Please see our videos for further explanation. There are cases in which a tongue which looks to have reattached completely, functions much better than it was functioning before the procedure. In this instance it is not called reattachment.



When does a child's "heart tongue" go back to normal? Is it a sign of reattachment?

The heart tongue can be developmental because that is how the tongue developed in utero. After the procedure, over time, almost all tongues will improve in appearance. However, in severe cases you may still be able to see a small notch at the tip of the tongue, which is to be expected. If after the procedure, the tongue loses its heart shape and in the next couple of weeks starts looking like how it looked before the procedure, it may be a sign of reattachment. Having said this, the most important sign of reattachment is a regression of symptom improvement.



How often are revisions needed after the initial procedure?

The need for a revision after procedure is solely dependent on the function. If you have noticed that the symptoms associated with the tongue have at first improved and then regressed, which may indicate a need for another revision. In our clinical experience we have noticed that there is a decrease in reattachment with proper exercises, evaluation, and treatment by a body worker and IBCLC. We at Agave also receive many patients who have had a procedure with not as much improvement in symptoms and we do our re-evaluations and determine the need for another procedure, after which the symptoms get improved. It is impossible to determine whether this was a partially done procedure or reattachment.



Specialists

How important is it to work with a chiropractor after a frenectomy procedure?

Tongue tie diagnosis is frequently associated with other musculoskeletal issues like torticollis. Because of these issues, we believe it is very important to work with a body worker (depending on your child’s age and symptoms). Body workers are chiropractors (with experience in working with children), myofascial therapists, physical therapists, occupational therapists, and feeding therapists. Pediatric chiropractors do not work by adjusting the baby’s joints, they work on the muscles and their attachments. These interventions are extremely important for successful improvement in function after the frenectomy. Often, just working with a body worker may improve symptoms to an extent that a frenectomy may be either delayed or may not even need to happen. It is very important to seek service from body workers who are specifically trained in oral tie issues in children as opposed to a body worker who only works with adults. It is important to keep in mind that some body-workers have differences in opinions with your regular medical providers on certain health related issues. We highly recommend getting a medical evaluation and treatment for issues within the purview of general pediatrics from a pediatrician. We recommend body work for children with TTs as we have seen improvements associated with a holistic approach. Our recommendation is narrowly focused on this issue and the management of TTs. Please check with your regular primary care providers about continued follow ups with the body workers.



What is all this talk about chiropractic therapy, myofunctional therapy, and craniosacral therapy? What is it for?

When a baby develops in utero with tongue and/or lip ties, it’s not just those areas that are tight; the muscles of the head, neck, face, and back can also be tight. Releasing the tongue or lip tie addresses just one of the muscle/fascial structures - many other muscular areas are still very tight, even after the tongue/lip release. Chiropractic therapy, Myofunctional therapy, and Craniosacral therapy address these issues. Many practitioners perform a combination of these therapies and are highly effective in improvement of function.



When should I see a Lactation Consultant (IBCLC)?

It varies. Some parents see a Lactation Consultant (IBCLC) on the day of the procedure even though your baby may be in pain or very sleepy after the procedure. The 3-5 days after the procedure can be some of the roughest days for your little one, so trying new positioning and new feeding techniques might be overwhelming. Discussing this with a LC on the day of your visit and / or with your provider would be the optimal way to identify the best time to see a LC for a follow up and for trying new feeding techniques.



How should I go about getting an IBCLC?

Post procedure, our own IBCLC at Agave will meet with breastfeeding dyads to review our aftercare protocol, assist with latching the baby, if desired, and review basic, age-appropriate, lactation management. Complicated lactation situations will be referred to your own IBCLC. If you have a relationship with an IBCLC, it is best that you follow with them, as we tremendously value relationships between families and their caregivers. If you do not have an IBCLC that you are working with already, we will refer you to IBCLCs that share our evidence-based philosophy, our safety protocols, and our proven model of care.



Any recommendations for myofunctional/craniosacral/chiropractic therapists?

Experts believe that Myofunctional/Craniosacral/Chiropractic work helps babies latch before and after a frenectomy procedure. They believe this will help with compensations for when the tongue or lip was not functioning properly. This includes a high tone or low tone suck, clenched jaw, biting, feeding better on one side over the other, and other issues like torticollis. At Agave, we have worked with many professionals. Please make sure that your bodyworker is certified in the discipline that they are practicing. We have Ramya Kumar SLP at our Deer Valley location who specializes in myofunctional therapy and craniosacral therapy. Others include: Dara Salzano Dacunha D.C. (Scottsdale), Chrissy Stamm-Christian, D.C. (Phoenix), Thrive Chiropractic--Dr. Shana Gorman-Dunn, D.C. (Phoenix), Integrated Therapies, LLC -- Allison Kennelly, MS. CCC-SLP (Phoenix). There are other professionals in the valley who we also recommend and a list may be obtained from our office or your IBCLC.



Any recommendations for Lactation Consultants in Phoenix/Tuscon?

Some include: The Milk Spot - Central Phoenix Arizona Breastfeeding Center - Tempe North Star Wellness - Gilbert Mommy Help Center - at home visits in Phoenix Modern Milk - Scottsdale and Gilbert Southwest Perinatal Education Services - at home visits in the East Valley Breastfeeding Counseling - Northern Arizona Breastfeeding USA - multiple Phoenix locations Banner Desert Support Group - meets every Thursday 1-2:30 p.m La Leche League of Arizona - multiple Phoenix and Tucson locations Mama's Latte - Northwest Tucson All About Breastfeeding - Tucson (Northwest Hospital meets every Wednesday at 1PM or 6PM at the Women’s Center classroom)



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