4 year

Five people stand in a line posing for a photo in front of a modern, multi-colored glass building facade.

Some babies are born with a short frenulum under the tongue. This inhibits the baby from extending the tongue past the lips.


Many people refer to this condition as "tongue-tied" (medically called ankyloglossia).


The tongue’s frenulum attaches the tongue to the floor of the mouth. It should allow the tongue to extend past the lower gums and lip, elevate to the roof of the mouth, and move from side to side. If it is too thick, too short, or too far toward the tip of the tongue it can affect feeding, speech, tooth placement, and growth of the mouth. 


Not all frenulums that appear thick need to be treated. If the tongue functions well and the baby is feeding successfully, we do not need to do any procedures. Dr. Stuppy has written a summary of the guidelines recommended by otolaryngolosts (ear, nose, and throat specialists) on management of tongue, lip, and cheek ties that you can read here. 


Tongue tie affects about 4 in 100 people. It is more common in boys and there often is a family history of tongue tie.

  • Check your baby’s weight (we check length and head circumference too at standard well visits)
  • Ask about your baby’s feeding, bowel, and sleeping habits
  • Do a physical examination
  • Ask questions about development (in a pre-visit survey- watch for these texts before visits
  • Ask if you have questions or concerns about your baby
  • Update immunizations as recommended per our office schedule and standard guidelines

HOW IS IT TREATED?

We usually schedule the first visit 1-2 days after discharge. You will need to call to schedule this visit. Due to the nature of our scheduling availability, you may be asked to schedule with a member of our team that you have not yet met, but we think you'll like every one of our physicians and nurse practitioners. All have extensive training and experience and work well together to care for our patient families. 


After the first visit newborns usually have several weight checks to be sure they are feeding well and establishing good weight gain. After that, they follow the typical well visit schedule.

PHOTOS FROM STANFORD.EDU

Our physicians take turns seeing newborns in the hospital. You may get to see a face you already know or meet someone new, but we all trust our work teammates to take great care of our patients.

There are times that newborns require evaluation and care from a neonatologist (specialist in newborn care), such as if your baby is premature, has breathing difficulties, is suspected of an infection, or has need of intensive care. The local neonatologists will update us on how your baby is doing before they go home.

In the office

We see newborns at the following hospitals each morning:

WHEN THE TONGUE'S MOVEMENT AFFECTS FEEDING, A FRENOTOMY MAY BE RECOMMENDED

  • Infection
  • Bleeding (usually minor)
  • Swallowed blood can lead to spitting up
  • Damage to salivary glands (rare)
  • Need for more surgery
  • Feeding aversion

After the clipping the underside of the tongue will get a yellowed area (called "granulation tissue"). This is the normal healing tissue and will resolve within a few days.

What if your baby needs special care?

If you will be delivering at another hospital, just give us a call after you deliver to schedule your first visit. Please bring any paperwork given on discharge to your first visit. This may include your baby's birth weight, discharge weight, any lab values - such as bilirubin, screening results (such as hearing and cardiac screens) and any other information provided. This can help us learn about the hospital stay and continue care most effectively.

Newborns are scheduled to see one of our nurse practitioners or pediatricians for each visit. While we know that you will eventually see one of our staff primarily, initially it may be necessary to schedule with another person.

We all trust each other to work within our team, and newborns present the unique circumstance of needing a visit without much notice. Most of our routine well visits are scheduled 2-3 months in advance, so we hold spots for newborns, but it may not be with the person you will choose to see long term. We know this is not ideal because you want to introduce your baby to your chosen practitioner, but we cannot all have newborn spots open or it would cause scheduling issues for all the other patients - including your family long term. While we each have our unique personalities and bedside manners, we all follow standard care guidelines and will take great care of your little one!

If you want to learn more about us, check out the videos we have from each of our pediatricians, about our office locations, general medical advice we give and more.

Learn about each of the physicians and nurse practitioners on our individual pages.

  • Work with lactation to improve latch
  • Work with a speech pathologist or occupational therapist for feeding therapy

Kansas and Missouri each have routine newborn screens that are done in the hospital or birthing center to identify conditions that can be dangerous when not treated but not easily identified on a physical exam alone. The goal is to identify and treat diseases early enough to prevent serious complications such as growth problems, developmental delays, intellectual disabilities, blindness, deafness, and seizures.

You can learn more about the screenings from:

Risks of clipping:

Treatment of tongue tie involves lifting the tongue and clipping the frenulum (frenotomy).

A frenotomy can be done by trained pediatricians, ENTs, or dentists. Some of our pediatricians have this training, so if you're concerned we can make sure you get scheduled with one of them for an evaluation. ​There are local dentists who do a laser procedure, but this is more expensive and has not been shown to offer any benefit. (See Dr. Stuppy's review of guidelines for more details.)

​The frenulum does not have nerves for pain, and most newborns tolerate the procedure well without any anesthetic. We usually ask that they feed immediately after the procedure to assess their feeding. 

It is recommended if the frenulum is very thick, posterior, very vascular or if there is a family history of bleeding disorders that an ENT specialist does the procedure.

We work as a team at Pediatric Partners - from the front desk receptionists, to our nursing staff, to our nurse practitioners and pediatricians, we're all here to take the best care of your family!

  • Advent Health -Shawnee Mission
  • Overland Park Regional Medical Center

In the hospital

Most of the time we can start our relationship at the hospital when we see your baby soon after birth, but sometimes we begin care after they are discharged from the hospital. We generally see babies in our office 1-2 days after they are discharged from the newborn nursery or NICU.


If you choose our office, be sure to let the hospital know who your pediatrician will be. The hospitals call us after the baby is delivered and we will see you each morning.


One of our physicians will round each morning in the hospital to check on your baby, see how feeding is going, and treat most problems that arise. Most babies are in the hospital 2-3 days and we see them on daily rounds to evaluate how they are feeding, how much weight loss they have, perform a physical exam, and discuss parental concerns.


As mentioned above, we work as a team. Our pediatricians take turns rounding each day, so you may meet several of us during your stay at one of the above hospitals and it may not be the pediatrician you plan to see long term in our office, but we will be sure that person hears all about your baby. 

What if you're delivering somewhere else?

We occasionally care for babies in the Newborn Intensive Care Nursery (NICU) if they are there for a short time and for minor issues.

We have a relationship with the Neonatologists (specialists in sick and premature newborn care) at each of the hospitals. They help care for the infants who are requiring more specialized care and let us know when they're ready to see us.

Alternates to frenotomy:

During the visit we will :

A newborn with a noticeable tongue-tie, characterized by a short, tight lingual frenulum restricting tongue movement.
Close-up of a newborn with an open mouth, showing the tongue and gums.

The pictures are the same baby before and after the frenulum was clipped.

Three panels showing an uncircumcised penis, a healing circumcised penis with granulation tissue, and a healed penis.

PROCEDURE DESCRIPTIONS

MOGEN CLAMP:

The type of procedure done is dependent on the training and experience of the person performing the procedure. Risks and benefits overall are similar. The final "look" of the penis will be the same after the first week.

Both types use a local anesthetic called lidocaine to numb the area. This injection may sting initially (sugar and a pacifier are used to help pain control for the sting) and the injection may leave a bruise at the base of the penis. Babies can still feel the cold of the cleaning product we use to decrease risk of infection and they can still feel tugging, but the sharp pains of the procedure are lessened with the lidocaine. The foreskin is pulled away from the head of the penis (aka glans). 

The remainder of the procedure done and aftercare depends on the type of circumcision.

There are two main types of circumcision, one that leaves a plastic ring (Plastibell) on the head of the penis, and another that removes the foreskin and is left open with petrolatum jelly on gauze.

Care depends on the procedure done. After a baby's circumcision, it takes about a week to heal regardless of the method used. 

After the healing has taken place, no special care is needed other than routine cleaning.

We recommend putting petroleum jelly on the head of the penis during the healing process to keep it from sticking to the diaper. If stool gets to the area, simply rinse with water without rubbing the area much. Reapply petroleum jelly each diaper change. We suggest you do not use any creamy products or lotions on the healing penis, as they cause irritation. 



  • The foreskin is pulled up and the clamp is placed over the glans, to protect it from being cut.
  • The clamp puts pressure on the tissues to prevent bleeding.
  • The foreskin above the clamp is removed.
  • No stitches are needed unless there is excessive bleeding, which is a rare complication.
  • The head of the penis will look open and raw during the healing process. This is normal!
  • Change the gauze pad with petrolatum jelly (Vaseline) with diaper changes since it will be soiled. 
  • Rinse the head of the penis with water if stool (poop, bowel movement, meconium) gets on it, but usually simply changing the gauze is sufficient.
  • Continue to place Vaseline gauze on the head of the penis until it is healed. You will know when it is healed when there are no more red or yellow areas.
  • If there are signs of infection, such as redness of the penis shaft, temperature over 100.4F, poor feeding or fussiness, your baby should be evaluated.

Sometimes the penis will sink into the fat pad surrounding it, allowing the skin to reattach over time.



If your child's foreskin comes back over the head of the penis, push back on the fat pad to pull the skin off the head of the penis with diaper changes. Apply petrolatum jelly (Vaseline) to the area to prevent sticking.

If it does stick, it is called an adhesion. This usually doesn't cause any problems - remember that uncircumcised penises generally pull away from the foreskin over the pre-pubertal years. The adhesions of a circumcised penis will also naturally pull away over time. If they cause pain, they should be addressed. 

A white substance called smegma sometimes is seen around the edges of the head of the penis. This looks like cottage cheese and is sometimes mistaken for pus. It is not pus and is a normal substance made by the penis. Gentle removal with a moist cloth is all that's needed if it's bothersome.

Circumcision types and care

The foreskin is attached to the head of the penis at birth and will usually naturally pull away over the first few years of life. A white substance may be seen as the foreskin pulls back. This is smegma and normal, not a sign of infection.

As long as the foreskin doesn’t easily retract, only the outside skin needs to be cleaned.


If the foreskin retracts a little, clean only the exposed area with water. Don’t use soap on this area - this can irritate the skin. After cleaning always replace the foreskin back over the head of the penis. 


As your child gets older and the foreskin has completely separated and retracts easily, begin to teach him to clean underneath it as he bathes. 


If the foreskin does not naturally pull away from the head of the penis an this causes painful erections, bring your child in for an evaluation of the situation.

Uncircumcised penis

A WORD ABOUT ADHESIONS...

After the Mogen Clamp it will look bright red and swollen initially, then less swollen. As it heals, yellow granulation tissue appears on the head of the penis. This is normal and NOT an infection. 

PLASTIBELL

  • A plastic ring (Plastibell) is inserted between the head of the penis and the foreskin and tied off.
  • The ring is left in place until it falls off naturally, generally 3-7 days later. 
  • Routine cleaning with diaper changes is done.
  • If the ring does not fall off within 14 days or if it slips down the shaft of the penis, bring your baby in to be evaluated. This is an emergency if it seems red, tender, or your baby has a temperature over 100.5F, is fussy or not feeding well.
  • Track your child's development with FREE online tools. 
  • Find developmental milestone information so you can keep track at home.
  • Pathways offers resources for infant and child development.
  • Zero to Three offers resources for infant and child development and parenting.
  • Did you know you can sign up for free weekly texts coinciding with your due date to help with every stage of pregnancy and the baby's first year? Visit text4baby for more details. 

Milestone Tracking and Tools to Maximize Your Child's Development

Childcare can be done in a person's home or in an established child care center. There are pros and cons to each, so consider your family's needs to start your search. 

ChildCare Aware has a searchable database to help locate childcare providers, check licensing of childcare providers and see inspection reports. Click on the state to find providers in Kansas and Missouri.

To help locate a childcare provider, learn how to find the best childcare, and more use this searchable database: Childcare.gov. Use their Tip Sheets to help find the best care for your child(ren).

Local Resources to Optimize Development

  • Parents As Teachers works with parents to teach them how to teach their infants through 3 year olds. 
  • Infant and Toddler Services provides therapies for Kansas infants and toddlers through 3 years of age with delays in developmental skills, such as speech and language or gross motor skills. 
  • First Steps provides therapies for Missouri infants and toddlers through 3 years of age with developmental delays.

Daycare:

Colic (Fussy baby) Resources:

Hot topic: Getting ready for Kindergarten

Kindergarten is not just about academics; it's also about socialization and building relationships with peers and teachers. Help your child develop essential social skills that will support their success in the classroom:

  • Teach them to share, take turns, and cooperate with others.
  • Encourage empathy and kindness towards their peers.
  • Practice active listening and following directions.
  • Foster independence in completing tasks and solving problems.

By nurturing these social skills at home, your child will be better prepared to interact positively with others in the kindergarten setting.

Separation Anxiety: Supporting a Smooth Transition

It's common for children to experience separation anxiety when starting kindergarten, but there are steps you can take to ease this transition:

  • Visit the school together before the first day to familiarize your child with the environment.
  • Establish a consistent goodbye routine and reassure your child that you will return.
  • Encourage them to express their feelings and validate their emotions.
  • Stay positive and provide plenty of encouragement and praise for their bravery.

With time and patience, most children adjust to the new routine and feel more comfortable in their kindergarten environment.

Developmental Considerations: Individualized Support

Every child develops at their own pace, and it's essential to consider your child's unique strengths and areas for growth:

  • Encourage activities that promote fine and gross motor skills, such as drawing, cutting, and playing outdoors.
  • Support language development through reading, storytelling, and conversation.
  • Provide opportunities for creative expression through art, music, and imaginative play.
  • Monitor your child's progress and communicate regularly with their teacher to address any concerns or areas where additional support may be needed.

By taking a holistic approach to your child's development, you can help them thrive academically, socially, and emotionally as they enter kindergarten.

If your preschooler is afraid at the doctor's office, have them watch this short video to learn what will happen.

Our website has many resources.

Some pages you might find helpful at this age include:

Development

Feeding & Nutrition

  • Kids can eat an unrestricted variety as long as it's a well balanced diet. A parent should decide what kids eat, but they decide how much! If they favor one type of food, offer it after other healthy foods have been eaten to ensure a good balance.
  • It's not unusual for a child's appetite to drop at this age. Provide healthy options and allow your child to decide how much to eat. Your child may eat one regular meal then consume the rest of their calories in small meals and snacks, so provide healthy options every time they eat.
  • Try to give a plant (fruit or vegetable) plus a protein each time your child eats. This helps them get to the 5-a-day fruit/vegetable recommended intake. 
  • Limit juice and minimize sugary snacks. Juice offers little nutrition and has a lot of sugar! See Dr. Stuppy's summary of the AAP Juice Guidelines for more. 
  • Low-fat milks are appropriate. Limit to no more than 24 oz. daily. Too much milk is dangerous because it fills kids up and they don’t eat other nutrient rich foods, leading to deficiencies in other vitamins and iron.
  • All children should receive a supplement of vitamin D and iron because they do not get enough in their diet. Learn more about vitamin D.
  • Let kids help serve themselves and prepare food - this helps them develop their skills and often times helps picky eaters increase their food intake!

Health

  • Kids get 8-12 viral infections per year. Each may last 2-3 weeks, so they seem like they're always sick, especially during the cold and flu season. Visit our illness pages as needed.
  • Fever (temperature of 100.4° F or higher) is the body’s response to illness. It can be a good thing by helping to eliminate infection. Treat only if uncomfortable.
  • Tooth health
  • When your child is able to spit after brushing, you can increase to a pea-sized amount of fluorinated toothpaste. 
  • It is time to establish care with a pediatric dentist if you haven't already. Check your insurance to see who is covered.
  • Smoking and vaping risks
  • Smoking and vaping in enclosed spaces allows smoke dust and particles to settle on clothes and hair, so even if a child is not present while smoking or vaping, they can be exposed later.
  • When a child inhales the smoke dust and can develop allergies, asthma, and ear infections.
  • Never smoke around your child or in the home or car – even if the child is not present at the time.
  • Keep all cigarettes, vaping devices, and lighters away from children to avoid them trying to smoke or vape - or start a fire!
  • If you need help quitting, find information on our Community Resources Page.

Safety for your family

  • If you are worried about your living or food situation, talk with us. Community agencies and programs such as WIC and SNAP provide information and assistance. Find information about this and more on our Community Resources Page. See the "Economic and Financial Help" tab.
  • Ask us for help if you have been hurt by your partner or another important person in your life. If you feel unsafe at home, see Safehome Kansas or call 913-262-2868.
  • When in crowds have your child wear or carry your phone number (such as on an arm band). Teach them to show it to another parent or worker if lost.
  • All parents should learn CPR and refresh skills every 2 years. For a list of CPR classes for both non-medical and medical professionals, search for "CPR" with your zip code on a web search engine.
  • Always leave contact information with babysitters. For more babysitter tips, see our Babysitter page.
  • Car safety:
  • Booster seats with a lap belt only are not safe at this age. Stay in the 5 point harness!
  • If you need a car seat sticker, ask us! They can help identify who to call in case of emergencies.
  • Do not put kids in thick clothing under a car seat belt. Remove coats and put blankets on top of the seatbelt.
  • Make sure your child is always properly strapped in the car safety seat during travel. 
  • Always wear your lap and shoulder seat belt to better protect yourself in case of accident.
  • Never drive after drinking alcohol or using drugs.
  • Never text or use a cell phone while driving.
  • Home safety
  • Keep medications, cleaning products, and other toxins away from young children. Secure furniture to walls.
  • Turn your hot water heater down to below 120° F to decrease the risk of burns.
  • Check your smoke and carbon monoxide detectors and replace batteries regularly.
  • Charlie's House is a great local resource for all your child proofing questions!
  • Keep the poison control number in your phone. 1-800-222-1222
  • Drowning danger: Never leave young children alone in the bathtub. Stay within arms reach of young children at the pool. Empty wading pools and buckets immediately after use to prevent drowning and mosquitos!
  • Keep the water heater set to less than 120F to avoid burns.
  • If you own guns, be sure they are stored properly locked with the ammunition locked separately. Ask us for a gun lock if you need one!
  • Outdoor safety:
  • Bug sprays with DEET are recommended when exposed to insects.
  • Street safety: Teach kids to stay out of the street and hold hands if possible in parking lots and when crossing the street.
  • Use a helmet and protective shoes (no open toed sandals or shoes that slip off) whenever on bikes, Big Wheels, scooters, etc.
  • Don't allow kids nearby when you're mowing the lawn. Projectile objects can hurt those who are too close.
  • Use sunscreen. Apply 30 minutes before sun exposure and repeat every 2 hrs as needed.

Looking ahead to the 5 year visit:

We'll talk about

  • Taking care of your child, your family, and yourself.
  • Developmental milestones - use the tools above to prepare!
  • If kids get their recommended vaccines at 4 years, there are no required vaccines at the 5 year visit. We will offer seasonal or catch up vaccines as indicated. Review the vaccines we'll give before your visit.