POST-OP INSTRUCTIONS FOR INFANT TONGUE-TIE RELEASE

The goal is for the area(s) released to heal and provide increased mobility. You should do the oral stretches with the baby laying down on a changing table, bed, or couch facing away from you like during the exam. Please follow-up with our office within 2-3 days. Begin doing the stretches the DAY of the procedure. You may use gloves (preferred) or clean hands with nails trimmed while performing stretches.

1. If the lip and/or cheeks were released, first put your fingers all the way in the fold of the lips and pull the lip or cheek up and out as high as possible, so you can see the white diamond(s) open. Push right on the area(s), in and up gently but firmly. It may bleed slightly (occasionally), but if you notice bleeding that is concerning, text or call us.

2. With one index finger, push down right behind the gum pad in the floor of the mouth, and push into and lift the tongue up and back just above the white diamond to put tension on the wound for a few seconds and repeat 3 times. Use your non-dominant thumb to push down on the gum pad and hold the mouth open. It may bleed slightly the first day or two, this is not a concern.

3. The main issue is to open and see the “diamond” all the way up on the lip and especially the tongue. If you notice it is becoming tight, then stretch/push a little more to open it back up.

4. Repeat this every 4 hours until your follow-up appointment. After the follow-up, at the two day mark, we usually will approve dropping the night time stretches.

5. If you can’t follow up in person, please do a “deeper stretch” and push twice as hard one time at 7 days to ensure it isn’t growing back together. You will notice some bleeding if it reopens or stretches out, which means it was growing back a little bit, and now it’s reopened. Hold pressure with gauze or a paper towel for 4-5min and the bleeding will stop. Symptoms (ie nursing pain) may improve after the stretch if pain was starting to occur again.

6. Play in your child’s mouth a few times a day with clean fingers to avoid causing an oral aversion. Tickle the lips, the gums, or allow your child to suck your finger.

7. At 1 week post frenectomy, please begin doing “guppy stretches” prior to every day time feed. The goal is to wait until baby has stopped flexing their neck forward and relaxes their head and neck back; upon baby relaxing, wait for 10-15 seconds before ending guppy. This helps with relaxation of the tight fascia (deep front line fascia) that is correlated with ties:

GUPPY pose

Following frenectomy, some babies with GI related issues (reflux or gas) may not like traditional tummy time on the floor. You may try the following as an alternative to floor tummy time:

Tummy time on a yoga ball

Tummy time on a yoga ball example 2

8. The released area will form a wet scab after the first day. It will appear white and soft. It may change color to yellow or even green. This is not infection, but is just a scab in the mouth. The white/yellow area will get smaller each day lengthwise, but HEALING IS STILL HAPPENING! So even though the white scab is not as visible, you must continue stretching or the surgery may need to be repeated. If you have any concerns, please contact our office.

9. Retraining how your baby latches to breast or bottle is important. Proper nursing position, proper bottle with proper nipple flow, or even pacifier use can help with strengthening. We recommend the Mam Pacifier, 0-6 months. The goal is for baby to suck on pacifier for 5 minutes at least 6 times a day; with time, the baby should be able to increase sucking on the pacifier to 10 minutes, and the 15 minutes, and so on. If your baby is struggling with sucking and is chompy, please contact our office so we can properly address this issue. If the baby does not learn to suck properly, re-attachment can occur.

Follow up with a lactation consultant (either Danielle or Dr Weaver) is critical if nursing. Bottle fed babies can also benefit with a visit for feeding recommendations. Bodywork with Dr. Michelle Weaver, DC, IBCLC is also very helpful and recommended. You should expect one better feed a day (two better feeds the second day, etc.). Sometimes there’s an immediate difference in feeding, and sometimes it takes a few days to weeks. Skin to skin, warm baths, white noise, swaddling, and soothing music can be very beneficial to calm the baby.

For pain give CHILDREN’S TYLENOL (160mg / 5mL) starting WHEN YOU GET HOME and for the next 2-3 days every 4-6 hours. For babies who weigh 6lbs give 40mg or 1.25mL, 7lb give 1.5mL, 8lb give 1.75mL, 9lb give 2mL, 10lb give 2.25 and 11lb give 2.25mL. Babies 12-14lb can have 80mg or 2.5mL, 15-17lb give 3mL. If your child is 6mo old and 12-17lbs, you can give Infant’s Motrin (ibuprofen) at 1.25mL (50mg). If your baby is refusing to nurse or seems to be in pain, please check the Tylenol dose is correct, and find an alternative way to get milk in (bottle, syringe, cup).

No Motrin for children under the age of 6 months.

Remember stretching every 4 hours for the first 48 hours is very important.

Your child’s lip will swell up slightly for a few days, and the released areas will be sore for a few days, at one week look much better, and at 2-3 weeks look much better and almost normal.

We recommend bedside bassinets for sleeping with swaddling of arms across the chest (if choosing to swaddle). We do not recommend the snoo for sleep.

If you have any questions, please text us at 949) 228-9253