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Pain Management

Baby

For most babies, the first 48-72 hours are the hardest after a lip tie or tongue tie procedure. However, after day 3, the discomfort often subsides and feeding becomes easier. Staying on top of pain management is very important. You may use some Children's Benadryl liquid applied with a Q-tip or finger on the site to help numb the area topically and it aids in healing.  This is very safe.  Your baby is not taking a dose orally.  The topical application which is just superficially absorbed will not cause drowsiness or other side effects.  Children's Tylenol may be used every 4 hours for 3-4 days safely for pain after the procedure.  If your baby is too sore to feed, then the Tylenol will break the pain cycle to help with feeding.  It is the tongue muscle that is sore, so systemic treatment and soothing behaviors work best. Make sure to include comfort measures like: skin to skin 30 minutes before feeding, baby wearing, epsom salt warm bath float, sing to your baby, reduce sensory input by creating a quiet environment, limiting visitors, spend more time at home, small breast milk ice chips on healing areas, tummy time, sleep posture hold and infant massage (links under After the Office: Aftercare Education).

Child / Adult

Children and adults may respond better to ibuprofen which needs to be given with solid food.  Ibuprofen can be given every 6 hours.  You may also alternate the ibuprofen with Tylenol, which can be given every 4 hours.  The Children's Benadryl liquid can be used before and/or after the stretch if needed.  Chloraseptic sore throat spray can also be used for the first few days to numb the areas.  Ice chips in the area, lots of popsicles, and soft foods feel good.  There are no food restrictions but chewier foods may cause more soreness while eating.  It is not unusual to get some bleeding with the tongue stretch if there is tension in the tongue or floor of the mouth.  Use wet gauze to hold on the area.  A cold wet black tea bag on the area will also quickly stop bleeding in the mouth by the action of the tannic acid in the black tea.  You may keep some wet black tea bags in the refrigerator for the first week to use with stretches.  The first week's focus is on keeping the tongue tip just behind the top teeth and the rest of the tongue should be suctioned to the palate at rest.  After the first few days, it will actually feel better to stretch more and this is a good time to start strengthening exercises (Myo exercises PDF in aftercare education).  Every mouth is different and when we see you for follow up, we may recommend seeing a chiropractor that works in the mouth to help with tension and/or a Myofunctional therapist to help build tongue muscle strength and coordination.

Mom's Nipple Pain  

Epsom salt soaks using a shot glass or a Hakaa milk collector.  Use gel pads for protection and use a lanolin based nipple cream.

 

You can make an all purpose nipple cream for severe cracking and trauma:

Modified APNO:

Mupirocin or Polysporin

0.1% betamethasone or 1% hydrocortisone

Lotrimin/Clotrimazole cream 

 

If thrush is not present, anti fungal cream is not needed, so simply mix equal parts of the first two, Polysporin and hydrocortisone.

Tylenol

For your child's specific dosing, please refer to the Tylenol dosing chart provided.

Tylenol can be given every 4 hours if needed for pain.  The only difference between infant and children's Tylenol is the size of the bottle.  They are both the same strength of 160mg in each 5 milliliters or teaspoon.

Ibuprofen

(6 months of age or older), please refer to the Ibuprofen dosing chart provided. It must be given with at least a few bites of solid food.  It can be given every 6 hours-8 hours for up to a week.  Ibuprofen brand names are Advil and Motrin. Infant suspension 50mg/1.25ml is a different concentration than the children's formulation 100mg/5ml.

Tylenol Dosing Instructions

Ibuprofen Dosing Instructions