Is anaesthesia or a general anaesthetic required?

Depending on age, the choice is for surface anaesthesia or infiltration anaesthesia. Surface anaesthesia is applied by means of a cotton swab and infiltration anaesthesia is actually inserted into the tissues by a needle and takes about 2 to 3 hours before it is works out.

If necessary, general anaesthesia is the choice of the therapist. However, there are publications in science that advise against general anaesthesia in young children.

See publication Anaesthetic considerations for surgery in newborns: www.tongriem.com/wp-content/uploads/2019/02/narcosevoorbaby.pdf))

What to do at home if the wound bleeds?

In very rare cases there is a coagulation disorder or anatomical variation that causes bleeding and will be solved immediately after the treatment.

One does not go home after the treatment before the wound is checked. In a baby, it is not expected that the wound starts bleeding at a later stage. In adults and older children, this may happen incidentally after the anaesthesia has worn off (anaesthesia contains vasoconstriction components). Most patients find that the numbness from the injection wears off after about two-three hours.

What can happen at home is that some scar tissue comes loose, scar tissue contains blood vessels. The wound wants to heal, and it should heal, but at the same time you don’t want too much scar tissue, which may restrict the mobility of the tongue again.

What to do: Slowly remove any clot or blood with a gauze before doing something similar to the one below. Keeping a baby upright and make sure that he or she is not too hot.

Do not rinse with water.

Press dry with a gauze for 3 minutes without letting go. If the wound is not dry another 5 minutes with small pressure.

Options for on the gauze: Strong tea is blood vessel narrowing and also xylometazoline (regular nasal spray).

A baby may immediately drink milk again.

If the wound is not dry after 10 minutes of pressure, please call the mobile number of the lactation consultant at the Tongue Tie Clinic (number on the card given to you). You must then return to the clinic after consultation with the therapist (1-way).

For treatments at a location other than the the Tongue Tie Clinic, the agreements with that doctor apply.

Pain relief around the procedure / paracetamol

Prior to the procedure, the doctor will numb the tongue or lip tie locally with surface anaesthesia on a cotton swab.

Overall anaesthesia or infiltration anaesthesia does not outweigh the disadvantages in babies and young and children.

A paracetamol suppository may be given before the procedure or afterwards. This is also a possibility prior to the aftercare exercises.

Paracetamol is a relatively harmless medication that has a fever-reducing and analgesic effect. You can give this on the basis of age and weight.

According to most package leaflets, the use of paracetamol should be given in consultation with a doctor under three months. However, it is indicated in pain, acute and postoperative. https://www.drugs.com/paracetamol.html

Rectal (suppository) is the most user-friendly. You can insert the suppository by sliding the tip up to 1 cm past the anus. Sometimes it is useful to hold the buttocks of your child together for a few seconds so that the suppository is not expressed.

You can buy paracetamol at the pharmacy and some drug stores. Because paracetamol can also be given to reduce fever, sales for children under the age of 3 months are not recommended with this indication. At a body temperature of 38 degrees or higher below three months you should always warn a doctor. The paracetamol is therefore exclusively given to relieve pain and discomfort.

Under the three months; 60 mg three times a day rectally

From three to 12 months; 120 mg three times a day rectally

From 1 year or from 10 kilos; 240 mg three times a day rectally

Questions about fever

No fever is expected as a result of the treatment. A wound infection or inflammation either. Fever is a body temperature above 38 degrees Celsius. In the event of a fever in babies under 3 months of age, you should consult your doctor. It is possible that your baby has a virus or other infection. In case of muscle ache or discomfort after the treatment you can give acetaminophen.

Other things you may notice after the release

After the release, you may notice things that may last a little longer, such as lip swelling, drooling, gagging, or other discomfort or peculiarities.

* Granulation tissue; This is a small lump of extra scar tissue that can form on the wound. If you suspect you see this, send a photo, it is not serious and if it is a hindrance to drinking it can still be removed.

* Drooling; Because the swallow has to be learned again after tongue tie release, it is possible to notice drooling for a while in a child or baby.

* Reattachment; After the treatment, the wound simply wants to heal with scar tissue.  With doing aftercare you hope the wound does not close too quickly or too tightly. If too much reattachment occurs, the tongue or lip mobility can be limited again. When you live abroad it is the adviceble to check the healing with somebody knowledgable in a week, that can also be done at our clinic if you can stay a few days, but has to be arranged with making the appointment for treatment. In The Netherlands you can call the Tongue Tie Clinic for an appointment.

* Muscle pain; After the treatment the adults and older children notice (muscle) pain or discomfort in the jaws, tongue and throat sometimes as well. See the FAQ about pain relief.

* Baby spits more; Because the baby drinks more effectively, it may be that the stomach is not used to the amounts and it spits back up, but it may also be that the baby is still drinking air for a while.

* Smelly breath / mouth; We sometimes hear this from parents and can last from a few days to a week, it’s ussualy no problem whatsoever.

* Swollen upper lip; This can last for up to 5 days after lipband treatment.

*  Quivering jaws remain visible longer; Because the tongue, after it has come loose, many of the muscles still need to be trained, it may be that the compensation continues with the jaw muscles, but compensation behavior may also need a chiropractor or manual therapist to remedy it. See the FAQ about compensation behavior and videos explaining this.

* You have to help lips flange out; The baby is not used to flanging the lip, this may be helped.

* Suction blisters still present; They can be present for longer, especially on the upper lip.

* Crying doing aftercare; What we hear from parents and notice at the aftercare consultation that the baby cries with the aftercare exercises, but stops as soon as you stop or start feeding or changing diaper and such.

* White plaques/debris on tongue still visible; Because the palate is often high and the tongue is not well trained to stay up, even at rest, the white plaques/ debris on the taste buds remains.

* Bottleteat; We notice that the teats with a broad base cannot go deeper into the mouth, so a teat that can go deeper and gives more mouthfilling, such as the smaller, narrower types, is often better.

* Baby stays upset longer than 48 hours, crying, drinking worse. In the older baby who has had to compensate for a long time with a tongue tie. Before the treatment, often these babies were fussy and drinking poorly and found there own “technique”. Treatment of compensation behavior is often necessary. See FAQ compensation behavior. People often give painkillers for longer. But one also has to take into account a normal virus infection occurs at the same time. You can go to the doctor with a fever, see the FAQ about fever.

* Gagging may still be present after the release.

* A baby cannot swallow the tongue after the release.

* Apnea are also observed in babies . It is not directly related to the release. Tongue tie can be related, read the research.