Among the risks and possible consequences related to frenotomy (the tongue-tie release procedure), the most common complication is post-operative hemorrhage, which is reported in various studies to affect between 3-19% of cases.

Although this is the most frequently mentioned complication in the scientific literature, an underestimated complication experienced by many families must be considered. This is the baby’s refusal to breastfeed after the intervention. We know that in many cases, it is recommended to give pain relief as a routine or preventive measure in the hours following the intervention, but this recommendation is not always enough to get the infant to return to breastfeeding calmly.

This refusal to feed is one reason why clinical experience suggests waiting until the infant is gaining weight or has regained birth weight to perform the intervention. Refusal to feed generates a lot of impact and stress for the families at a key moment in the establishment of breastfeeding and when the infant should not lose weight.

Therefore, it is essential to evaluate the possibility of feeding refusal as one of the risk factors after frenectomy. In addition, this factor can cause the undesired end of the breastfeeding journey.

Frenectomy support is key

Consequently, closely accompanying the families is necessary. This implies evaluating the breastfeeding process before the intervention, accompanying the family immediately after the intervention, and following up in the days following the intervention.

Pre-intervention support

During the initial evaluation, special attention should be paid to infants who have already shown some refusal of the breast before the intervention. Regardless of the cause of the refusal, an infant who has previously shown difficulties in feeding at the breast is more likely to continue to refuse the breast after the intervention, and this refusal could become even more intense. The family should have this information beforehand so that expectations are realistic, and if the refusal intensifies, they do not blame themselves for having performed the intervention on their child.

Post-frenectomy support

Immediately after frenotomy, it is essential that the infant makes an effective first feed at the breast and it should be evaluated if significant changes post-frenectomy can be observed. To do this, it is important to find the space and place for the dyad to resume breastfeeding while the professional checks for any subsequent bleeding that hasn’t stopped. This is the moment to inform or remind the family about how the hours after the intervention are expected and to offer tools and/or the possibility of contact in case the family feels overwhelmed. If the infant requires it, it is key that the family is given adequate preventive or active guidelines for pain relief medication. This is key information for the family and ensures that they can handle the situation that may arise in our absence with more peace of mind.

As has been mentioned, some infants show a great refusal to feed after the intervention. These infants stop feeding for hours, do not give in to crying, and get upset when they are approached at the breast. In these cases, it is essential to provide emotional support to the families so that they can sustain the stress involved, offer alternative feeding resources, and a close and empathetic follow-up. Most of these infants usually accept the breast again after a few days, but in some cases, it can take longer, or if they had previous difficulties, they may refuse the breast permanently.

It is essential that families have the key information to deal with this situation and that they can count on the close and timely support of the professional (or team) who carried out the procedure.

Bibliographic references

Hale, M., Mills, N., Edmonds, L., Dawes, P., Dickson, N., Barker, D., & Wheeler, B. J. (2020). Complications following frenotomy for ankyloglossia: A 24-month prospective New Zealand Paediatric Surveillance Unit study. Journal of paediatrics and child health, 56(4), 557–562. https://doi.org/10.1111/jpc.146

Kim, D. H., Dickie, A., Shih, A. C. H., & Graham, M. E. (2021). Delayed Hemorrhage Following Laser Frenotomy Leading to Hypovolemic Shock. Breastfeeding Medicine: the official journal of the Academy of Breastfeeding Medicine, 16(4), 346–348. https://doi.org/10.1089/bfm.2020.0319

O’Connor, M. E., Gilliland, A. M., & LeFort, Y. (2022). Complications and misdiagnoses associated with infant frenotomy: results of a healthcare professional survey. International Breastfeeding Journal, 17(1). https://doi.org/10.1186/s13006-022-00481-w

Varadan, M., Chopra, A., Sanghavi, A. D., Sivaraman, K., & Gupta, K. (2019). Etiology and clinical recommendations to manage the complications following lingual frenectomy: A critical review. Journal of stomatology, oral and maxillofacial surgery, 120(6), 549–553. https://doi.org/10.1016/j.jormas.2019.06.003