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For Tethered Oral Tissue Release Surgery (Tongue and/or Lip Tie)

The following are answers to frequently asked questions after someone has had their lip and / or tongue tie surgically released.

Can I breastfeed after the surgery?

Yes you should resume breastfeeding on demand immediately after the surgery for both tongue and lip tie, this is the best initial physical therapy for the baby. Depending on your experience and age of baby, we encourage you to see a lactation consultant or appropriate health care provider to ensure that your breastfeeding is the best it can be. Following care, it is important to know that there is a process of re-learning and re-training for both Moms and babies, which is why working collaboratively with other health care providers is so important to ensure all aspects are optimized.

My baby was being fed with a bottle, what should I do now?
Following the release of tethered oral tissues (tongue ties), we recommend breastfeeding and/or utilizing other alternative methods of feeding that encourage baby’s tongue to be more active, and rest up against the palate (roof of mouth). The tongue needs to re-learn, gaining this necessary muscle function/memory, and the increased tongue movement helps reduce the risk of re-attachment.
Medicine cup feeding with small amounts of expressed breast milk placed on the baby’s inner lower lip (flanged outwards) is an example of an alternative optimized feeding method. There are other alternative methods from spoon feeding to finger-syringe feeding, all of which facilitate breastfeeding and optimized function. As such, at Little Bird, we strongly encourage our patients to see a lactation consultant to help re-introduce breastfeeding and/or learn about the available alternative feeding methods that are best for you and your baby.
If your baby is currently bottle feeding fully or partially it is strongly recommended that you meet with a lactation consultant to discuss ways to transition your baby to the breast or to establish a feeding routine that will help develop the oral cavity and work in conjunction with your family’s unique needs.
My baby acts like the stretches are hurting them and I am afraid to continue with the stretches. What should I do?

It is important to know that you are not hurting your baby, and to ensure the best result of the release, the post-surgical stretches and exercises are critical, so don’t stop. For the 3 seconds that you are holding the stretch, baby may react with a cry or moan, as this is something that is new and different for them. What you will notice is as the stretch is released, your baby will soothe and calm. We encourage you to first do the playtime exercises and then the stretches, immediately followed by breastfeeding (or feeding with alternative methods instructed) to provide positive reinforcement and further soothe your baby.

Note: As baby’s learn very quickly, we recommend changing up your routine in regards to the playtime suck training exercises, stretches, and nursing.

My baby acts like they don’t like the post-surgical stretches and suck training exercises should I still do them?

Yes, the post-surgical care is as important as the release itself. It is very important that you continue to do the daily stretches and exercises as instructed to delay oral wound healing to allow for the best possible release result (and reduce the risk of re-attachment). If you do not perform these stretches or exercises, the oral tissues can prematurely heal and close the wound too quickly! So keep doing them as instructed.

If you are uncertain about the stretches and exercises, or desire to learn different techniques that you feel more comfortable performing, please call our office to learn more.

Can I pull too hard with the stretches?

Not really, the oral tissues are very strong and you will not cause any harm so you should pull with a strong and steady pressure for at least 3 seconds as was demonstrated at the consultation and follow up appointments. If you are doing it correctly you will see the open diamond shape wound with a white / yellow coating, and as you stretch – the diamond should be elongated vertically. If the wound is closed pull harder to re-open it, or call our office and let us know what you are seeing. Again, this re-opening does not cause discomfort or pain as the fibres involved are scab like and do not have feeling (“innervation”).

Note: If you notice some minor bleeding when performing the stretches (especially in the early days following the release), this is a positive sign that you are likely stretching adequately and keeping the wound elongated and opened.

How long do we have to do the exercises and stretches?

The recommendations are different depending on the age of patient.
For babies and young children, we recommend that you perform the exercises and stretches for 6 weeks after the procedure in order to ensure a good release result. So don’t forget 5 times a day for 6 weeks – use our checklist schedules provided at your appointment.

For older children and adults you will have been instructed to perform myofunctional exercises two to three weeks prior to the surgical release, and for at least 2 weeks post operatively – with patient dependent exercises thereafter.

There seems to be bleeding from my baby’s mouth, is this normal?

It is important to remember that the mouth is full of saliva, similar to a glass of water. If one drop of food colouring is put into that glass of water, the full glass reflects it. Same with our mouths, the amount of bleeding is minimal (1-2 drops), but will make the saliva turn red and can look like a lot. Do not worry. Normal oral wounds do not form a dry scab, so oozing is expected, especially with stretches in the first few days post-operatively, if done adequately.
If when you look in the mouth you actually see bleeding like from a fresh cut, you can simply apply pressure with your finger and some cotton gauze or a clean face cloth for 5 minutes and the bleeding will likely stop. Again, a small amount of oozing from the wound in the mouth is normal.
If you are concerned, please call our office to speak with our team or come in for an assessment. Your care is our top priority, and we want you to feel cared for and reassured.

My baby’s tongue does not appear to be on their palate when they are sleeping or when they are crying after the procedure is this normal?

The establishment of “optimized” tongue position, suctioned up on the roof of the mouth when at rest will vary depending the age of your baby / child/ yourself at the time of surgery. The older the baby/child was at the time of surgery the more muscle memory their tongues had with a compromised low rest position in their mouth.
One must also remember that even newborns, had potentially 3 months (within the 3rd trimester) of sub-optimal tongue rest position. As the tongue is really just a large muscle (made up of 7 groups of muscles) with muscle memory. It will take some time for the tongue to relearn the new natural, optimized rest position but with exercises this will happen! Keep doing the exercises and stretches and the tongue will find its new optimized home. Every patient progresses at their own unique pace.

My baby’s sleeping behaviour and suckling did not change immediately after the surgery, is this normal?

This depends on the age of the baby / child at the time of surgery. Newborns and infants under one month of age who have had a release have the best chance of immediately establishing optimized tongue rest position, and suckling with nasal breathing provided your breastfeeding position is best for you and baby’s nose is not blocked. We strongly encourage seeing a lactation consultant or appropriate health care provider before and following treatment at LB, to ensure best care, and breastfeeding for you and your baby.

Older babies and children will take some time to adapt to the change and establish optimized function so the effect you were expecting may not be immediate, but you will see progress in the days, weeks, and months ahead provided you continue with the stretches and exercises. Every patient progresses at their own pace.

My baby/child seems to still have their mouth open at times (when sleeping or awake), what should I do?

If you notice that your baby/child continues to have their mouth open following treatment, we recommend raising their jaw (to close their mouth), and/or gently close their lips. Babies/young children learn best through repetition, and their muscles have memory. The more you do this as friendly reminders, the more likely good habits will form with consistent lip seal and nasal breathing.

My baby has developed a fever and looks unwell, is this expected?

This is not likely due to the treatment that your baby received with their release as most babies and children make an uneventful recovery from this procedure. If the wound(s) look normal as we described – open with white or yellow coating – then it is unlikely that the wound is causing the fever or making your baby unwell.
It is most likely another “bug” like a cold or flu that they have contracted. If they have a high fever or look very ill, please contact your family doctor/pediatrician immediately or go to a local emergency or walk-in clinic for an assessment.

What else can I do to comfort my baby?

Making small popsicles with expressed breast milk, and offering that to your baby. You can use this to encourage baby to move their tongue and the cold temperature offers additional relief. Using the infant chew provided at your appointment, allowing for baby to gum/chew can also be quite soothing. Skin to skin contact, as well as gentle bouncing movements up/down with baby in your arms (imitating the feeling that baby had when previously inside your womb) is also encouraged.

Is there pain after the procedure?

There should be minimal post surgical pain from either the tongue or lip tie release as the frenum that is released is composed of connective tissue that does not have any feeling (innervation). For the first 24 hours following the release, we recommend comforting baby (skin-skin, nursing on demand, etc.) as baby begins to familiarize themselves with their new anatomy. If you think your baby or child is in discomfort you can give them children’s Tylenol for pain. You may first want to give them a popsicle (with expressed breast milk or traditional), which will be cool and soothing to the wound and will also exercise their tongue and lips.

Older children and adults will feel some mild discomfort, especially in the first 24 hours similar to when you bite your tongue or lip by accident and should not require medications for pain. The most common response following tongue release treatment is that your tongue feels “heavy” as you have never had to move it fully. Everyone is unique; as such if there is some mild to moderate discomfort there is no harm in taking Tylenol or Advil to relieve the discomfort. In the first 24 hours, it is most important to take it easy, but to keep moving your tongue (talk, read books aloud, sing, etc.).

If you or your child are experiencing severe pain, please contact our office (905-876-2473).

After the procedure my baby’s cry and laugh both sound different is this normal?

Yes, the baby’s cry and laugh and any other sounds from their mouth are produced in part by the lips and tongue, so if these tissues were released they will move differently and sound may change. Again this is normal. Think of Happy Feet – your little one is finding their voice.

After the procedure my child’s /my voice sounds different is this normal?

Yes, a release of oral tissues (tongue and lips) that are involved with speech may certainly affect the sound of your or your child’s voice. We recommend that you talk, read aloud or sing as much as possible, to re-train your newly released oral tissues.

Note: Tongue and/or lip tie releases are never conducted for the sole reason of speech impediments. There must be other diagnostic criteria discovered in addition to findings relating to speech.
Speech acquisition occurs between birth and 6 years of age. During which time, following a release, you may notice changes or improvements in your child’s speech (or sounds). Depending on the age of your child, a referral to a speech language pathologist may be recommended.

What do I do if the stitches have come out or look like they are hanging? *Applicable for older children/teens/adults only*

As was explained at LB, the stitches that are placed are expected to fall out as long as you are following the post-operative exercises. This can range between patients depending on how often they are following the exercises and how much they are using their tongues.

If you are concerned, you can call our office but this is not an emergency unless there is significant bleeding like a cut. In most cases stitches do not have to be replaced, as they are desired to fall out. The material used will dissolve both in your mouth or when swallowed. If the string is bothering you – you can cut the loose end to shorten it.

What can my child or I (teen/adult) eat after the procedure?

We recommend a soft diet for the first 48 hours with foods such as eggs, pasta, soups, milk, yogurt, popsicles, smoothies, processed / cooked soft foods. Then resume your regular diet. Avoid spicy / acidic foods like tomatoes and oranges since this will irritate the wounds.

What activities can be resumed after surgery?

Patient dependent, but you may want to take it easy on the day of the surgery. All regular activities can be resumed after the surgery, and older children and adults should be encouraged to talk since this is good therapy for the tongue and lips. A soft diet is suggested for 48 hours post surgery.

Note: Babies should resume their normal patterns of sleeping, awakening, and feeding immediately after the surgery.

Me or my older child feels some pain or discomfort with the stretches what can we do?

You can suck on an ice cube or popsicle immediately before doing the stretches but again the discomfort is mild and very short lived so like most exercises when you feel some discomfort or burn you know it is working – so press on. With each day, it will feel better.

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