Getting Prepared For A Tongue Or Lip Tie Revision
You've made the decision to have your baby's tie released, or maybe you are headed to see the doctor for the first time to have a consultation - You need to know what to expect and how to prepare. I can help.
Have These Items On Hand
I recommend having the following on hand prior to the procedure for pain management and exercises/stretching:
PAIN MEDICATION OPTIONS
Infant Tylenol for children under 6 months of age
Ibuprofen (Motrin) for children over 6 months of age
HOMEOPATHIC/ HOLISTIC ALTERNATIVES
Boiron Arnica Montana 30C: Dissolve 5 pellets in 1 oz dropper bottle of distilled water; give 5 drops every 2-3 hours as needed. Store chilled. This can be found at Sprouts, The Vitamin Shoppe, Whole Foods
Chamomilla (irritability and inflammation) – Boiron Camilia single doses (follow directions on box).
Breast milk ice chips – acts as a natural numbing agent for pain.  Freeze milk flat in a ziplock baggie or milk freezer bag in a thin sheet and place tiny pieces under lips, tongue, and cheek, and let melt slowly.
IMPORTANT!Â
Please note that for the first 24-48 hours, your baby will be very sore. Staying ahead of the pain at this time is extremely important.  You may also notice some feeding difficulties during this time. It is important to consult with your IBCLC within the first few days of healing to ensure the best outcome of the frenectomies.  Feeding improvement can take up to 2-4 weeks to be seen.  Additional bodywork by a chiropractor may also be needed.
What To Expect At Your Appointment
Show up with your forms already completed online if possible. You will likely spend the consultation reviewing the completed forms and the provider will be performing an oral examination. If treatment is recommended and if time allows, it can sometimes be done at the same time as the consultation. If not, the provider will schedule you to come back another day. The procedure is a quick, in-office treatment and no general anesthesia is needed.  Due to laser safety regulations, parents are often not allowed to be in the treatment room. This will vary depending on the provider. A topical anesthetic is often (sometimes not though you will need to ask your specific provider what they do) used for patients. For kids older than 1 or 2 a local anesthetic is also applied in the treating areas. For older children, some providers will say that the child needs to undergo general anesthesia. If this is the case with your provider and you prefer not to have general anesthesia please get a second opinion or reach out to me and I can give you a referral.
Days 1-3
Week 1
Weeks 2-4
Weeks 4-6
"White Diamond" Healing Patches
The term “white diamond” is commonly used when talking about lip and tongue tie healing. The diamond is the shape of the wound created by the laser.  The area will form a set, soft scab after the first day.  This is a natural “band-aid” and can be white or yellow. In jaundiced babies, the scab can even be a neon yellow color.Â
What To Expect After The Procedure
Excess Fussiness And Crying
The first few days or even the first week – this is why it is so important to stay ahead of the pain to avoid any discomfort.  When children are in pain and uncomfortable it makes exercises more difficult to do.
Bleeding
Some patients may bleed a little after the procedure, especially after the first few stretches. This is normal and when mixed with saliva looks like a lot of blood.
Difficulty With Latching In The First Week
This is common and why it is so important to follow up with your IBCLC after the procedure ideally in the first few days and 1-3 times that first week. Your baby may also need bodywork as well.
Increased Saliva (drooling) And Bubbles
This occurs because of healing and an increased movement of the tongue and is usually temporary.
Increased Sleeping
This can occur because of medication and exhaustion from crying after the procedure. It also acts as a coping mechanism for discomfort.
When To Call Your Doctor
- Uncontrolled bleeding
- Fever greater than 101.5ËšF
- You have concerns and feel you need their opinion
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Tips
- If your baby moves a lot and is squirmy during the stretches, you can use a swaddle and place baby’s head in your lap or get the help of a second person to hold baby.
- Use nitrile (non latex gloves) and use an LED head lamp for better visibility.
- Frozen breast milk chips to be placed in frenectomy areas to help with pain and temporarily numb areas.
- In my personal experience, I have found that it is easier to do stretches prior to feeding baby but you can do what works best for you and your baby.
Stretching
Stretches ensure that the lasered frenum does not reattach. Â Use nitrile gloves if possible or clean, washed hands. Â Start the first stretch 4 hours after the procedure.
Lip Stretching
- Start with the lip stretch first. If you start with the lip stretch and baby cries, it will be easier to get access to the tongue afterward to do that stretch.
- Place your index finger under the lip and move it up until you reach the bone (this is the vestibule)
- Run finger left to right three times
- Lift lip up towards nose and hold for 3 seconds (an excellent video series can be found here.)
Tongue Stretching
- Place both index fingers under the tongue and lip tongue upwards and backward like a forklift
- The goal is to visualize the diamond
- Use the middle finger to push the chin down – hold the stretch for 3 seconds
- With index finger and rolling pin motion rub the wound up and down three times Â
Sucking Exercises
- Rub the lower gumline from side to side so the baby's tongue can follow. This motion strengthens lateral or side-to-side tongue movements.
- Let baby suck on your finger. Slowly pull your finger out while letting baby try to suck it back in. This will strengthen the tongue.
- See videos for better understanding at the bottom of the oral ties page here.
Stretching Exercise Notes
•Please note that these stretches are extremely important to try to avoid reattachment and to obtain the best possible result.
• Lighting is important. You need to be able to see the wound.  Purchase an affordable LED headlight like a camping headlight.
• Your baby will not be happy with the stretches at the beginning but it will get better... for you and your baby.
