Your Toddler’s Visit
Our #1 priority is to ensure that families who visit our office feel as though we are listening to them, answering their questions, thoroughly evaluating their child, and providing the best quality care possible. The consultation appointment consists of a thorough review of your child's symptoms, a discussion about tongue ties and how they may impact your child in more ways than you may have realized.
Consultation
Once you arrive and are checked in, an assistant will bring you and your child to Dr. Aaronson's consultation room. Dr. Aaronson will then come in and chat with you for a bit about your child's symptoms, any issues you are having with feeding, and she will review your child's medical history. Certain things like traumatic births, long labors, a history of chiropractic treatment, etc. may be important factors to know in order to properly diagnose your child.
She will spend about 20 minutes discussing tongue and lip ties and how they can impact function. It is important for parents to understand what ties are so that they can be fully aware of how their child's condition might be causing issues that they may not have linked to a tongue tie. This allows for parents to make informed decisions on their child's treatment. There is no wrong choice for treatment, as long as it is an informed one.
Evaluation
In order to properly diagnose a tie, the lip and tongue must be maneuvered in a way that can clearly expose any restrictions. This involves a lap-to-lap exam, in which a parent is seated across from the doctor, and the child's head is placed in Dr. Aaronson's lap. Dr. Aaronson will then lift the child's lip, move the cheeks, and lift under the tongue to look for any restrictions. It is important to note that the presence of a frenum (a band of tissue) connecting the lip or tongue to the rest of the mouth does not necessarily mean treatment is needed. Dr. Aaronson evaluates whether the frenum is inhibiting the child's mouth from going through the necessary movements to properly latch and suck.
After the examination, Dr. Heidi will thoroughly explain her findings and will discuss treatment options at that time. Depending on the age of the child, the severity of the tie, and whether your child has been working with a feeding/speech therapist and has been prepared for treatment, there is a chance treatment may be possible at the first visit. In many cases, the age of the child and the difficulty for the parents to manage post-operative exercises may prevent treatment from being done until the child is older (usually around 4).
Parents do not need to make any treatment decisions at the time of the visit if they are not ready to do so.
Treatment
The treatment of choice for tethered oral tissues is called a frenectomy (or frenotomy), which is a minor surgical procedure that releases the tension on the frenum, allowing the tongue and lips to move freely.
While some providers use a scalpel or scissors, Dr. Aaronson uses a CO2 laser to quickly and nearly painlessly release the tethered tissue. The benefit of a laser is that it reduces postoperative swelling and bleeding by sealing off the lymphatic and blood vessels.
Your child is brought back to the treatment room by an assistant. We ask that parents stay in the waiting room during the treatment, which usually takes less than 5 minutes. This is standard laser safety protocol, and is also because Dr. Aaronson needs to focus 100% of her attention on your child, and having worried or anxious parents in the corner of the room is distracting.
Once your child is comfortably swaddled, we place protective glasses over their eyes to prevent any damage from the laser. Pre-op photos will be taken for documentation and insurance purposes. A frenectomy takes less than a minute to complete. A topical anesthetic gel is given to help reduce discomfort during the procedure. The assistant holds your child steady while Dr. Aaronson uses the laser to quickly release the frenum(s). Although the actual laser treatment takes about 5-10 seconds, Dr. Aaronson needs to access the mouth and get a good look at the lip and/or tongue prior to treatment. This is usually the part where children scream and cry, because they simply don't like fingers in their mouths!
As soon as the release is done, your child is picked up and comforted while the assistant goes to the waiting room to retrieve the parents. The parents are brought back to the room and you are free to feed your child if you would like. You can use a bottle, sippy cup, breast, or purees.
Dr. Aaronson will review the stretching techniques and post-op care at this time. She will discuss pain management, what to expect with healing and pain, and any concerns you should be aware of that would warrant a phone call. She will then give you her personal cell phone number and encourage you to call/text her with any questions or concerns that may arise.
Post-Operative Care
To ensure the best possible outcome, it is imperative that you follow up with your feeding specialist after the procedure. They will help make sure your child's function is improving, that the tongue is getting stronger and more coordinated, and that healing is as expected.
It is also extremely beneficial to see a manual therapist or bodyworker after the procedure. This helps loosen up your child's fascia and releases tension throughout the body to allow for ideal healing and function. Through chiropractic care, occupational therapy, craniosacral therapy, osteopathy, or other methods of manual therapy, children respond very well to tongue tie release and have easier recoveries.
If there is any concern about the wound healing, Dr. Heidi will gladly see your child for a free follow-up visit within three months of treatment. If you have not been working with a feeding specialist and/or bodyworker, there may be a charge for the follow up visit, as healing is not as predictable without proper aftercare and oral rehabilitation exercises.
