Oral aversion after frenectomy, or tongue-tie release, is one of the most common complications in the care of ankyloglossia. In this post, we are going to talk about this situation and provide tools on how to deal with it.

Incidence of oral aversion

A baby’s mouth is not only intended to receive food; but it is a fundamental part of their learning process, which will allow them to get familiar with their body and set limits, and also, as they approach 3-4 months of age, the world around them. This stage is the so-called ‘oral phase,’ providing unique sensory experiences and allowing them to learn about the world around them through their mouth.

Given the above, what can happen when a baby undergoes a frenectomy in the first months of life? Usually, there are no complications, but we should be aware that one potential complication is oral aversion (O’Connor, 2022). Oral aversion can be initiated when the infant associates an oral experience with a negative situation, such as pain, discomfort, fear, and so on, and these situations can occur during frenectomy.

After the procedure or in the hours following the procedure, the infant may begin to refuse the breast or bottle feeding. They may cry, pull away, or tense up when feeding is attempted. In O’Connor’s study (2022), on a sample of 211 infants, this experience is reported to occur in 28%. From our clinical experience, we know that oral aversion is a known complication that can be reversed in most cases but needs the close attention of a breastfeeding expert.

Informing about oral aversion before performing a frenectomy

Most families who get a frenectomy done for their baby usually do so to continue breastfeeding more effectively, either for the mother or for the infant. And what happens when a baby refuses to breastfeed after the procedure? Then, the mother’s emotions get out of control; guilt, frustration, fear, helplessness, and so on appear.

This is why the risk of oral aversion must be mentioned in the informed consent forms given to the families, just as is done with the risk of hemorrhage after the intervention. On the other hand, families must know that if the feared aversion appears, they can count on help with trying to reverse the situation as soon as possible. The professionals who perform frenectomies don’t always have all the resources and information to deal with these circumstances. That’s why if they do not have them, it is essential that they have a specialized team or that they can refer these families to a person who can accompany them and offer them resources to deal with the situation as soon as possible.

Tools to deal with oral aversion after frenectomy

Usually, we eventually get the infant to continue to breastfeed, but there are also cases of rejection in which this goal can not be achieved. When an infant and their family find themselves in this situation, we must take the following into account:

• We provide a pleasant and relaxed environment for the family; this can be achieved by attending to them in a cozy space, if possible with a comfortable armchair or sofa, reducing the light, and avoiding noise or interference from other people or professionals.
• Allow the family to explain their situation and all the emotions that are experienced and generated; therefore, avoid cutting off the story; if the mother cries, do not rush her or tell her, ‘It’s ok.’ Instead, listen assertively and validate all her feelings before saying anything.
• If the baby cries intensely, assess how long they have been crying and how many hours it has been since the last feed. If it has been many hours, suggest to the families if they want to try to offer the baby some milk. On most occasions, we have observed that the refusal is towards the breast or bottle but not so much to finger suction, and therefore milk should be offered using the finger-syringe technique.

Once the situation is contained, possible actions to restore breastfeeding can be explored:

• Wait until the baby is sleepy or in quiet alertness before attempting to nurse.
• Start the feed standing up or while the mother makes lateral rocking movements or knee bends.
• If the mother is very tense, suggest that she breathes more slowly and ease any tensions she may be experiencing.
• The use of an appropriately sized nipple shield should be explored.

Whether a first latch is achieved or not, the family should take home resources they can try – co-sleeping skin-to-skin with no clothes on, bathing together, and making the baby laugh – along with those they will have tried in the session. They must also be informed about what to expect and when they should contact you again.