The Peds in my office do frenotomy right in the office. They do not refer out
to an ENT or Pediatric surgeon. The oldest child done in office was four years
and topical anesthesia was used.  This is something the Peds are looking for
on newborn assessments and discuss with the parents.  In infants no topical
anesthesia is used.  There is maybe a spot of blood (maybe, usually none) and
then the breastfed baby goes straight to breast.  Mom's feel an immediate
improvement.  I've watched dozens and don't know why such a big deal is made
out of needing an ENT or surgeon unless Peds are afraid of liability. Of
course, there are still Peds and others that don't believe its a necessary
procedure.

Warmly,
Pat Lindsey, IBCLC
Pediatrics Plus Staff LC (and private practice)
Orlando, FL