What is the treatment for a 7-month-old with a cut at the upper lip frenulum after a fall?

Treatment of Upper Lip Frenulum Cut in a 7-Month-Old After a Fall

Most upper lip frenulum lacerations in infants heal spontaneously without intervention and require only supportive care with wound hygiene and dietary modifications. 1

Initial Assessment

First, assess for child abuse, as trauma affecting the lips, gingiva, tongue, and palate in children younger than 5 years should raise suspicion for non-accidental injury. 1, 2 Document the mechanism of injury and ensure it is consistent with the developmental stage—a 7-month-old who is not yet cruising or walking should not sustain falls from standing height. 2

Examine the wound to determine:

• Depth and extent of the laceration 1
• Active bleeding (apply firm sustained compression if present) 2
• Associated dental or gingival injuries 2
• Signs of more extensive facial trauma 2

Wound Management

For most frenulum lacerations in this age group:

• No suturing is typically required, as these injuries generally heal well by secondary intention 1
• Clean the wound gently with water to remove debris 1
• Topical antibiotic ointment (such as bacitracin) may be applied 1 to 3 times daily to help prevent infection, though use in children under 2 years requires asking a doctor per FDA labeling 3

Note: The upper lip frenulum is a normal structure present in all newborns, with most attached at the gingival margins (83% in one study). 4 Simple lacerations to this structure do not require surgical intervention or frenectomy. 4

Post-Injury Care Instructions

Provide caregivers with specific instructions:

• Soft diet for 10 days following the injury, avoiding hard, sharp, or irritating foods that could disrupt healing 1
• Restrict pacifier or digit sucking for the first 10 days 1, 2
• Maintain good oral hygiene with gentle cleaning to optimize healing 1, 2

Monitoring and Follow-Up

Instruct caregivers to watch for:

• Signs of infection: gingival swelling, increased pain, purulent drainage, or fever 1
• Breathing difficulties (though unlikely with isolated intraoral laceration, this warrants urgent re-evaluation) 1
• Delayed healing beyond 10-14 days 1

Re-evaluate if any concerning symptoms develop. 1

When to Refer

Immediate referral to a pediatric plastic surgeon or pediatric surgeon is NOT necessary for simple frenulum lacerations. 5 However, refer if:

• Extensive gingival or facial swelling develops 2
• Multiple teeth are affected or displaced 2
• There is concern for deeper tissue involvement requiring reconstruction 5
• Signs of infection do not respond to conservative management 1

Common Pitfalls to Avoid

• Do not over-treat: Frenulum lacerations are common in infants learning to crawl and pull up, and most heal without intervention 4
• Do not confuse with pathology requiring frenectomy: Surgical frenectomy is indicated for orthodontic or prosthetic issues in older children, not for traumatic lacerations in infants 6, 7, 8
• Do not miss child abuse: Always maintain a high index of suspicion when the mechanism doesn't match the injury or developmental stage 1, 2