Timing of release

If you have been told your baby has a tongue or lip tie, you might be wondering about when to have the frenecotmy. When it’s first discovered, parents frequently either want to go straight to release, or never have a release. As a provider, the timing of release is just as important as whether or not to do a release.

There are many factors that go into timing of release and they can be unique for each family. In general terms, on the baby side we are looking at weight gain, body tension, ability to get midline, ability to be soothed, reflux, sleep, diapers, reflexes, symmetry, and oral function. For the parent we are looking at milk supply, physical recovery from birth, breast and nipple pain/issues, mental health, sleep, nervous system regulation. With the family we also need to look at things like how long until return to work, if partner has time off or if any family has ability to help, any big trips or vacations. We even need to consider the release provider’s schedule, if they are going on a vacation or booked up for weeks/months that is something to consider too. There is a lot that goes into this picture and it’s never the same.

We do our best to find the right time, that will address most of these positively (it’s pretty impossible to meet every criteria well). There are also times when we absolutely won’t send a baby for release. Those are:

-Baby not gaining

-Baby not able to be soothed

-Parents mental health/stress

-Borderline- baby unable to get into midline, and address tension

Let’s look at those. If a baby isn’t gaining weight, a procedure, even one that will help feeding, is going to increase stress and will likely make things worse! We need to feed the baby first, it might only be a few days, to a week, but weight gain needs to be safe and stable. A stressed baby does not need a stressful procedure!

A baby that cannot be soothed, colicky, fussy cries for hours. Parents are walking the house, driving their car, trying everything they can but baby seems very inconsolable. While the tongue tie, air intake and feeding issues are likely making baby more fussy, a procedure is definitely going to make baby even more fussy and upset. This is also a baby that’s nervous sytem is just fried, and likely the parent's nervous system is fried to by this point! So first we stabilize baby and parent’s nervous systems. That might be bodywork, rhythmic movements, and other nervous system regulating behaviors. Once baby and parent are doing better, then we can consider release.

Parent’s mental health is a big consideration. A frenectomy is work- wound care, pain/fussy baby, oral exercises, bodywork, plus all the worry and stress. If the parent is struggling already, they may not be ready to take on this extra work. Getting support lined up- therapy, medication, doula, neighbors, family, friends, lots of ways for the parent to have support and get stabilized before adding in more stress.

Lastly, we want baby to be able be able to get into midline with movements. Baby doesn’t have to be able to stay midline, they may still have a head turning preference, or even torticollis, but we want to be able to get baby to be midline with movements. We also need to look at the tension and see if there is too much tension for a release. The release provider needs to be able to see the tongue frenulum well, and if they can’t then they can’t release. So a tense baby needs bodywork before considering release.

As you can see there are a LOT of considerations for the timing of release. Each parent and baby have different needs and we need to look at many factors and help the family find the best possible solution.

If you have questions about timing of release, reach out, I would love to hear your thoughts!