Advice about treatment tongue tie restriction and aftercare

If cutting a tongue and/or lip tie is necessary, I recommend having this done by a healthcare provider who is specialised in this field.

Experience shows that the attending physicians in Amsterdam (ENT, Surgery, etc.) have varying experience, and their views on cutting and the importance of breastfeeding differ. As a result, it can occur that no treatment is given, while this is desired. Some midwives are skilled at it, check with your own practice if applicable. The treatment in the Amsterdam region is performed with a 'special' scissor.

For more information on tongue and lip tie restrictions, see here (Tongue and lip tie ).

Specialised Practitioners

If treatment is really necessary, I recommend going to one of the specialised practitioners listed below. All except Octant perform the treatment, using so-called 'electrotome' (a type of laser) and are familiar with the influence of a restricting tongue and lip tie on breastfeeding.

ENT Specialist (KNO-arts) Dr. Venker (and colleagues) located in Alkmaar Medical Centre. See the ENT (KNO) Alkmaar MC department to make an appointment. NO lacatation consultant present. A referral from your GP is required.
Tongue Tie Clinic (specialised dentist) Staas and Bergmans in Rosmalen (near Den Bosch). See Tongue Tie Consultation Rosmalen. Lactation consultant present. No referral from your GP needed - I will sign you up and they will call you back to schedule an appointment; it is reimbursed in the basic insurance for children (dental care < 18 years).
Tongue tie Clinic (specialised dentist) Octant in Hoorn. See Octant Mondzorg. METHOD Laser treatment. NO lactation specialist present. No referral needed, you can make an appointment yourself.
Tongue Tie Clinic Kirsten Slagter and coll., in Groningen. See Tongue Tie Clinic Groningen. Lactation consultant present. No referral needed; reimbursed in the basic insurance for children (dental care < 18 years).
Tongue tie Clinic (specialised dentist) TopDental in Volendam. Zie Tongue tie treatment TopDental Volendam. Lactation consultant present. No referral needed; reimbursed in the basic insurance for children (dental care < 18 years). Lacatation advise on spot available, not included. Mostly treatment of Type 1 and 2 restriction of Tongue ties.
All practitioners use an 'electrotome' (a type of laser, except Octant..Both methods have the same result and both methods immediately stops (or restricts) blood loss, so that the practitioner has a good view of the area to be treated. If the restriction of the tissue is stiffer, or more 'posterior', treatment with these methods are the most appropriate way in my opinion.
Painrelief: the area to be treated is numbed locally. Paracetamol 60mg can be given preventive (b=shortly before intervention) and after treatment (60mg a 6 hrs max 48 hrs)
Tongue tie Clinic (specialised dentist) Octant in Hoorn. Zie Tong-lipriem treatment Octant. NO Lactation consultant present. No referral needed; reimbursed in the basic insurance for children (dental care < 18 years). Treatment is done with 'waterlaser'. Different method, same results.

Please let me know if and when you decide to treat the tie so that I can make a referral to the practitioner. In addition, I would like to inform you about the methods of aftercare that are right for your specific situation.

General instructions

Different practitioners can give their own formulated advice. The practitioner will give you instructions, and usually demonstrate them to you. In general, they provide the instructions on paper.

I recommend watching the videos and reading the instructions on paper and doing these exercises a few times before the treatment. This way you both become familiar with it.
The aftercare consists of two aspects. Exercising the tongue muscle, and keeping the wound surface stretched/flexible.
In the first few days, aftercare is done around every feeding moment. After a few days, it is already less often, about three times a day. This will be for two weeks.
The use of a pacifier is not recommended for the first few days, as this puts pressure on the wound surface and could encourage re-growth.
You should also consider consulting a specialist chiropractor or osteopath. This can already be done in advance.

Nuance of Mamma Minds

As an experienced practitioner and specialised Lactation Consultant IBCLC, I am happy to provide some further and more nuanced information. This allows you as parents to choose which aftercare best suits you and your baby. My addition to the standard advice is that you can (try to) do it with care and love. Do the aftercare but use timing and playfulness. Do what you can, but don't force anything. I would like to inform you about various options below. It is a somewhat more active and gentle method.

I recommend that you do the aftercare, within the realms of what is possible for you and your baby.

How do you do the aftercare?

The videos below show how you can do the aftercare in addition to a PDF (link) compiled by the working group Tongue-Ties of the NVL. In principle, all aftercare instructions are the same, there are only small differences among the various practitioners. Below we explain where the differences come from.

Videos

PDF

The Working Group Tongue and Lip Ties of the Dutch Association of Lactation Experts has investigated this aftercare and put it on paper. Please read this before your treatment and practice it with your baby.

Aftercare instructions on paper (Dutch)

I have put some playful exercises on paper to help the tongue discover new movements. This provides a relaxed way to improve tongue movements and is fun to do!

Playful Tongue Exercises

What do we know about aftercare?

There is no scientific research available yet to say what is best, whether or not to do aftercare and to what extent exactly. The exercises are based on practical experience. Aftercare exercises seem to reduce the chance of the restriction growing back. In addition, it encourages the tongue to make new movements, which helps the baby to use the tongue more effectively.

Benefits of aftercare: Aftercare exercises and wound care seem to reduce the chance of regrowth. It stimulates new movements for the tongue muscle. It can be a moment of playful contact. Many babies will allow aftercare if it is done with love and care.

Disadvantages of aftercare: Sometimes doing aftercare causes disstress and crying. The baby can show resistance, stress or pain. Maybe because it is sensitive, or maybe because there is tension from the parents or from the baby itself. Then tailor the aftercare to your situation and baby. Do what is possible in a different way. Find another time to do the care and keep it playful and loving. A little fresh red blood may be visible when doing the exercises. This is normal and decreases quickly with suction.

Pain relief

The procedure (cutting) can cause some restlessness and sensitivity in the first few days. Keep this in mind and offer as much body contact as necessary. Due to the sensitivity, you sometimes even see a temporary refusal of the breast. With a peacefull approach and skin-to-skin you will usually soon come together again. You can give a 60 mg paracetamol suppository before and after (maximum 1 dose, every 6-8 hours). This can help to maintain feeding and/or to start aftercare. You should not see an increase in temperature, no fever after cutting. If your baby develops a fever, contact your GP.

Expectations

Changing drinking technique and behaviour takes time. Sometimes you only notice a change in tongue motor skills and lip tension after two weeks. When feeding, try to pay attention to sufficient grip after cutting, for example by using the 'Concorde' breastfeeding position.

Let us know if there are any questions. I am always interested as to how it goes.