Deciding whether or not to release your baby's tongue-tie isn't easy. Though the procedure is considered low risk, it's still surgery on the person most precious to you. You want to explore all the potential disadvantages of a tongue tie release, including the cons & possible risks.

Complication from Tongue Tie release is about 1% , with minor bleeding being the most reported post-release complications. More severe complications that have been reported include feeding challenges, respiratory events, significant bleeding & weight loss. 

No doubt, the possibility that your baby may have difficulties breathing or uncontrolled bleeding is absolutely terrifying. Fortunately, these side effects are extremely rare, and often the studies that report them don't tell the whole story. 

Is A Tongue Tie Release Really Necessary?

At the heart of it, you're trying to figure out if you must put your baby through surgery to see an improvement in your baby's ability to feed. 

If a short or tight frenulum is leading to issues that are causing feeding (breast or bottle) to be painful for you, unsafe for your baby, or stressful for both of you, a tongue tie release is likely necessary. 

This necessity for a release is especially true if you see little results despite working through an actionable care plan with a Tie-Savvy IBCLC who has conducted a thorough assessment of all the things that could be causing your baby's feeding challenges. 

A thorough assessment should include checking: 

• how your baby uses their mouth, including checking specific tongue movements (cupping, elevation, extension, etc.)

• the height, width & shape of your baby’s palate

• how coordinated & responsive your baby's reflexes are

• the tone & responsiveness of your baby's facial muscles

• if your baby has any limitations in movement of their neck, back, hips, arms & legs

• If any environmental factors may be influencing your baby's feeding ability, such as using a Snoo or excessive swaddling

And this is all, in addition to addressing any latch & positioning adjustments that could help make feeding less stressful, less painful, and safer for you and your baby.  

Until you have a clear picture of all of the contributing factors leading to you & your baby's feeding challenges, it's impossible to know if a tongue tie release is necessary. 

Pros & Cons of Tongue Tie Release Surgery 

There's a good chance you've heard about the possible advantages of having your baby's tongue tie released. Less discussed, however, are the potential disadvantages or cons of tongue tie surgery. One major consideration is that nobody can promise outcomes, which probably feels like a massive downside of the procedure.

In the table below, you can weigh the common benefits of the procedure with the potential drawbacks.

While many parents report seeing an immediate, significant improvement after their baby's tongue tie release, in my experience, most parents report little to no noticeable difference after their baby gets back from the procedure. In the days/weeks following the surgery, as their baby gains strength in their tongues new range of motion, most parents begin to see changes. 

It's not hard to find parents who report no improvements or, in some cases, a worsening of issues. Again, from my experience working with parents after a "failed" release, the tongue tie was typically NOT the only or primary issue causing feeding challenges. 

Luckily, working with an oral function savvy lactation consultant BEFORE the frenotomy can significantly reduce the likelihood of falling into the latter scenario (no improvement or worsening issues). Additionally, Lactation support before the release procedure can prepare can get your baby physically & emotionally ready for surgery. 

And yes, I know the idea of helping your baby get emotionally ready may seem cooky, but I promise it's a real thing. A common theme amongst tongue tie babies is poor state regulation- they often go 0-1000 and are hard to calm down. By working on state regulations beforehand, we can make sure your baby can cope with the internal & external stressors of the release procedure, decreasing the chances of issues like breast refusal or oral aversion. 

Possible Risks & Complications Of Getting Your Baby's Tongue Tie Released  

No surgery comes without risks, which is true for tongue tie releases as well. Most babies have some bleeding and site soreness on the day of surgery. Parents can manage pain at home with both pharmaceutical & natural remedies. 

Other minor issues your baby could experience include

• Discomfort of the oral muscles, typically around days 3-5

• Fussiness or irritability

• Excessive drooling

• Scarring/reattachment

Less common but possible complications of the surgery include damage to the salivary glands or tongue muscles & excessive bleeding. The likelihood of your baby experiencing one of these issues depends on your baby's anatomy, the skill of the provider, & the severity of the tie. Some providers may be able to counsel you on your baby's specific risk factors; however, in many cases, release providers are unaware of specific anatomical variances that make these complications more likely until after they've begun the procedure. 

In preparing this article, I read through the published research on the complications of tongue tie surgery in infants. I also read through a few published posts that focus on the more severe reported complications, such as airway obstruction & dehydration. 

I think it crucial that we briefly analyze & discuss these potential risks so that you can better understand what is possible vs. probably for your baby. 

Poor Feeding, Respiratory Events, & Weight Loss (Kinda)

A research study conducted in New Zealand looked at the rate & type of complications of frenotomies performed in hospitals in children less than 1-year-old. They were specifically interested in looking at moderate to severe complications. 

In their study, there were 16 reported cases of complications. Based on the calculations in their study, the risk of moderate to severe complications was 0.0000139% (annual average incident rate 13.9/100 000). 

Something important to know when reviewing this study-and something this ScienceDaily article fails to point out- is that they looked at "any complication] attributable to, or arising from, any form of frenotomy for ankyloglossia, irrespective of whether this was the main reason for presenting to the pediatrician."

In their research paper, they counted weight loss & missed medical issue (due to focus on tongue-tie) as two complications for a baby who was already losing weight due to a heart defect. 

This scenario is drastically different from a baby who was previously gaining well and began to lose weight after tongue-tie release, which certainly would be a cause of concern. 

They also included complications reported over 100 days after the release. The average time from procedure to the reporting of complications was about 14 days, which coincides with a typical follow-up timeline. 

Nonetheless, they found that of the 16 babies who had complications:

• 7 had poor feeding after the procedure

• 4 had an episode of apnea or breathing difficulties

• 3 had pain

• 3 had bleeding

• 3 had weight loss (all of which were preexisting and related to the release itself)

• 2 had pallor/anemia

• 2 had excessive scarring

• 5 had "other" complications, which included unsettledness; peripheral cyanosis; greyish black stools; ulcer; severe hypernatraemia (171), hypothermia, and 20% weight loss

The number adds up to more than 100 because they reported multiple complications for some babies. 

Many of these babies were already medically fragile, and the reporting of complications were not limited to NEW symptoms that presented as a direct result of the procedure. 

Sublingual Hematoma, Swelling, & Ulcer

In this review, the authors looked at published reports & research regarding 3 months old with tongue-tie and/or feeding problems. The study looked at, among many things, the rate of complications of tongue tie release surgery. 

Reported complications which were exceedingly rare but included

• Poor feeding

• Bleeding that resolved with local pressure

• Damage to salivary ducts

• Massive edema under the tongue

• Ulcer

• Need for re-release (in 2% of cases)

They emphasize that the complications are rare and can be minimized by ensuring the release is done by a trained provider that uses a checklist before doing the procedure. 

The checklist they recommend includes things like confirming with a Lactation Consultant that a tongue tie is the cause of feeding difficulties, ruling out other causes of poor feeding like UTi, confirming the baby had a Vitamin K shot after birth, noting any bleeding disorders in the family, and doing a follow-up with the baby post-procedure. 

Of all of the research studies I reviewed in preparation for this post, the two outlined above were the only ones that reported on complications outside of the common/expected side effects of surgery in infants under a year old.

There were a few that considered the risks inherent to anesthesia usage. The possible risks of general anesthesia for tongue tie release in infants far outweigh the benefits and anesthesia is typically not required/recommended. Some providers may suggest using general anesthesia and if you're considering it, definitely chat with them about the risks & complications of putting your baby under. 

Conclusion

Circling back to the ultimate question of whether or not you should get your baby's tongue tie released, it's up to you to determine if the procedure's potential risks outweigh the benefits. 

I work with parents where we make incredible improvements in feeding without a release. I also work with parents where the only way to achieve safe, painless & stress-free feeding (breast or bottle) is to do the surgery. 

The pros vs. cons of the procedure depend significantly on your situation, what you've tried already, if you have access to a quality release provider who does a functional release, and your baby's feeding ability & medical history. 

Feeding dysfunction, of which tongue tie is just one cause, is often complicated to resolve. If you need help fixing your baby's feeding challenges or want help determining if your baby is ready /in need of a release, I encourage you to schedule a tongue tie assessment consultation with me.