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1. Bodywork

Manual therapies like chiropractic, osteopathic manipulation (these first 2 are most likely to be covered by your insurance), cranial sacral therapy (focuses on the head/neck/shoulders only), physiotherapy, and many more! 

The practitioner and their skill set is an important factor in deciding which type to go with along with the areas your baby needs treated, your IBCLC or pediatrician should help you determine which will be right for your baby.

2. Oral motor exercises

These gentle exercises are meant to address compensations and work toward function.  They are done in the mouth and on the face and may include other body movements.  Unlike bodywork, these exercises are done daily by the parents as directed by your IBCLC. Some providers call this Suck Training.

3. Managing the feeding plan

This is evaluated and organized by your IBCLC.  The feeding plan balances the need of the infant and parent and works toward feeding goals. 

Your IBCLC will manage your feeding plan according to your goals and to get the bet outcomes for you.  This can include counseling on pumping, feeding positions and techniques, supporting milk supply, and referring to other providers.

*these first 3 components are part of your pre and post release plan*

4. An effective release

Scissors or laser …it doesn’t matter as long as your provider is skilled and performs a full release to allow the tongue and/or other tissue to move normally.  The release allows for movement while bodywork, oral motor training, and feeding plan management work together to get to normal function.

5. Wound care

Sometimes called stretches or exercises these are targeted on the site which was released (the diamond shape under the tongue).  Wound care is necessary for posterior releases to prevent reattachment and aid in the tissue healing correctly.

Sometimes your provider will suggest oral motor exercises along with the wound care.  Your IBCLC will suggest additional, customized oral motor training in addition to these.

Without all 5 components your baby may not achieve full functionality.  Your IBCLC should be able to guide you through this process and make referrals to skilled providers as needed.

What to Expect After a Tongue Tie Release (Frenotomy)

• When appropriate anesthetic is used, the procedure is generally not painful but it is irritating to be swaddled and have the mouth held open for the procedure.  Your baby may be a little fussy after but can be soothed with skin-to-skin and a feeding.
  
  
• Baby may initially feed very well but about 5-6 hours later they may be quite fussy and difficult to console.  When adults get the procedure done, they report that they experience muscle fatigue which is quite uncomfortable.  Try not to use a pacifier and instead to offer skin-to-skin and other forms of soothing.  Smaller, closer spaced feeds may work better temporarily.
  
  
• Work with baby’s skills and abilities.  We aren’t trying to challenge their feeding during healing. Latch and hold your baby the way that works best for them.
  
  
• Feeding starts to improve over time as the tongue strengthens and other muscles which have been compensating start to relax. 
  The suck training exercises (oral motor work) recommended are very important in this process of “teaching” your baby how to use their newly released tongue and to address areas of tightness and weakness.
  
  
• After about 4-5 days the wound will start to contract and feel tight again.  Many parents worry that this is reattachment.  Continuing your gentle wound care is important to keep these tissues soft.
  
  
• Stretches should be done quickly and gently.  I don’t recommend doing them before feeds to avoid associations with feeding.  If you practice the stretches on yourself and your baby before the procedure it will increase your confidence and skill.

• Effective and comfortable feeding requires a lot more than just a tongue which can fully move and function.  It also requires that baby isn’t experiencing pain or discomfort anywhere else.  Bodywork helps baby find full function through gentle manipulations.  This can include pediatric chiropractic, osteopathic manipulation, cranial sacral therapy, or other types of bodywork.  Ask your provider or IBCLC for referrals to providers who are experienced working with infants.

• At home, you can support your baby with movement, massage, and at-home care like Tummy Time.  

• A visit with your IBCLC about 2-5 days after the procedure is important to check on the wound healing and to adjust your suck training and bodywork instructions.

❤ Megan