The Role of IBCLCs After a Frenectomy

Understanding Tongue Tie from Birth Onwards – Post 4

In the previous post in this series about treating a tongue-tied infant, we talked about the value of consulting an International Board Certified Lactation Consultant (IBCLC) before a frenectomy procedure. An IBCLC will guide parents towards breastfeeding methods which are comfier and healthier for both mom and baby, while offering advice on exercises which help the baby’s body prepare for the frenectomy. They also educate on tummy time, as well as the risk of “baby containers” such as swings and car seats.

However, an IBCLC remains an invaluable resource after an infant has undergone surgery to release a tongue tie. In this post, we’ll take a look into a qualified IBCLC’s continuing role in securing the best outcome for your baby post-frenectomy.

What to expect following a frenectomy
In general, 1-5 days after a successful frenectomy should be the time at which the mother transfers milk to the baby more effectively than ever before, depending on if there was lactation support immediately after the procedure. However, around a week after the procedure, there will be some time during which the healing enters the contraction phase. This means that the surgical wound in the baby’s mouth gets smaller, which can make feeding more difficult.

There will also be times during the healing phase when the baby’s brain needs to “reorganize” and re-learn how to use the tongue to feed. At these times, parents may need advice or help on how to supplement the baby’s breastfeeding with other techniques like pumped bottled milk. An IBCLC can advise on what to expect and how to supplement feedings when needed.

How many appointments with a IBCLC are needed?
The answer to this question is really very case by case. Some babies I treat will have been working with an IBCLC for 2-3 weeks before baby and mom are ready to have the procedure. Some are sent after 1 visit. Depending on the complexity of issues a family may only need 1 follow up with an IBCLC or they may be working for quite some time if there are supply issues or baby has a need for something like “suck training.” Regardless of how many mom and baby need, these visits are invaluable and will set the stage for a wonderful breastfeeding relationship…which sets the stage for the best early growth and development of the face, jaws and airway!

What an IBCLC does after the procedure
One of the most important things an IBCLC can do after a procedure is to monitor the way that the baby breastfeeds. If a baby had a tongue tie, then both mother and child will have made adjustments to compensate for the issues this caused. So, after the tongue tie is released, they both need to re-learn feeding from the beginning. Ideally a IBCLC will treat mother and baby as if it is day one, showing them how to latch and feed now that the tongue tie is not requiring compensations. When a proper position and latch has been achieved, feeding should be painless for both mother and baby.

An IBCLC will usually perform another weighted feed after the surgery, in which they weigh the baby before and after feeding to check how much milk they have taken in. They can then offer a modified feeding plan. For example, if a two-month old baby was taking in just half an ounce per feed before the procedure and is taking in two ounces per feed after it, that is great progress. However, that amount is still short of the recommend four-to-five ounces that they should be taking in. An IBCLC can offer recommendations like continued pumping and supplemental feedings until the baby can take in the full amount they need on their own.

Looking after your baby in the longer term
One of the reasons that a frenectomy is so important is that it will allow better breastfeeding. Along with chewing solid foods, breastfeeding is one of the primary factors which drives the development of the face, jaws, airway, and good tongue function. After a frenectomy, an IBCLC will focus first on making sure that the baby is well-fed, and is getting all of the milk that they need. Then, they will set expectations with the parents so they know what to watch for when it comes to feeding.

To aid in healing after the procedure, the IBCLC can set physical therapy exercises for the baby’s tongue for six weeks after surgery, sometimes longer. They will also educate parents on intentional wound care, and equip them with exercises specifically tailored to this goal. Other areas of baby care will also be covered, such as how many diapers per day a baby should be going through.

An IBCLC will also check whether the baby’s muscles are super tight or flacid, indicating they are in need of a bodyworker. If they notice the healing contraction is particularly intense, or suspect that some fibers may have been missed in the frenectomy, they may recommend returning to the surgeon.

In short, a good IBCLC will act as parents’ go-to resource, offering consultations and advice on the development of the baby after surgery.

Accessing an IBCLC after a frenectomy
As I mentioned in the last post, many offices do not offer the services of an IBCLC immediately after a procedure. So I recommend that parents make arrangements to see an IBCLC for a follow-up appointment either on the day of the procedure or the day after. If this is not possible, talk with the IBCLC about aftercare in advance of the procedure so you know what to expect. If your office does have an IBCLC available to you after the procedure, then you’re in luck! They can help make sure that mother and baby are comfortable and happy with the new experience of feeding without a tongue tie.

In practice, accessing an IBCLC can be a challenge due to logistics or insurance issues. When dealing with insurance companies, I have found that they are most interested in contracts which are profitable for them, not in setting up patients with the healthcare providers who are best suited to their needs. The business of healthcare means that insurance companies can race to the bottom to find the cheapest provider, not the best. Parents should be wary and ask providers if they guarantee their work, and ask to see before and after pictures. In my case, I have thousands of images of children and babies before and after interventions which I would be happy to share with prospective patients.

Unfortunately, parents often forgo the services of an IBCLC because their services are not included in their insurance plan. However, the consultations are not overly expensive – typically they are between $100 and $300 for a visit of up to three hours – which is very little compared to the medical costs of treating a tongue-tied baby. (Not to mention the healthcare costs that will be ongoing for a tongue-tied child/adult.) Like taking a car in for routine maintenance, I believe that an IBCLC consultation offers great value for both parents and baby in the long term.

Why consult an IBCLC after a frenectomy?
From all of this, you can see how valuable the services of an IBCLC are. In fact, I would say that an IBCLC is even better positioned to help parents and babies with the specific challenges of a tongue tie than most pediatricians. At this time, pediatricians are not trained in assessing tongue ties or on breastfeeding in medical school, while the right IBCLC will see postoperative frenectomy babies at least every week. Some pediatricians have taken it upon themselves to take lots of CE and research so they can be a better help to families in this area, but not many. Before asking your pediatrician for breastfeeding help or advice, ask them what types of continuing education they have taken after medical school to become better versed in breastfeeding management. If they can’t answer that, you are likely better off asking a friend for help who has successfully breastfed a few kiddos. To summarize this post, I believe that the recommendations offered by an IBCLC hold weight and will get the best outcomes for parents and baby.

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