We advocate two types of aftercare following release of tongue tie / lip tie;
- Active wound management to prevent reattachment
- Mouthwork / bodywork to aid transition to a more effective way of feeding.
- Lower the chin and hold with both thumbs. With both index fingers scoop under tongue; gently and smoothly stretch upwards at very base of tongue so that the diamond opens fully. Repeat three times.
- With the pad of one index finger sweep upwards on the centre of the diamond. You do not want to disrupt the fibrin patch but prevent the upper and lower halves from adhering. Repeat three times.
- Sweep once side to side at the very base of the tongue to ensure there is no vertical band of tissue forming.
- Massage the diamond with a little virgin coconut oil to help keep the diamond flattened thus working against the contraction of the edges towards the centre.
- Gently rub your finger along baby’s lower gumline and stimulate the sides of the tongue. As you go to each side your baby will habitually follow with their tongue, strengthening the lateral muscles and encouraging use of the new extra range of movement.
- Sweep finger side to side across palate going backwards a tiny bit each day to reduce hypersensitivity of the gag reflex.
It is very important that you maintain a very positive association with touching your baby’s mouth. Firstly ensure that you choose times during the day in which your baby will be most receptive and ensure they are kept comfortable, so have given pain relief if necessary. For a young baby, mid-feed can often be a good choice; your baby is less likely to be hungry but not so sleepy that they don’t want to be disturbed.
Sit in a comfortable position with your baby facing you, resting on a cushion on your lap. Keep the interaction relaxed and playful.
Done correctly these exercises will not cause any distress to your baby and a good relationship with you touching their mouth can be created and maintained.
Active Wound Management
Following the procedure your baby now has a diamond shaped surgical site under their tongue. We need this wound to heal slowly, from the outside inwards, maximum 1mm a day, over the space of a week or two. If your baby has also had a lip tie release that site will need to be cared for in the same way.
The most efficient way for the body to heal itself is to reseal the site along the line of division (reattachment) so we have to actively maintain the surgical site open to achieve healing by re-epithelialisation, whereby you get new skin cell growth across the surface of the wound. This maintains the freedom of movement of the tongue which was achieved by the surgical release.
Babies have an exceptionally good healing potential, the mouth provides an environment promoting healing and the body wants to respond to the insult of surgery. Therefore in order to ensure correct healing you are going to need to work at maintaining the surgical site open.
The bottom half of this diamond shaped wound is on the floor of your baby’s mouth and the top half is under their tongue just in front of the base. Therefore it is important to separate the back edges of the wound to achieve adequate separation of these two raw surfaces to prevent either primary or secondary intention healing. We will show you how to do this and all the other exercises before you leave clinic.
As well as keeping the surgical site open we will show you how to massage the diamond. This also interrupts any attempt at formation of scar tissue before it can become established.
In our experience babies tolerate this wound management very well when the surgical site is maintained open. The problems only arise when scar tissue has been allowed to develop by either too infrequent or ineffective wound care. Pulling against this scar tissue is painful, and aggravating established scar tissue can encourage it to become more organised and fibrous.
Our aim is to make sure you are confident in your ability to adequately manage the wound so this scenario never arises.
Active wound management also ensures that your baby achieves their optimal outcome from the procedure not just a partial improvement.
In our experience babies fall into one of the three following groups after release;
- Baby automatically seems to know how to co-ordinate movement of the freed up tongue resulting in a fast improvement of their feeding technique. This is typically about one third of babies.
- Although we know that the baby now has the ability to alter their feeding pattern they need help and time to adapt from established habits. A baby has had 6 months in-utero, sucking and swallowing amniotic fluid plus their experience since birth. This is typically two thirds of the babies.
- Baby has developed a compensation mechanism in order to cope with the tie(s). By releasing the tongue tie we interfere with this technique and thus baby has to find a new feeding pattern. The advantage of this group of babies is that as they are forced to reorganise how they feed, they can achieve a new pattern quite quickly once the initial frustration has been overcome. This group is rare, about one in a thousand, but they are very unsettled for the first couple of days.
Even if your baby adapts quickly to a more effective way of feeding, they are still going to need help as they will fatigue due to using the muscles in a different way to what they have previously been accustomed to.
Also, if your baby has been compensating for poor tongue movement by using more jaw activity, the tongue may have taken a ‘back seat’ and we need to help your baby utilise the tongue again as the primary tool for feeding. Even though we have freed the tongue up, the baby may not use all this extra range of movement so we need to encourage it.
If you are breastfeeding our Lactation Consultant will help you to achieve a deep latch and discuss ways to encourage and maintain an effective feeding technique.
If bottle feeding they will show you how to use paced bottle feeding, as this will help your baby to use the tongue in the best functional way for rehabilitation following release.
We also show you suck training to help with co-ordination and strengthening of tongue and mouth muscles.
We are strong advocates of Craniosacral Therapy as releasing any residual tension, especially around the jaw, can help achieve a more effective suck. If you would like to explore this option we can suggest Therapists either here in Knocklofty or local to where you live.
Active Wound Management
This needs to be carried out 3-4 hourly, with one maximum 6 hour gap at night (i.e. 6 times in 24hrs).
Do this diligently for 4 weeks, then on a reducing basis before stopping at the end of the 5th week.
Start with massage around the temporomandibular joint and lower jaw until mouth is relaxed; don’t force your way into baby’s mouth.
These only need to be done during daytime.
Stimulate a suck rhythm with index finger uppermost on palate, gently circling if necessary. With other hand gently tuck chin so tongue remains elevated in mouth. Next draw finger towards yourself coaxing tongue to extend. As baby’s suck gains in co-ordination and strength combine the two elements.