Frenectomy

Lip and tongue tie (frenectomy) #

tl;dr #

  • Fixing a lip and tongue tie can really help a baby and mom with breastfeeding.
  • Unfortunately, the people you are supposed to be able to trust (pediatrians, lactation consultants, pediatric dentists, ENTs, etc) aren’t trained or are misinformed about it, so many parents are shamed or misled about it.
  • If you find the right specialist, getting a good diagnosis and procedure can be pretty straightforward.

Specialists #

After talking with LOTS of people, these are the experts I’ve found per region:

  • LA: Dr. Chelsea Pinto
    • Our top choice in California because she is renowned for both her skill in doing the surgical procedure, as well as being able to explain clearly how and why she is making her diagnosis.
  • SF Bay Area: Dr. Shervin Yazdi
    • Universally praised by referrals and parents and the go-to expert for Northern California. We personally got a weird vibe from him, so chose to go to Dr. Pinto instead.
  • Wisconsin: Dr. Graham
    • If we had been closer to Wisconsin, we would have gone to Dr. Graham. She had incredible knowledge, and perhaps the most obvious commitment to seeing families succeed.

Lessons learned #

  • Tongue ties seem to be something that falls between the cracks of specialists. Pediatrians, lactation consultants, and ENTs are likely to give you misdiagnosis, especially aobut anterior tongue ties.
  • The primary objection from people like pediatricians is that there hasn’t been a large scale double-blind study to prove that frenectomies help breast feeding, and therefore they say, “the science doesn’t support it”. Imo, this just means that we need to study it more, but we have to make decisions today on preliminary research.
  • There seems to be an asymetric value vs risk calculation that pediatricians are missing here. The surgery is extremely minor, so if it has the potential to help dramatically, it seems weird that people are so against it.
  • Waiting makes things worse, so pediatricians recommending waiting is bad advice:
    • Younger babies have less tissue to cut, thus experiencing less pain
    • Younger babies (under 3 mo) have a natural suck reflex that goes away at 3 mo, so it is easier for newborns
    • Younger babies have less muscle memory to retrain after the procedure
    • Anecdotally, it is very common for moms to have frenectomies done on their second kid in the first week of life to avoid the challenges of waiting on the first kid.
  • If you get the procedure, Dr. Graham suggests that you have a “team” to help you be successful. This can include an occupational speach therapist to work to do exercises to retrain the tongue and a lactation consultant to help adjust to breastfeeding with a mobilized tongue.
  • Lazer is better than scissor becuse it is easier to work in tight spaces for anterior tongue ties and the lazer coderizes as you go, so you avoid bleeding.

Resources to learn more #

Research

Podcasts

Books

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