Written by: dr. Dira Firzanti. – Lactation Doctor, Bekasi, West Java

Baby M is the second child of Mrs. N and Mr. D, a baby girl born by caesarean section at 38-39 weeks of gestation at a private hospital in Cibitung, West Java on August 19 2023. By. M is a term baby (NCB), according to the gestational age (AGA) with a birth weight of 2670 gr and a length of 48 cm. Right after delivered, the baby was crying loudly and was immediately taken to the perinatology and not getting early initiation of breastfeeding. After meeting the baby 6 hours later, the mother tried to give direct breastfeeding to the baby.

The mother felt that there was no milk coming out from her breast and the baby was not latching on and sucking well. In addition, she experienced pain during breastfeeding. When the baby was brought to lactation counselor (dr.D) it was found that the baby had a posterior medial tongue tie and grade 3 lip tie and had an H+1 incision. During pregnancy, mothers diligently had their pregnancy checked by a specialist in obstetrics and gynecology, and she also had received lactation education.

The mother has 2 children. The first child was 2 years 3 months, a girl, and had been breastfed for 22 months. The mother wants her second child to receive breast milk for 2 years. The mother took absence from work and the father worked at a hospital in Karawang. The mother took care of the baby with the help of a household assistant at home. The follow-up visit to IBCLC Pediatrician was on 25 August 2023. The baby was 6 days old during this visit. The mother said that the breastfeeding process was still uncomfortable and sometimes felt painful for her. Neither tongue exercises and aloe vera gel was given regularly. It was found that there was a re-attachment of the tissue under the baby’s tongue; thus, blunt pushing was done. There was a little bleeding and it stopped when the mother breastfed the baby. The mother was reminded that the administration of aloe vera gel should not be missed when performing tongue exercises and that aloe vera gel and triamcinolone ointment should be given at the incision site alternately between each tongue exercise. After being treated, the changes could be felt by the mother and she told that breastfeeding was more comfortable and painless. The baby seemed to be sucked stronger deeper and the baby looked satisfied when breastfeeding. It was expected that the mother to come for check up a week later.

The next visit was on August 30 2023 when the baby was 11 days old. The baby weight had increased by 48gr/day to 2860gr. It was categorized as good nutritional status within -2SD on WHO Growth Chart. There was no remaining tissue under the tongue, and from breastfeeding observations the baby seemed calmer and could breastfed more continuously. The mother said that tongue exercises were regularly given and aloe vera gel were also applied during the exercises. The frequency of tongue exercises had been reduced to 4x/day.

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Mother was expected to have a check-up a week later. The next visit was on September 8, 2023, and the baby was 20 days old. There was an increase in body weight by 48.8gr/day, which resulted in 3300g. It was categorized as good nutritional status within -1SD on WHO Growth Chart. There was no remaining tissue at the incision site, tongue exercises were still carried out 4x/day for the next 1 week. When the baby was 1 month 16 days old, her weight increased by 36.8gr/day, (weighted 4300gr). It was still within good nutritional status range.

Table 1. Weight Growth and Nutritional status in baby M

Picture 1. Baby M’s weight growth graph


Aloe vera gel is a gel that comes from the aloe vera plant. Aloe vera gel have antiseptic and anti-inflammatory effect. It can also stimulate fibroblasts and macrophages, increase collagen formation and proteoglycan synthesis, increase the function of growth and granulation factor hormones. These effects can accelerate wound healing. It can coat wound by creating a thin layer, inhibiting germs from entering the scar and preventing infection.i

Wounds are a loss of epithelial integrity. When this barrier is damaged due to various causes, the tissue cannot carry out its function adequately. It is therefore very important to restore its integrity as soon as possible. Wound healing involves a complex process. Applying aloe vera, especially its mucus to wounds topically, can speed up the wound healing process because aloe vera mucus contains glycoproteins, which reduce pain and accelerate repair and glucomannan, which is a compound enriched with polysaccharides which can influence fibroblast growth factors and stimulate cell activity and proliferation. and increases collagen production and secretion so that it can accelerate wound healing.ii

Performing exercises after lingual frenectomy plays an important role in accelerate healing, reducing pain and swelling, and restoring oral function. Incorporating these exercises into your post-frenotomy care routine can help you achieve a smooth and successful recovery. It is important to remember that each person’s healing process is unique and it is best to follow each step of the tongue exercise procedure.

It is also important to start slowly and gradually increase the intensity and frequency of exercise as wound healing progresses. With proper care, patience, and dedication, babies can fully recover after a frenotomy and experience the benefits of improved oral function and quality of life.iii


In every case post-frenotomy there will be a slight scar that will most likely fuse back together, and it must be prevented. Carrying out correct tongue exercises and administering aloe vera gel are necessary to achieve maximum results, by closing the frenotomy scar and prevent reconnection of the incised tissue.





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