When to cut the frenulum
A short frenulum can make it difficult for infants to breastfeed, as proper suction is linked to the mobility of the tongue. When breastfeeding, babies need their tongues to have the best reach possible. From a professional point of view, the baby’s frenula can best be assessed by a lactation consultant. Don’t hesitate to contact our sister clinic GYN MEDICO in this matter even if you’re not a client yet.
The most common problem for babies is the sublingual frenulum, which excessively restricts the movement of the tongue. Extreme cases in which the baby cannot extend its tongue even to the level of the lower lip can prevent correct suction to the breast. These cases are usually detected and resolved in the maternity hospital, but frenulum incisions made there may not be deep enough. In less extreme cases, the baby sucks, but the frenulum prevents it from moving properly, making feeding difficult. Babies like this feed only when they are most hungry and it’s difficult for them to drink until they’re full. This leads to shorter breastfeeding times, poor breast emptying and reduced milk production. In the worst case, it can lead the baby – who would otherwise feed more and longer without frenulum problems – to completely refuse to be breastfed.
Problems can also be caused by an overly tight or short upper lip frenulum, which makes it impossible for the baby to move its upper lip. This can have a negative effect on the depth of suction. The upper lip frenulum often causes problems for mothers as well, as the baby’s insufficiently lifted upper lip moves across the breast during suction and causes pain even when it is sucked in the correct position. In such a case, a so-called suction blister may form on the baby’s lip.
How the procedure works
Unlike frenotomies in older children, cutting the frenulum in infants is a very simple procedure that takes literally only a few seconds. We place the baby on a chair, open its mouth, locate the frenulum and immediately make an incision. There is no need to analgosedate the baby, and the mother or father can be present the whole time while looking at the baby, talking to it, and holding its hands. The baby usually responds more to being handled and having its frenulum held in place rather than the actual incision itself.
After the procedure, the mother takes the baby to a separate private room, where she can try to let the baby breastfeed or calm it down in other ways. The wound may bleed slightly after the procedure, but this passes quickly. The baby is best calmed by sucking on the breast or another method that works for it.
Healing and care after the procedure
The wound in the baby’s mouth heals quickly, and a yellow-white coating will appear as a sign of healing. If the baby reaches into its mouth and minor bleeding begins again at home, it’s best to calm it down by breastfeeding again. If the baby is more restless than normal, parents can also apply a suitable and gentle sedative recommended by a doctor on the first night following the procedure.