While the procedure to release oral restrictions (frenectomy or frenotomy) is a fairly minor procedure, it’s still a pretty major event for a family with their baby!  The video below describes many things, in detail, that can be done ahead of time to help be prepared. Below that is the quick written summary and product descriptions.

The NC Tongue Tie Center does not endorse any specific brand of these products and there are no affiliate links or sponsorships involved.

Those linked to are simply examples to pull from.

There is a lot of information here! We recommend reading through it more than once, as well as watching the video. The products linked to vary a lot in price and availability. It is not necessary to have all of them. Pick what works for you, your family, your baby, and your budget.

 

Ahead of time

  • Practice Stretches
  • Practice helping your baby deal with discomfort
  • Gather tools for recovery, including comfort measures and tools for stretches
  • Make sure you have all aspects of a good team in place (see below)
    • Meet with them ahead of time, if possible, so everyone has a baseline
    • Scheduling follow ups with them in the week following the procedure is also good to do ahead of time.
  • If attending our integrative clinic, plan to be there for up to 3 hours the day of the procedure.
  • Plan for wound care following the procedure. Someone will need to be available every 4-6 hours for 2 weeks following the procedure and every 6-8 hours for another 2 weeks after that.
  • If at all possible, parents who wish to work on improving breastfeeding will benefit from being with their baby for 48 hours following
    • If needing to supplement, having multiple tools to do that is helpful. Your infant feeding expert should have these.

A Complete Team

There are multiple factors in what contributes to full oral function. An accurate diagnosis and complete release of all restrictive oral tissues is important. This is what the NC Tongue Tie Clinic can provide. Through our integrative infant clinic we can also provide manual therapy (bodywork) and feeding support immediately post op.

However, there are other things that babies need support in post op. Muscles are building stamina for moving in a whole new range of motion. Babies bodies have been compensating for a restricted range of motion up to the point. Due to both these factors, there are often muscle soreness and muscle tone issues involved in the recovery process. For this reason, we highly recommend having a tongue tie savvy manual therapist (also called bodyworker) as part of the team. This might be an LMBT, CST, Chiropractor, OT, PT, or DO. That’s a lot of letters! Basically, someone who performs therapeutic manipulation of the hard and soft tissues of the body AND has take time to learn about the specific needs of babies before and after being tongue/lip tied. The NC Tongue Tie Clinic can provide a list of professionals to choose from in the area, if that would be helpful. Seeing a tongue tie savvy bodyworker 2-3 days before release and 3-4 days after release is ideal. They can otherwise guide you in your baby’s specific needs.

Function is also the most important aspect in recovery following release. This means that working with an expert in infant feeding (and other forms of oral function) is strongly urged. This is most often an IBCLC and sometimes can be an SLP or OT, as well. What is important is that this person is an expert in infant feeding as well as very educated about what babies need pre and post release of tongue ties. If they’re familiar with the other things below, that would be a good sign! The NC Tongue Tie Clinic can provide some options, on request. Seeing this person about 5 days before release (to start Prehab) and 5-7 days post release works well in many cases. Some people also choose to make an appointment 2-3 days post release, for help with mastering stretches and to check on healing. Seeing them ahead of time will help with establishing what timing is best, for you and your baby, based on your specific circumstances. Options covered by insurance can often be found, if needed.

 

Tools for Recovery

  • Plan to “hunker down” the evening of procedure
    • plan for other supports that might help with this, such as help with other kids or pets as well as being home for the rest of the day
  • Plan for at least six continuous hours of skin to skin contact
    • this can be done by anyone you trust to hold your baby and each care provider doing some of the time
    • a good skin to skin product or soft baby carrier will help make this much more practical
      • If you aren’t sure how to use your carrier, bring it with you for our integrative clinic and we can help you out!
      • This video has good instructions for babies under 4-6 weeks.
      • This video has instructions for older babies.
  • Plan for being able to be successful with wound care. This will involve getting into your child’s mouth multiple times a day for several weeks. For a lot of parents, this is the thing they feel the most anxious about.
    • Many parents find cotton finger cots to be helfpul in dealing with slippery mouths
    • Parents of older babies and toddlers often benefit from having a mouth prop available.
  • Plan tools for supporting your baby as their mouth is sore. Most parents will choose just some of these tools, but all can be combined.
    • Ibuprofen or Tylenol if your baby is not old enough for Ibuprofen
    • Cold breastmilk or formula (readymade formula would be much more preferable over the powdered kind ) -1-2oz
      • Having some cold in the refrigerator, with a dropper, or frozen in a thin sheet in the freezer ahead of time works well
    • Post Frenectomy Tincture
      • This is a product created specifically for use after release of ties and is in concentrations safe for infants
      • This can be kept cold the day of the procedure and used, like cold milk, frequently. Then it can be kept at room temperature and applied to the site after stretches several times a day.
      • This product contains many of the things listed above, including homeopathic arnica and slippery elm, as well as chamomile and lavender. It would replace most things listed above, but can take longer to get than other products.
    • Homeopathy (see below)
    • Hydrosols
      • This document has instructions for hydrosols for babies or essential oils for older kids/adults:
    • Slippery Elm Bark Extract (see below)

 

Homeopathy

Some parents may choose homeopathic remedies for addressing post op discomfort and soothing. It is best to consult directly with a homeopathic provider for an individualized plan. However, we have consulted with experts and they recommend 30C Arnica and 30C Hypericum. For a baby under 6 months old, this should be breastmilk or formula. For older babies water is fine, but milk can still be used. If the tablets have a coating on them, they may need to be crushed up a bit, to dissolve well. Five tablets would be dissolved in 30ml (~1oz) of liquid. 2.5-5ml (0.5-1tsp) is one dose.

Dosage could be started 1-2 hours post procedure and done every 12-60 minutes. The more fussy the baby, the more frequent the dose. Swirling or stirring the milk before each dose is recommended. Starting with every 30 minutes, then increasing, if needed works well. Once fussiness starts to fade, gradually spreading out doses and stopping once 60 minutes apart for 2-3 doses is typical. Many people stop faster, as well. Homeopathy is done in an adaptive way, based on need, and overdosing is not a concern if using breastmilk or formula.

 

Slippery Elm Bark Extract

Slippery Elm Bark is often used by herbalists and some doctors for GERD, stomach ulcers, and burns. Herbalists that we have consulted have suggested that it is a good option to meet the unusual healing goals post release of oral restrictions (to reduce discomfort but not speed healing and maximize tissue elasticity). For babies, alcohol free tincture (glycerite) is what is recommended. One half to a whole dropper of cold slippery elm extract can be applied directly to the site as often as every hour for 2-8 hours following the procedure. It can also be applied, at room temperature, following stretches in the weeks following the procedure. It can affect the absorption of some medications, so should not be used within 2 hours before giving a medication. If given too often, it can cause diarrhea.

 

We will also be there with you, all along the way, through multiple follow up consults and a virtual support group. What we have learned is that preparing as we’ve outlined in addition to our integrative model facilitates the best possible post procedure experience.  Your trust in us means everything to us and we take that very seriously. The right preparation, through practicing skills ahead of time and having several options for post release comfort measures, can go a very long way toward confidence and a smooth recovery!