Frenectomy

**LibraSunCNM, BSN, MSN, CNM** · Oct 24, 2019

When I worked Mother/Baby at a large teaching hospital, there was *one* pediatrician from the largest practice that rounded at that hospital who would do in-hospital frenectomies before discharge (so one out of probably 40 peds). If you happened to use that practice and she happened to be the one rounding that day and your baby happened to need a frenectomy, you were good. Otherwise I never saw it done. There was actually a lot of animosity between some peds and our IBCLCs, who used to try to gently point out when they thought babies had a tongue tie. Some peds really don't think it's ever necessary, and I've met a few IBCLCs who diagnose almost every baby with some type of tongue or lip tie. I've never witnessed ENT getting involved before discharge.

Cara Fowler, BSN, RN · Oct 29, 2019

At the hospital I work at, most of the time it's either the pediatrician, lactation consultant, nurse, or parent that notices a baby is tongue-tied. Most of the time out lactation consultants catch when a baby is tongue-tied or the pediatrician. This happens but from my experience not incredibly often. If a baby is tongue-tied and is not negatively affecting breastfeeding, then most of our physicians won't recommend a frenectomy. If there is an issue with breastfeeding due to a tongue-tie, from there the pediatrician will decide if and when the frenectomy is performed and by whom. I've witnessed a pediatrician perform a frenectomy on a baby at the mother's bedside. Most of our frenectomies are done by a team of neonatologists who perform circumcisions and frenectomies in our nursery with the consultation of the pediatrician.

haunani, BSN, RN · Jan 3, 2020

My previous 2 hospitals, both with about 2400-2800 deliveries/year did NOT do them in-patient. They referred out to pediatric dentists for all cases, if they even agreed that it existed.

My current hospital, a community hospital with about 300 deliveries/year, has a pediatrician that will do them while they're still inpatient.

labordude, BSN, RN · Jan 6, 2020

On 10/24/2019 at 10:50 AM, LibraSunCNM said:
There was actually a lot of animosity between some peds and our IBCLCs, who used to try to gently point out when they thought babies had a tongue tie. Some peds really don't think it's ever necessary, and I've met a few IBCLCs who diagnose almost every baby with some type of tongue or lip tie. I've never witnessed ENT getting involved before discharge.

There was a recent analysis (JAMA Otolaryngology) of infants referred to ENT by IBCLCs for tongue-tie. 62-ish% of them DID NOT end up undergoing any frenectomy procedure. Also, the most recent Cochrane review showed no benefit. I see lots of talk about them from some of our lactation team but almost never hear anything from pediatrics.

https://jamanetwork.com/journals/jamaotolaryngology/article-abstract/2737712

https://www.cochrane.org/CD011065/NEONATAL_surgical-release-tongue-tie-treatment-tongue-tie-young-babies

**LibraSunCNM, BSN, MSN, CNM** · Jan 7, 2020

5 hours ago, labordude said:
There was a recent analysis (JAMA Otolaryngology) of infants referred to ENT by IBCLCs for tongue-tie. 62-ish% of them DID NOT end up undergoing any frenectomy procedure. Also, the most recent Cochrane review showed no benefit. I see lots of talk about them from some of our lactation team but almost never hear anything from pediatrics.
https://jamanetwork.com/journals/jamaotolaryngology/article-abstract/2737712
https://www.cochrane.org/CD011065/NEONATAL_surgical-release-tongue-tie-treatment-tongue-tie-young-babies

I do agree it's over-diagnosed in my area. I can't agree there's never any benefit to frenectomy, as someone who breastfed an infant with a severe lip tie. I don't think pediatrics as a whole has accepted it as much of a "thing."

klone, MSN, RN · Jan 7, 2020

Agree with Libra - yes, it's overdiagnosec; and yes, it makes a HUGE difference when a true tie is released.