The stretching exercises can be the hardest on parents and infants; it is also the most important! We believe that the more frequently you do the stretches, the more it decreases the chance of reattachment. It takes time for the tongue muscle to be strong enough to stay up on the palate and stretch itself naturally which prevents reattachment of any tissue to the boney gum line. A new tongue frenulum will form with time but we want it to be soft and attach from the middle of the tongue to the middle of the soft tissue in the floor of the mouth. The minimum number of stretches that is required is every 4 hours for 2 weeks, then massage 3 times a day for 3 months. Reattachment can happen even after the wound looks healed, so do not stop the stretches or massage early. If you are considering decreasing these stretches please contact our office. This may be good time to repeat some cold laser therapy for a few sessions to help with pain and healing. Check out the Pain Management section also for help. The stretches do not need to be forceful, but they need to be firm, like you are pushing your finger into peanut butter. There are several different times or ways you can try these stretches. Preference will vary based upon each child and their routine. You may start these stretches 4 hours after revision.
Some parents find it helpful to do these stretches when their baby is crying because at this time the baby’s mouth is already open with the tongue raised making it easier to get in the mouth for a few seconds. (Plus, you are not making child upset as they are already upset).
Some parents like to do these stretches right before a feeding because breastfeeding can help soothe the baby immediately after and also when a baby is sucking, endorphins are released which can help with pain management. If your baby is too sensitive they may not want to latch afterward; so then just feed first and stretch after feeding.
Some parents prefer doing these stretches while their baby is in a deep sleep. Their baby may not wake at all and if they did wake, they were able to return to a full sleep immediately. With this method, the baby will not remember having stretches done at all (this may not work for all babies).
Pacifiers can be used to teach the baby how to use the posterior part of the tongue for suction. We recommend using the Mam orthodontic (not the sensitive skin) pacifier 3 times a day for at least 5 minutes. We recommend not using the soothie/hospital or Nuk pacifiers for these exercises.
If your baby has a high arched or bubble palate, use your fingers as hooks on either side of the gums to gently pull the palate apart towards the ears for 5 pulls or 5 seconds 3 times per day.
If your baby tends to bite or chomp when approached by anything, we would like to break this habit. Using a gentle, tickling motion to rub the upper and lower gums from the far left side around to the right then back to the left 5 times, 3 or more times per day is recommended. Look to see that your baby's tongue follows your finger. This is good retraining for the tongue coordination also. You may use breastmilk or coconut oil on your finger if you like.
If you are using a bottle to feed your baby, we recommend using The First Years Breastflow bottle as a first choice or the Lansinol mOmma bottle with the NaturalWave nipple as a second choice. Make sure to use paced bottle feeding so your baby does not get used to a faster flow of the bottle.
Follow this link to further understand Paced Bottle Feeding for a Breastfed Baby: How to bottle feed the breastfed baby
We recommend you do what works best for your child’s routine.
Position your baby so that you are able to look into their mouth. Roll a hand towel or a receiving blanket and placing it behind their neck may help their head flex back, making it easier to get into their mouth.
Place your finger horizontally and use the pad of your finger across the wound to roll down the gum, the floor of the mouth and lift the tongue towards the roof of the mouth in a tight J motion then push down the floor of the mouth to stretch out the lower diamond in a marching action from one corner of the diamond across then back again. Change fingers every other time to get different angles of the diamond so the area heals symmetrically. The purpose of this exercise is to stretch both the tongue muscle and frenectomy site to lessen the chances of reattachment and keep the wound open as it is healing.
The goal of this therapy is to keep the tissue that is healing open and separate. We want this area to heal without the released tissue sealing back down to the floor of the mouth which will limit the function of the tongue. We want the diamond to heal long and lean and not short and squatty. We believe that being diligent with the therapy will reduce the risk of reattachment. It is not necessary to take a long time to do them. It is best to get in and out quickly, but to be sure you are effectively separating the tissues when you stretch. Continue the stretching treatment for 2 weeks and then schedule a follow up to assess healing.
At the 2 week recheck visit, we will assess if you are ready to change to massage 3 times per day for 3 months. This does not need to be every 8 hours or at night, just 3 times per day that is convenient for you and your family. For the lip(s) and cheeks, rub inside and outside of the gum and lip area. Stretch the lip up to the nose and use a finger to stretch out the inside of the cheek muscles. To massage the tongue area, put your finger into the diamond area and rub the floor of the mouth all around to keep the area under the healed diamond moving in different directions and prevent any thick tissue from adhering to the gumline. This will prevent scarring and reattachment of the area under the diamond. We do not want any tension on the inner gumline. You can use coconut oil for your massage and alternate with gentle and firm rubbing for a few minutes per session. Keep it fun and soothing. It will often feel a bit more tense at 1 month after the procedure but loosen with massage. If at anytime it feels restrictive and is affecting function, please schedule a follow up office visit. We are always happy to recheck the areas at any time. Your hands will be in the mouth for 3 months so you will pick up any changes.
Helpful links and videos for care:
Infant body massage:
www.tummytimemethod.com by Michelle Emanuel
Sleeping posture hold: https://www.youtube.com/watch?v=Qb-TO-ZvNEM
Mouth breathing video: https://www.youtube.com/watch?v=c6Rao9TWGTU
Guppy exercise for tight lower jaw: https://youtu.be/l33RaQ0rURc