Release of Tongue and Lip Ties
We always try to provide treatment as soon as possible after your consultation appointment, usually on the same day for infants as time is of the essence for the little ones. The sooner your baby’s lip and/or tongue tie is released, the more likely they will eventually breastfeed successfully!
What to consider about tongue tie release
For infants, lip and tongue-ties are closely associated with difficulties while feeding, whether it’s with a breast or bottle. Often, the baby will struggle to latch and create a steady flow of milk or formula. They may end up gumming the nipple, which can be extremely uncomfortable for breastfeeding mothers. During this process, they often accidentally swallow a lot of air, creating digestion problems including excessive gas or bloating. Slow weight gain or excessive fussiness while feeding are also two common signs.
One of the earliest signs a child might have a lip or tongue-tie which was missed in infancy is difficulty transitioning to more solid foods. They may find it very hard to take bites and swallow properly. Even though most children have their own quirks while learning to speak, certain impediments like a lisp may develop and be persistent. A parent might also notice their child primarily breathes through their mouth or snores, this could be due to the restricted tongue partially constricting their airway.
Benefits of using a laser
The use of a laser makes the process more comfortable and faster for your little one. The laser gently removes the restrictive oral tissue with precise control and cauterizes at the same time, meaning your infant should experience minimal bleeding or discomfort and no need for suturing.
Getting ready before your consultation
Stretching and strengthening exercise
Stretching and Strengthening Exercises – babies that need tethered tissue release often have weak or disorganized sucking patterns. Before your appointment, it’s very beneficial to start exercises to build your and your baby’s confidence and dexterity for the important work coming up. These movements will help make your baby’s recovery faster and ensure the ties do not reattach.
- Let your child suck your finger and apply gentle pressure to their palate. Once your baby starts to suck on your finger, just press down with the back of your nail into their tongue. This usually interrupts the sucking motion while your baby pushes back against you. Listen for a seal break and then put your finger back up into the palate to re-stimulate sucking. Repeat as tolerated.
- Let your child suck on your finger and do a tug-of-war, slowly trying to pull your finger out while they try to suck it back in. This strengthens the tongue itself. This can also be done with a pacifier.
- Slowly rub their lower gum line from side to side and your baby’s tongue will follow your finger. This will help strengthen the lateral movements of the tongue.
- With one index finger inside the baby’s cheek, use your thumb outside the cheek to massage the cheeks on either side to help lessen the tension.
Day of the procedure
Pain Relief – for children over 2, we recommend you give your child acetaminophen (Tylenol) 30 minutes prior to the procedure. This way, any possible post-op discomfort is prevented, and you can focus on caring for your child. Use the dropper in the manufacturer’s packaging and ensure the bottle of Tylenol is 160mg/5mL dosage. (Not the concentrated form).
You may also use whatever works for your family or use nothing at all. We’ll be placing a topical numbing medicine during the procedure and in most cases we will also numb using a lidocaine infiltration, so not everyone needs medication beforehand.
Aftercare
Once your baby is home, call us right away if there is active bleeding, develops a fever of more than 101.5, or if your baby is refusing to nurse or take a bottle.
Starting several days after the frenectomy, the wound area will develop a whitish ‘scab.’ It may appear yellow if your child had elevated bilirubin after birth. This is quite normal. Sometimes it will slough off on days 5-7 revealing tiny petechiae that can ooze a bit of blood. By day 14, the surgery site is mostly healed.
POST SURGERY, TONGUE AND LIP TIE EXERCISES AND STRETCHES.
Video Credit: A big thank you to our friends over at La Petite Dent Pediatric Dentistry and Orthodontics in Nanuet, NY for letting us share this awesome video!
After surgery exercises and stretches
Now the hard work begins! The main risk after a frenectomy is reattachment of the lip/tongue tie. All surgical wounds tend to tighten (or contract) as they heal. A child’s mouth heals very quickly, and previously tethered tissues may close too soon causing the previous issues and symptoms to return. The exercises and stretches covered below will help lower the chances of reattachment happening.
Please perform your exercises 6 times per day for the first 4 weeks. Over the next two weeks, you can taper off. Like any new skill, stretching and strengthening your child’s lip or tongue will be anxiety provoking and tricky. Know that it will get easier in time. We are here for you and only a phone call away! Stay calm and positive. Let your child feel this is playful and not stressful. Stretching exercises should be firm and gentle, not quick or forceful.
When performing the exercises, position yourself at 12 o’clock (i.e. directly behind your baby). Have your baby in your lap or on a table/bed.
Upper lip stretches
Place two fingers under their lip and gently pull up as high as it will go. Try to visualize you are rubbing their lip to their nose. Now, gently sweep side to side 6-8 times. Remember, the goal is to stretch the opposing surfaces of the lip and gum where the lip tie used to close them together.
Under the tongue stretches
Place two fingers under their tongue, ‘pick up’ the posterior (back) part of their tongue and lift towards the roof of your baby’s mouth. The key is firm pressure. Try to visualize the laser incision site as having a diamond shape. A tongue needs three separate stretching motions:
- Once you are under the tongue, pick up the back (posterior) part of the tongue as high as it will go towards the palate. Hold it there for 3 seconds, relax, and do it again 6-8 times. The goal is to completely lengthen the diamond so that you can visualize the area under their tongue.
- Place your finger in the middle of the diamond and do a gentle circular stretch for several seconds to dilate or open up the diamond.
- Turn your finger sideways and do a rolling pin motion to try and keep the diamond as deep as possible. Start at the fold “center” of the diamond and move to either side of the diamond top and bottom to loosen up the muscles of the tongue and floor of the mouth
tongue-tie-before-operation
tongue-tie-same-day-post-operation
tongue-tie-three-weeks-post-operation
tongue-tie-one-month-post-operation
Support
It is essential that you follow up with your lactation consultant, myofunctional therapist, speech therapist, or physician after the procedure. They will recognize when your child is using workarounds and coach you and your baby on the best pathway forward!
Click to read an excellent article on the team approach to improving the breastfeeding experience.
We are only a phone call away if you need any help and we welcome all questions and concerns. Your baby is relying on all of us for their well-being. We are here to support you!