After visiting several Doctors, Dr. Jenna Khoury saves the day with a laser frenectomy

Bennett Riley Young: Our Story on how a laser frenectomy saved his little life. 

Written by: Jennifer ( Bennett’s Mother)

Our son Bennett was born full term by repeat c-section on January 20, 2016 at 8 lbs 20 inches. He was our fourth child and our second boy. Our other children were so excited to finally meet their little brother.

Bennett seemed healthy and nursed well right from the start. Our three children had nursed until they self weaned at 15 months of age. I felt confident that things were going well. He nursed so well, in fact, that all of the nurses that cared for us during our four day hospital stay commented on his great latch and his instant love for nursing. A few lactation consultants came by but none of them examined Bennett. One of them examined my breasts when I told her that they were painfully engorged, something that had not happened to me after delivery with my other children. She assured me all was well and advised not to pump because that would worsen the problem.

Bennett and I were discharged from the hospital and his weight was just below his birth weight. This is completely normal for a newborn. He continued to appear to nurse well. At one week of age his weight had dropped to 7 lbs 9.5 oz. I was reassured that weight gain may take time since he was exclusively breastfed. This seemed normal as a small drop in weight had occurred with my other children. Bennett had acid reflux symptoms (swallowing air, painful reflux of milk up in his throat, excessive gas) which I mentioned to our pediatrician. His sister had experienced silent reflux but gained weight very well on ranitidine. The pediatrician wanted to wait and see if things improved in another week before starting medication.

At two weeks old he still only weighed 7 lbs 10 oz . He was still having reflux symptoms and was started on Prevacid daily. I told his pediatrician that I was getting plenty of milk when using a breast pump; I would get 3-4 oz after nursing him. I brought in pictures of my pumped milk to prove this to her because I felt like they didn’t believe me that I had plenty of milk. In hindsight, being able to pump so much milk after nursing was a red flag. His pediatrician thought that he had a cow’s milk protein allergy and soy allergy so we were told to try Nutramigen formula and I was to stop all dairy and soy. He refused to drink the formula (it smelled terrible). My milk supply began to decline. I attributed this to what everybody kept telling me- I had just had a c-section and I had no appetite. Now my intake was reduced further by not being able to eat dairy and soy.

At three weeks old he had declined to 7 lbs 8 oz and was diagnosed as “failure to thrive.” His formula was changed to Alimentum and he was sent to Rady Children’s Hospital for STAT labs. The labs showed increased bilirubin and liver enzymes. He had a urinalysis which was normal. I gave Bennett 2-3oz of Alimentum formula every 2-3 hours for 24 hours and I brought him back to be weighed again- he was now 7 lbs 11 oz.

The next day the pediatricians office consulted with Rady Pediatric Gastroenterology via phone and they advised that we stop Alimentum and start fortifying my breast milk with Enfamil Newborn Formula. They completely disagreed that Bennett had allergies and thought that it was a calorie issue. They thought perhaps I had “low-calorie” breast milk. We were given an appointment with Rady Pediatric Gastroenterology in a few weeks for further assessment.

It was at this point that I had noticed my milk supply dropped to nearly nothing. I would pump and get maybe an ounce from each breast. This made some sense- I had been giving Bennett formula so I thought my supply would decrease. I was just very surprised at how much it declined in a period of a few days. The pediatrician encouraged me to try to nurse him as often as possible while still giving him the fortified breast milk in a bottle.

It was at this point that I started to experience extreme anxiety about Bennett’s health and to question things and ponder our situation. I had been told that my breast milk was “low-calorie”, that Bennett had a cow’s milk allergy, soy allergy, etc. I felt as if his health care providers were just making things up but had no idea what was actually going on. My milk had gone from robust to nearly non-existent in a matter of 48 hours. Something was very wrong and I did not think that any of these explanations made sense.

I told our story to several friends, co-workers, family members, and on a breastfeeding support group on Facebook. One common theme kept appearing: “Did you check him for tongue tie?” I had watched as four pediatricians in the hospital, our own pediatrician, and our nurse practitioner examined him for a tongue tie and all reported that he was not tongue-tied. As a nurse practitioner myself, I had been taught to examine for tongue tie in infants with difficulty nursing or gaining weight. I saw nothing that indicated a tongue-tie.

Bennett had his 5 week check up and he had gained just 3 oz in a week on the Enfamil Newborn formula. I was disappointed and very worried. The Thursday and Friday that Bennett had turned 5 weeks, I extensively researched his symptoms on the internet and found that he had every single symptom of a lip-tie. He had acid reflux, was diagnosed failure to thrive, made a clicking sound while nursing, gummed the nipple, and he fell off the breast often. He also had a red ring that appeared on his upper lip after nursing or bottle feeding- a classic sign. I researched how to check for a lip-tie and found the website of Dr. Lawrence Kotlow, a pediatric dentist. Dr. Kotlow had a wealth of information on his website including pictures of lip-tie diagnostic classifications. It appeared to my untrained eye that Bennett had a grade III or IV lip tie. I couldn’t believe when I found a pediatric dentist a mile from our house specialized in this area. I scheduled him for a consult with the pediatric dentist the following Monday. I felt hopeful for the first time in weeks.

As I poured over lip-tie and tongue-tie literature I found that not one provider had examined our son for lip-tie (I was present at every exam) and not one health care provider had examined him correctly for a tongue-tie. The correct placement is for the child to lie on their back in the parents lap, facing away from the provider. This is the only way to adequately visualize the posterior tongue. The provider then places two fingers under the tongue and pulls back, exposing the entire floor of the mouth. The lip is also lifted out and up to expose a possible attached frenum. The providers that examined Bennett had been face-to-face and stuck one finger up under his tongue for about a nano-second; some of them just inspected and did not touch him at all.

I felt like a kid awaiting Christmas morning as I anticipated our pediatric dental appointment. On Monday afternoon we walked in to see Dr. Jenna Khoury of The Brush Stop Pediatric Dentistry and Orthodontics. My heart leapt as she asked me to hold Bennett in my lap while she examined him from behind. Yes! Finally- she knew what she was doing!

It was the best bad news I had heard in years: Bennett had a stage III lip-tie and a stage IV, or “posterior” tongue-tie. I could not see the tongue-tie and she helped guide me to place two fingers under his tongue to feel the tight, wire-like frenum. Dr. Khoury recommended surgery to correct the lip-tie and tongue tie but explained that the surgery may or may not help. She encouraged us to follow up with pediatric gastroenterology and to get the opinion of a lactation consultant before we decided how to proceed.

The next day we saw the pediatric gastroenterologist. Bennett had once again only gained 3 oz in 7 days. He was still taking Enfamil Newborn formula 2-3 oz every 2-3 hours and nursing when he wanted. The pediatric GI reassured me that things were going okay and that he was at least gaining at this point. I explained to the pediatric GI that Dr. Khoury diagnosed him as tongue-tied and lip-tied. She looked under his tongue and reported that all looked fine. I pulled up Bennett’s lip to show her his lip-tie and she expressed that it should not be causing him any difficulties. She stated that while it was my choice to go ahead with surgery if desired, she would prefer for me to take Bennett to see an otolaryngologist at Rady Children’s Hospital.

Once again, I felt defeated and unsure of myself. I really thought that we had discovered the cause of Bennett’s failure to thrive and now those hopes had been shot down.

The next day I saw my own OB for my 6 week check up. He asked how I was and I proceeded to tell him about the difficulties we had been facing over the past 6 weeks. He sent me to his lactation consultant, who happened to be there leading a breastfeeding support group. She put Bennett down on the exam table and stated that she could tell how severe his tongue tie was just by looking; he had a heart shaped tongue and the tongue was kept very close to the floor of his mouth. She proceeded to examine him and found that Bennett was lip-tied and tongue-tied. She agreed that surgery was necessary.

My husband and I discussed all of this information and decided that the right path for us was to have Dr. Khoury perform the surgery. She was the person that I trusted more than anyone at this point. She didn’t promise a cure, or say that her way was the right way or the only way. She was patient, kind and knowledgeable about infants with lip and tongue-ties. We cancelled the second opinion with the otolaryngologist and scheduled the frenectomy.

Bennett went for the laser frenectomy at 6 weeks old at 8 lbs 5 ounces, just 5 ounces above his birth weight. 12 days after surgery, he was up to 9 lbs 13 oz. He had gained a pound and a half in less than a fortnight! The relief we felt with that much weight gain was immense.

Bennett is now just over 8 weeks old. He is nursing with a much better latch and is learning to nurse more efficiently. He takes a bottle with less choking and swallowing air and in half the time (it had previously taken him 20-25 minutes to take 3 oz). He has no more painful gas. We are so excited that he hit every developmental milestone for a 2 month old at his recent well-baby check-up.

I share this story to spread knowledge about tongue and lip ties. If you are a Mama that is struggling with milk supply, sore nipples, a gassy baby, a baby that isn’t gaining weight and/or has been diagnosed as failure to thrive, a baby with acid reflux, a baby with the “red ring” on their upper lip after eating- or any other concern, please, please DO NOT wait it out. Find somebody in your area that is an expert in tongue and lip ties. Do not assume that your pediatrician or family practitioner knows how to correctly examine for this condition. If they are not examining your baby in the fashion that I described above: GO SOMEPLACE ELSE! You are the Mama, you know your child the best and you are your child’s best advocate.

Here is the video:

Pictures of laser frenectomy

Bennett had his frenulectomy at 6 weeks and 2 days old. Here is a picture of his latch before the surgery:

Before revision || Tongue Tied baby-  The Brush Stop Pediatric Dentistry

And here he is nursing right after the surgery:

After revision || Tongue Tied baby-  The Brush Stop Pediatric Dentistry

 

Stage III lip tie and stage IV tongue tie corrected by Dr. Jenna Khoury, DMD at 6 weeks and 2 days old.

 

BEFORE- Stage IV “posterior” tongue tie

BEFORE- Stage IV "posterior" tongue tie || The Brush Stop Pediatric Dentistry

AFTER

Tongue- tie post operation- laser revision The brush stop pediatric dentistry

BEFORE- Stage III lip tie

BEFORE- Stage III lip tie || The Brush Stop

AFTER- Dr. Jenna Khoury, DMD did the laser revision.

The Brush Stop - pediatric dentistry ( tongue tie and lip tie)

 

Left: 14 days before frenectomy, 7 lbs 8 oz Right: 12 days after frenectomy, 9 lbs 13 oz

Post tongue tie and lip tie Laser revision || The Brush Stop Pediatric Dentistry

If you want to read more about tongue ties and lip ties and laser frenectomy, I highly recommended these sites:

My favorite, Pediatric Dentist Specialist, Dr. Jenna Khoury, DMD, pediatric dentist at The Brush Stop in Carlsbad, California:

http://thebrushstopdental.com/pediatric-dental-services-carlsbad-ca/specialized-care/lip-tie-and-tongue-tie/

 

 

 

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