Infant Post-Op

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Q: How long are babies in pain after treatment?
A: Every baby is different. Some babies are only sore for a day or two, while for others, pain and swelling peak around days 4-5. Some moms also report days 7-10 were the most fussy days. There are even some babies who act as if nothing happened at all and don't seem to be in any discomfort. Treat your baby based on how he or she is acting - if you think they are in pain, give some Tylenol or Arnica (see chart below), and lots of cuddles.

 

Q: I gave my baby pain medication and she is still uncomfortable. What else can I do? 
A: If your baby is in pain and is not due for pain medication any time soon, try giving lots of cuddles and skin-to skin-contact. Maybe take a warm bath with baby and try latching baby in the bath. Breastmilk ice chips/slushes can help with pain, too. Babywear as much as possible, if you can. Human touch releases oxytocin, which lowers pain levels. Please note that babies are able to sense their mothers' stress and anxiety. If you are finding yourself upset and crying over your baby's distress, hand her over to another caregiver or put her down and take a few minutes to relax and compose yourself.  

Healing

 

After the release, there will be a diamond-shaped wound under your child's tongue and/or lip. It takes about 2 weeks for the wound to heal (sometimes a bit longer). The healing will begin almost immediately after treatment, and the wound will often be larger than you would expect. The wound will be whitish yellow, or sometimes even neon yellowish green (common in babies with jaundice) and will look similar to pus. This is normal!! 

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A normal healing lingual (tongue) frenectomy

Source: Dr. Bobby Ghaheri

This is a video of Dr. Aaronson's 7-year-old daughter's lip tie release as it healed, starting on day 1 and ending on day 13.

At home you may notice that the upper lip is now freed into a new fuller position. This is due to the tension release of the previously underlying frenum. If there is any swelling, it will be slight and would be under the nose where the lip and nose meet. This will go away in a day or so. It should not be significant and never distort the lip. This newfound lip and tongue mobility may also be a little confusing to your baby as he/she adjusts to this improved muscle freedom. You may notice your baby sticking out their tongue or drooling more – this is normal!
 

There are two important concepts to understand about oral wounds: 

  1. Any open oral wound likes to contract towards the center of that wound as it is healing (hence the need to keep it dilated open).

  2. If you have two raw surfaces in the mouth in close proximity, they will reattach. 

 

The purpose of the exercises is to ensure that a new frenum heals with increased flexibility. I highly encourage you to approach these exercises in a positive manner. Your technique AND positive demeanor are equally important.
Please do one round of exercises before bed on the day of the procedure. On the following day, you may start the exercise protocols listed below. Consistency is key. Do NOT exceed more than 6 hours between exercises.

A small amount of spotting or bleeding is common after the procedure, especially in the first few days. Because a laser is being used, bleeding is minimized. Wash your hands well prior to your stretches (gloves aren't necessary). Apply a small amount of coconut oil, breast milk, formula, or water to your finger prior to your stretches.

Do one stretch on the evening of the surgery. Then, skip ahead to the next morning. My recommendation is that stretches be done 3-6 times a day for the first 3 weeks, and then spending the 4th week quickly tapering from 6 to 5 to 4 to 3 to 2 to 1 per day before quitting completely at the end of the 4th week. 

POSITIONING

The best position for stretching your baby's lip and tongue is to have their head against your belly. An alternative position would be with the baby laying down and you by the side of their head (for example, with the baby laying on a changing table and you standing near their head.) It is more difficult to do the stretches if your baby's feet are pointing towards you.

The Upper Lip

 

The upper lip is the easier of the two sites to stretch. If you must stretch both sites, I recommend that you start with the lip. Typically, babies don't like either of the stretches and may cry, so starting with the lip allows you to get under the tongue easier once the baby starts to cry.

For the upper lip, simply place your finger under the lip and move it up as high as it will go (until it bumps into resistance) and hold for 2-3 seconds.

 

Then gently sweep from side to side, as if you were brushing invisible teeth, for about 5 seconds. Remember, the main goal of this procedure is to insert your finger between the raw, opposing surfaces of the lip and the gum so they can't stick together. 

The entire lip stretch should take less than 10 seconds to complete.

Here is Dr. Bobby Ghaheri's video that shows lip stretches (scroll down for the tongue stretch video)

THE TONGUE

 

Parents have the most trouble with the tongue stretches - if you are struggling, remember you are not alone!! The following stretches are from Dr. Ghaheri's website, www.drghaheri.com. Videos are available on his site to help with stretches. 

 

To stretch the tongue, insert both index fingers into the mouth (insert one in the mouth and go towards the cheek to stretch out the mouth, making room for your other index finger). Then use both index fingers to dive under the tongue and pick it up, towards the roof of baby's mouth. The tongue needs three separate stretching motions – height, width, and depth – to minimize reattachment: 

1. With clean hands, press down on the baby’s chin to gently open the mouth.

2. While the baby’s mouth is open, use one or two fingers from the other hand to tuck under the baby’s tongue and gently lift it upwards and back, exposing the healing diamond-shaped wound.

3. Hold this position for no more than 3 seconds.

4. You may gently massage the wound to make sure it feels soft and squishy. DO NOT RUB HARD!!!

Source: drghaheri.com

Here is a video from Dr.  Ghaheri that shows how to do the stretches:

Here is another video from Dr. Ghaheri that shows the stretches:
PUPPET STRETCHES

This video from Dr. Chelsea Pinto shows the "Push, Scoop, n' Stretch" method to lift the tongue:

If you are concerned that there is some adhesion in the wound, you can do a deeper stretch to loosen up the scab. This video from Dr. Richard Baxter (Alabama Tongue Tie Center) shows how to achieve this:

 

Suck Training

It is important to work on suck training and tongue strength with your child within a few days of the procedure. You do not need to start immediately, but give them a few days to allow the discomfort to pass, then begin a few times a day. Your IBCLC is the best resource for knowing which exercises will best benefit your child. Here are some videos that show some tongue strengthening exercises: