Are There Any Downsides to Performing a Frenotomy on a Baby?

When a baby has a tongue-tie, parents may wonder whether a frenotomy is necessary and whether there are any downsides to having the procedure done.

A frenotomy is a procedure that releases a restrictive lingual frenulum, the small band of tissue under the tongue. It may be considered when tongue movement is restricted and is contributing to functional problems, particularly feeding difficulties.

While frenotomy is generally considered a minor procedure, it is still a medical procedure and should not be recommended simply because a baby has a visible frenulum. The American Academy of Pediatrics recommends a careful feeding assessment and nonsurgical support before considering surgery for symptomatic ankyloglossia.

Does Every Baby With Tongue-Tie Need a Frenotomy?

No. Having a tongue-tie does not automatically mean a baby needs treatment.

Some babies with a restricted frenulum feed normally and have no significant functional problems. Others may have difficulty latching, transferring milk, or maintaining an effective feeding pattern.

Breastfeeding difficulties can also have many causes that are unrelated to tongue-tie. This is why an evaluation should look at the baby's overall feeding pattern rather than relying only on how the frenulum looks.

The AAP recommends assessing the infant's feeding and considering other possible causes before surgery. When significant functional problems continue despite appropriate nonsurgical support, frenotomy may be considered by a trained professional.

What Are the Possible Downsides of Frenotomy?

Frenotomy is usually a short procedure, but parents should understand the potential risks before making a decision.

1. Temporary pain or discomfort

A baby may experience some discomfort during or after the procedure. Appropriate pain-management measures should be discussed with the healthcare professional performing the procedure.

The amount of discomfort can vary depending on the baby's age, the technique used, and the individual situation.

2. Bleeding

Some bleeding can occur because the frenulum contains blood vessels. Significant bleeding is uncommon, but parents should understand that bleeding is a possible complication of any procedure involving tissue.

The provider should also review relevant medical history and factors that could increase bleeding risk before treatment.

3. Infection

Infection is another possible complication, although it is uncommon after frenotomy. Parents should receive clear instructions about what normal healing looks like and what symptoms should prompt them to contact their healthcare provider.

4. Scarring or reattachment

Healing can sometimes result in scar tissue or reattachment of the released tissue. This may affect tongue movement and, in some cases, may require additional evaluation.

The exact healing process varies from one child to another, so parents should follow the aftercare instructions provided by their child's clinician.

5. Feeding may not improve

This is one of the most important points for parents to understand.

A frenotomy does not guarantee that every feeding problem will disappear. If a baby's feeding difficulties have another underlying cause, releasing the frenulum may not solve the problem.

Research reviewed by the AAP suggests that frenotomy may reduce maternal nipple pain in some breastfeeding situations, but evidence for broader or long-term breastfeeding benefits remains limited. That is why a comprehensive feeding assessment is important before deciding on treatment.

What About Laser Frenotomy?

Some providers use a laser to perform a tongue-tie release. The technique can be precise and is used by trained clinicians for selected patients.

However, parents should not assume that laser treatment is automatically better simply because a laser is used.

The AAP's 2024 clinical guidance states that there is not evidence showing that laser frenotomy is superior to other methods of frenotomy in infants younger than six months.

The more important question is whether the baby actually has a restrictive tongue-tie that is causing a significant functional problem and whether treatment is appropriate.

What Should Parents Expect Before a Frenotomy?

A good evaluation should go beyond simply looking under the baby's tongue.

The clinician may ask about:

• Breastfeeding or bottle-feeding difficulties
• Latching problems
• Clicking or smacking sounds during feeding
• Milk leakage
• Feeding duration
• Infant weight gain
• Maternal nipple pain
• Tongue movement
• The baby's overall feeding function

The Alabama Tongue-Tie Center begins with an evaluation to understand the child's symptoms and functional concerns before discussing treatment options.

For parents who are unsure whether their baby may have a restriction, an evaluation can help determine whether the symptoms are consistent with tongue-tie or whether another feeding issue should be considered.

Is Frenotomy Safe for Babies?

Frenotomy is generally considered a low-risk procedure when performed by a trained professional, but "low risk" does not mean "no risk."

The AAP recommends that the provider discuss the benefits, alternatives, risks, pain-control options, and postoperative care with parents before the procedure.

Parents should also have an opportunity to ask questions about the clinician's experience, the specific technique being recommended, expected healing, and follow-up care.

If you're researching tongue-tie treatment for infants. it can help to understand the evaluation and treatment process before scheduling an appointment.

What Happens After Frenotomy?

After the procedure, the baby may need time to adjust to the change in tongue movement. Feeding may feel different, and parents should follow the clinician's instructions for feeding and follow-up.

The AAP does not recommend routine postoperative stretching exercises for infants because current evidence does not support them.

If your child has ongoing feeding concerns after a release, the appropriate next step may be reassessment rather than assuming another procedure is needed.

For older children, feeding or speech concerns may require collaboration with other professionals. Alabama Tongue-Tie Center also provides pediatric speech and feeding therapy support and can coordinate with a child's existing therapist when appropriate.

Should You Have Your Baby's Tongue-Tie Released?

There is no single answer that applies to every baby.

A visible tongue-tie does not automatically require a frenotomy. The decision should be based on the baby's symptoms, tongue function, feeding assessment, and whether appropriate nonsurgical support has addressed the problem.

For families considering treatment, the goal should be to determine whether the restriction is actually affecting function and whether the potential benefits of a release outweigh the possible risks.

If you are concerned about your baby's feeding, tongue movement, or possible tongue-tie, consider having your child evaluated by a qualified professional rather than making a treatment decision based only on photos or online symptom lists.

Alabama Tongue-Tie Center evaluates infants and children with suspected tongue- and lip-ties and provides treatment options based on the child's individual needs.

Frequently Asked Questions

Is frenotomy painful for a baby?

A baby may experience some discomfort during or after frenotomy. Pain-control options and appropriate aftercare should be discussed with the healthcare professional before the procedure.

Can a tongue-tie grow back after frenotomy?

The released tissue can heal with scarring or reattachment in some cases. Follow-up with the treating provider helps monitor healing and tongue function.

Does every tongue-tied baby need surgery?

No. Some babies have tongue-tie without significant functional problems. Treatment should be based on symptoms and function rather than appearance alone.

Is laser frenotomy safer than traditional frenotomy?

Current AAP guidance does not find evidence that laser frenotomy is superior to other frenotomy methods for infants younger than six months. The provider's training, evaluation, technique, and appropriate patient selection are important considerations.

What should I do if my baby has breastfeeding problems?

Start with a complete feeding assessment. A pediatrician, lactation professional, and other qualified healthcare professionals may help identify the cause. If a restrictive tongue-tie is contributing to persistent problems, a qualified clinician can discuss whether frenotomy is appropriate.