After the procedure, your baby will have increased tongue mobility, but as early as 3 months, when they are swallowing amniotic fluid in the womb, have adapted their feeding technique to cope with their tongue tie, so they need to learn how to use their more mobile tongue in a new way. Their facial muscles have often had to work harder than they should to feed, in order to compensate for their restricted tongue movement, and these areas then carry a lot of tension. A lot of babies will adapt quickly. For others, this may take a few days or weeks. But all babies will benefit from a little help from their parents, in the form of regular feeds, tummy time, and a set of exercises as set out below.
These exercises are easiest in babies who are only a few weeks old. They are not meant to put undue pressure or stress on mother or baby is or to be a source of guilt if not managing it all. Skin to skin, holding your baby and tummy time alone will still be of benefit if you feel it is too much for you or your baby.
After care is divided into mouth work and body work.
Open Mouth: get in a comfortable position and put the padded part of your thumb on the baby's chin, encouraging them to open their mouth wide. This encourages the baby lift the tongue towards the roof of his/her mouth.
Suck training: use the pad of your index finger to touch the front part of the top of the baby's mouth, encouraging them to suck. Don't go too far back of they may gag. Gradually, you can work your finger back a little further, but stop if your child is uncomfortable. Ensure their top and bottom lips are fully flanged during this procedure, When they start sucking, you can give a little pull for a few seconds, then a wiggle of your finger, encouraging their tongue to move around and cup your finger. Place your thumb from the other hand on the babies chin, lowering the jaw. This encourages the tongue to work extra hard to maintain suction. do this a few times (3-5) and stop when your baby is tiring and losing suction easily.
Tongue lateralisation: using a windshield wiper motion, gently rub your finger back and forth over his hard palate. Then gently rub the baby's gums on the top and then bottom gumline with the tip of your finger, back and forth (3-5 times).
The sleeping tongue posture hold is really helpful for wound opening in the first week post frenotomy and is done with the baby asleep, so can be a really good option for parents who are struggling with the above.
You can do this before each feed.
IF THE BABY ISN'T HAPPY WITH THIS, DON'T WORRY – feed them and you can try again next time. It is best done in a relaxed and playful way. Never force your fingers into your baby's mouth. Be sure not to obstruct the baby's airway or put your fingers under the chin at any time. Mouth work is best done just before a baby is showing cues that they are hungry, but before they get irritable or too hungry, but whenever works for you is fine.
Here are some helpful links to mouth work and suck retraining:
Using the pads of your index fingers, gently massage the baby's jaw from in front of the ears, using light circular motions, moving along the lower jaw as far as the chin. you can do this movement a few times until the baby's jaw starts to relax.
Also, tummy time can encourage strengthening and active use of mouth, head and neck muscles. Tongue-tied babies HATE tummy time but benefit the most from it. For a baby under 8 weeks of age, this may only be a few moments before the baby gets uncomfortable and they need to be taken off their tummy, but they baby's comfort time on the mat will gradually increase. Here's a video and another and another to get you started.
Cranial osteopathy and craniosacral therapy work at releasing muscle and fascial tension in the body that can result from poor feeding techniques as a result of tongue tie, or due to pregnancy or birth factors. It is a useful adjunct to pre- and post-frenotomy aftercare.
The best time to do bodywork is after nappy changes when baby is already on the floor, but it's best to slot these into your baby's usual routine.
Here's a video of parents perform some simple relaxation movement on their baby:
Bottle fed babies often benefit from a period of paced bottle feeding post-procedure. This allows a baby to control the flow of milk a little easier whilst adjusting to their new suck-swallow-breathe mechanics.
Here is a useful video for paced bottle feeding
If your feeding your baby with both breast and bottle, for whatever reason, it is important to protect your milk supply. This is best done in conjunction with an IBCLC. Paced bottle feeding (above) may be easier for baby. Carol Smyth, IBCBC has some excellent guidance on how to navigate combination feeding.