• When the tongue tie is identified as contributing to feeding problems or challenges, we also carry out our own assessment to assess the severity of the tongue tie and need for frenotomy.

• It is also a requirement prior to frenotomy here at the clinic, that the baby has been given Vitamin K and there is no family history of blood dyscrasias.

• Tongue-tie should be delayed until 24 hours after baby has received intramuscular Vitamin K or 24 hours after the baby has completed 2 oral doses of Vitamin K.

• The parent/s are required to give written informed consent prior to the release.

• Babies may have the procedure performed with/without anaesthesia with little discomfort up to around 4 months of age.

• The baby is placed supine with the elbows held flexed securely close to the face. The tongue is lifted gently with gloved finger and thumb so as to expose the frenulum. With sterile scissors, the frenulum is released by approximately 2 to 3 mm at its thinnest portion, between the tongue and the alveolar ridge, into the sulcus just proximal to the genioglossus muscle. Care is taken not to incise any vascular tissue (the base of the tongue, the genioglossus muscle, or the gingival mucosa). There should be minimal blood loss.

• The infant will be returned as soon as possible to the mother for feeding.

• Reassessment of nipple pain and infant latch is assessed post release during feeding.

• There is specific after - care required following the procedure which is discussed and demonstrated post release by our onsite Lactatation Consultant.

• Occasionally a small white healing area may be seen under the tongue; this is normal and should resolve within two weeks of the release.

• It is important that mother and baby are followed up after the procedure. Our service offers follow up support by either of the team. Skilled breastfeeding information and support is essential following frenotomy and is offered by our lactation consultant as part of our fee.

• There is also a wide range of breastfeeding support available in Ireland offered by Public Health Nurses, voluntary groups such as La Leche League, Cuidiu, Friends of Breastfeeding, hospital clinics and International Board Certified Lactation Consultant (IBCLCs). Links to support include: International Board Certified Lactation Consultants (IBCLC)

POST PROCEDURAL CARE:

We will ensure that the parents have contact details of our team members so that any post procedure concerns can be addressed appropriately. Our lactation consultant will follow up each case with a telephone call and discussion with the parents over the coming days.

CONTRAINDICATIONS FOR PERFORMING FRENULOTOMY:

A family history of unusual bleeding or clotting problems would indicate that frenulotomy referral should be sent to the ENT frenulotomy service.

INFECTION PREVENTION:

The practitioner performing the procedure is responsible for ensuring that all equipment used is sterile and has not passed its expiry date. We follow hospital guidelines on infection control by ensuring that we effectively decontaminate all equipment used and the treatment room and adhere to strict hand hygiene before and after each procedure. We ensure that we adhere to hospital guidelines on infection prevention using aseptic non-touch technique (ANTT) when carrying out the frenotomy procedure.

AFTERCARE

This needs to be carried out 3-4 hourly, with one maximum 6 hour gap at night (i.e. 6 times in 24hrs). Do this diligently for 4 weeks, then on a reducing basis before stopping at the end of the 5th week. Start with massage around the temporomandibular joint and lower jaw until mouth is relaxed; don't force your way into baby's mouth.

• Lower the chin and hold with both thumbs. With both index fingers scoop under tongue; gently and smoothly stretch upwards at very base of tongue so that the diamond opens fully. Repeat three times.

• With the pad of one index finger sweep upwards on the centre of the diamond. Repeat three times.

• Sweep once side to side at the very base of the tongue to ensure there is no vertical band of tissue forming.

• Massage the diamond with a little virgin coconut oil to help keep the diamond flattened thus working against the contraction of the edges towards the centre. Mouthwork. These only need to be done during daytime.

• Gently rub your finger along baby's lower gumline and stimulate the sides of the tongue. As you go to each side your baby will habitually follow with their tongue, strengthening the lateral muscles and encouraging use of the new extra range of movement.

• Sweep finger side to side across palate going backwards a tiny bit each day to reduce hypersensitivity of the gag reflex.

• Stimulate a suck rhythm with index finger uppermost on palate, gently circling if necessary. With other hand gently tuck chin so tongue remains elevated in mouth. Next draw finger towards yourself coaxing tongue to extend. As baby's suck gains in co-ordination and strength combine the two elements.

A successful outcome is now dependent on your management of your baby's oral care over the next few weeks. Our Lactation Consultant will maintain contact with you over the coming days and you are also welcome to contact us at any time if you have any concerns.