INFANT FRENECTOMY/FRENOTOMY/FRENULECTOMY

Today I want to talk about infant frenectomies.  If you are a Mom and tried to breastfeed but were not able to you may already have heard of this procedure.  If you are a Mom and tried to breastfeed but were not able, I hope this will help you for your next baby.

Brazil passed a law in 2014 that all infants must have their frenums inspected within the first 48 hours of life.  The USA and many other countries are lobbying to have similar laws passed.  The World Health Organization recently released it’s new stand on breastfeeding and frenectomies which basically states that when needed it is helpful and there is no downside to the procedure (ultimately, though there is soreness for a short time after.)  The American Academy of Pediatric Dentistry recently released it’s stance on breastfeeding, ‘it is not a life choice, but a health concern’-paraphrased.  I mention these to give the proper weight to the topic.

So what is a frenectomy?  I will keep this post to infants, but I plan to blog about how frenum restrictions impact older children and adults in a future post.  The most common frenum restriction to impact breastfeeding is the tongue, and I will concentrate this post on the tongue (though there can be other restrictions affecting the latch, especially the lip.) Underneath the tongue there is a layer of embryonic tissue which is the same tissue that is found in the fetus between the fingers and toes that creates webbing.  The process that gives us separate fingers and toes is called “apoptosis”.  The skin under the tongue can have incomplete apoptosis and this fibrous tissue restricts the movements of the tongue.  (Historical documents show that midwives would use their fingernail to clip the restriction right after birth if it was present!)  This is relevant because the tongue needs to make a 3 part undulation for proper latch and milk transfer.  If the tongue cannot make this undulation, there will be a lot of efforts to adapt, and some are successful enough for breastfeeding, breast-milk in bottle or some combination of formula and breastmilk feeding.  If they cannot adapt and if mom is persistent in her attempts to breastfeed, these are some of the signs the infant and mom will likely have:

Mom: painful breast/nipples, mastitis, fungal infection, flattened nipples, decreasing supply (due to lack of sufficient stimulation from inadequate latch)

Infant: clamps painfully onto breast, slides off, takes a long time to nurse, tires easily while feeding, reflux, gas, when crying tongue stays in bottom of mouth

In summary, if you desire to breastfeed but are finding it difficult, please seek out help from a qualified, informed provider as quickly as possible.  I see babies everyday.  I can’t tell you how many moms come and have already been to a pediatrician, ENT, even a lactation consultant who have said everything is okay.  If the child is not latching well, if breastfeeding is painful, everything is not okay.  Please use these links to learn more about a simple, almost painless, laser procedure that takes minutes.  It can change your life and your infant’s life.  My favorite thing to hear right after helping a mom with a newborn, “Oh my God!  I can’t even feel him on my breast anymore.  This is wonderful!  Thank you so much!!”

Attached to this post you will find the frenum inspection protocol used in Brazil, and used by many providers in the States now.  Below are Helpful Links:

Lingual frenulum protocol infants_04.23.14

http://tonguetie.net/

http://www.portlandfamily.com/posts/tongue-tied-babies/

http://www.kiddsteeth.com/dental-topics.php?mode=desktop#breastfeeding_health

http://www.nhs.uk/conditions/tongue-tie/Pages/Introduction.aspxLingual frenulum protocol infants_04.23.14

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