> Dear Jay (Janet?), > > You wrote: > > > Subject: Re: Frenotomy > > I have a client who is having a heck of a time finding someone to do a > > frenotomy and "Is sedation necessary" > > Have you considered contacting some Family Practice docs. I know I'm a > little biased, but I find that overall they have a more holistic approach > than most peds. I worked with a great group for 6 years and the "oldest > doc" (about 45'ish?) was the one who pointed out to me that frenotomies > used to be so common that the circumcision instruments till have a little > cutting notch on the other end which was used for frenulum clipping. > > "Can someone give me a detailed description of frenotomy?" > > He showed me how to do my first one and I've done one more since then. We > didn't sedate either one. (It can't possibly hurt 1/1000th as much as > circ.! and most are not sedating them although most of "my" docs do penile > block nowadays.) With the first child I just had mom hold baby's body > /arms (she was a nurse--not worried about being too upset by this > procedure) and my nurse hold the head steady. When the baby opened wide to > cry I used sterile surgical scissor and gloves to snip the thick, white > extra-frenula tissue. The tongue moved with the cry but the frenulum > actually seemed surprisingly "still." So it wasn't as difficult as I had > imagined. I did 2 or 3 tiny snips (1mm each?) til I saw a drop of blood > (or less?) and knew I was done. I don't recall the baby crying any harder > when I hit blood. We immediately handed baby to Mom to nurse and she was > ecstatic as there was IMMEDIATE relief for her. This was her 3rd nursed > baby and she had come to us saying "something isn't right; it hurts and I'm > sore." She just kept repeating her happy surprise at the change. Before > she left, I checked the sleeping baby's mouth--no blood or evidence of the > "surgery." > > My 2nd one was not as easy as we were in the hosp--decided to try using the > "circ.board"--papoosing device--which the kid absolutely hated. Did same > procedure but don't recall any blood (plenty of sweat on me though--don't > like tied down, screaming, trying to thrash babies--goes against my > instincts!!) but knew I had cut thru plenty of non-vascularized tissue > (again just a few mm). This Mom had not noticed any soreness as we had > been unabe to get him to latch much prior. He still didn't latch > immediately but did well within a couple of weeks. His Mom's a BF peer > counselor now. > > Meg Wright, PA-C > Physician Assistant