It is very important to start stretching the tongue and lip area at least 4 hours after the procedure to maintain patency of the opening. The mouth heals very rapidly and we don't want the diamond opening to close up or reattach to the inner gum line. We would like to see it stretched and expanded to help with eating and speech development.
Use your clean fingers to massage and stretch the site. You may first rub the gums, inner cheeks and palate in a playing motion to encourage the tongue to move and relax the baby. Try to make a game of it to discourage oral aversion. After the massage, place your finger horizontally under the tongue touching the inside lower jaw. Roll down the inside gumline and push firmly on the floor of the mouth; roll over, lift and stretch the entire diamond shaped opening. Make sure you see the opening and that it stays as large as when it was created. You can login to your Patient Portal to view the after pictures to look at the diamond. Your finger should rub over and pull the diamond up to the palate. Lift the tongue up to the roof of the mouth holding and stretching with your finger for 1-2 seconds. Then take the pad of your index finger and march the floor of the mouth from left to right and back just between the lower diamond and the salivary glands. Go from left to right then right to left. This will stretch out the lower diamond better and keep the floor of the mouth pushed down towards the belly button. Stretch before or after feeding; at least every 4 hours for at least 2 weeks. Stretching the upper lip involves using your finger to lift the upper lip so that the area above the teeth is visible and you see the opening. Push the lip up in the center and rub the upper gumline horizontally to prevent sticking. You may use coconut oil for this also. For buccal ties, just continue rubbing over the upper gumline to push the cheek muscle up and prevent it from sticking down to the gumline. When your baby is feeding, make sure the lip is flipped and stretched up and is relaxed.
If your child or infant sleeps through the night, please wake to stretch for the first 2 nights then you may skip one stretch at night to allow sleeping 8 hours at night and just stretch during daytime hours. Make sure to do a good, firm stretch in the morning. This may be a bit uncomfortable, so using the Benadryl liquid topically before may help. Push at the diamond points and at the crease to keep the area stretched wide and prevent it from contracting down. Rubbing the sites will prevent scarring and prevent the need for a revision. After the 2 week medical clearance, you should continue rubbing or massaging the frenectomy sites and the floor of the mouth at least 3 times a day for 3 months.
You can use some coconut oil on your finger to massage the gums and rub the sites to prevent the tissue from sticking together. You can also dip your finger in some Children's benadryl oral liquid to apply to the areas prior to stretching. This will slightly numb the area and help with healing. It can be mixed with the coconut oil also. It is not unusual to see some oozing of blood for the first few days so do not be alarmed. This can be a positive warning to encourage you to keep stretching to prevent the diamond from sealing together; not doing so will prevent elevation of the tongue. Bleeding can also be caused when there is tension on the muscle or the floor of the mouth. This is an example of when massage and bodywork can be helpful. The bleeding will stop with sucking or feeding, or with holding a cold, wet piece of gauze on the area.
For the day, you can expect the tongue tie opening to look like a beefy, red diamond-shaped opening. But it will quickly start to fill in with healing grayish/whitish/yellowish tissue. We want the opening as large as possible, so keep stretching. We recommend using Tylenol ever 4 hours for the first 2 days then wean to as needed. Ibuprofen (with solids) is recommended instead if your baby is over 4-6 months and is eating solids. When we see you for the initial 2 to 4 day follow up and if your baby is still uncomfortable, then we can repeat a cold laser treatment to help with healing. If your baby continues to have feeding problems after fully healed, we have may recommend additional breeding therapy from an Occupational Therapist. We also have referrals for Chiropractics, Craniosacral Therapy, Speech Therapy, and Myofunctional Therapy.
Remember it is important to continue to breastfeed as much as possible to help your baby learn how to use their tongue’s new abilities. It may take several days or as much as 2 – 8 weeks for you to see and feel a difference. New muscles are being used and they need to develop some strength. As the area is healing, continue the mouth massage to keep the tissue soft and prevent the need for a revision. It is normal to feel some tension in the sites around week 4. Keep massaging firmly and check in with us. Remember, we do not charge our patients for site rechecks.
Continue to use topical ointments and hydrogels for your nipples if they are sore, cracked or bleeding and follow up with your lactation consultant. You may have to continue to use your comfort measures for a while longer as your baby continues to learn to and use the tongue correctly. You may wean off of using a nipple shield as your baby's mouth gets stronger. Skin to skin and co-bathing is very soothing for mom and baby.
Feel free to text Dr. Sacker and Dr. Berger directly and include pictures. You may also email videos and links.