If you are worried about your baby after the procedure PLEASE CALL ME for reassurance, however the following information is what to expect in the first few days following the procedure.
Unfortunately, for most babies the tongue tie release is NOT AN INSTANT FIX
The baby will have undoubtedly had some time feeding with a restriction under their tongue and as such, will need time to re build strength in that muscle and to learn to move their tongue in a new way.
The procedure can sometimes mean a reduction in nipple pain immediately, or breastfeeders may experience a 'different' feeling in the way their baby feeds, but in most cases, it takes time, patience and perseverance for the baby to increase the strength in their tongue in order to be able to feed more effectively. Healing sore/damaged nipples, means building new skin cells and this takes time.
It is important to continue with Lactation Consultant support following the release to ensure that things improve.
What to Expect:
Occasionally the 2ndfeed or third feed following the procedure doesn’t seem to go as well. This is because depending on how tight the tongue tie was, sometimes the tongue SPRINGS up towards the roof of the mouth and the baby struggles to get it back down to move in the right way. The baby has a disorganised suck following the procedure as they are just not used to moving their tongue in a new way.
If baby is particularly fussy, struggling to latch you can:
· Express a little milk onto a teaspoon and give this directly to calm them down to latch.
· Encourage baby to suck on a clean finger to establish a rhythmic suck, bring baby to breast still sucking…whip finger away and encourage the latch that way.
· If you have any expressed milk, using a syringe ‘dropper’ the milk onto the breast whilst the baby is trying to latch, and if they come off again, drop milk into the corner of their mouth whilst they are suckling to encourage them to stay there.
· Baby may be a little grumpy, have plenty of skin to skin cuddles for comfort and reassurance, and don’t forget to look after yourself too! (eat and drink well, and get rest when you can)
*If your baby is old enough for analgesic you may wish to consider a dose of paracetamol or ibruprofen
FOLLOW THE RECOMMENDED DOSE FOR YOUR BABY’S AGE ON THE PACKET
· There should be NO MORE BLEEDING, however some older babies put their fingers in their mouths and ‘knock’ the wound site, which may cause a small bleed or oozing. This can be normal, just FEED the baby and it will stop.
CALL SARAH IF ANY FURTHER BLEEDING OCCURS (this is Very rare)
Baby may be still a little grumpy or disorganised with their suck, you may find that you have to encourage them using the techniques above, or they may be feeding better than before.
· Continue with skin to skin, remember to take care of yourself too.
Day three for some babies can be the worst day for feeding. The tongue is a muscle, and has had a period of time with restricted movement. Similar to when an adult exercises for the first time in a while, day 3 after exercise the muscles in the body ACHE. Day 3 tends to be an achy day for babies following release, as a result they can be grumpy again and may struggle with the latch again.
If your baby is old enough for analgesic you may wish to consider a dose of paracetamol or ibruprofen FOLLOW THE RECOMMENDED DOSE FOR YOUR BABY’S AGE ON THE PACKET
· Continue with skin to skin cuddles for reassurance and hormone boost for baby
· The White/Yellow Patch under the tongue might appear today THIS IS NORMAL.
The White/Yellow Patch Under the Tongue:
The white/yellow diamond shape under the tongue following the procedure appears a couple of days later and can be there for up to a week. IT IS NORMAL -there is no need for any wound care.
That diamond shape usually turns into some scar tissue. Just like when we have a wound on a knee, scar tissue forms and so under the tongue is no different-scar tissue forms under the tongue. Just like the scar tissue on a knee, the scar tissue under the tongue can tighten, and this can restrict the tongue movement again. Usually a week or two after the procedure sometimes some of the original symptoms may come back. It is important to contact me and you can either come to the free Eton clinic, or book another consultation with me so that we can accurately assess what is going on. To the untrained eye, the scar tissue can look like the frenulum-and so sometimes parents are told that the tongue tie has 're grown' or ' come back', this is not true. It takes around 4 weeks for the mouth to heal fully, and cutting into scar tissue creates more scar tissue, so it is never a good idea to cut again within 4 weeks of the original division, and indeed that is if it needs doing again at all. As the scar tissue softens, the tongue mobility improves again and the symptoms resolve. There are also a number of reasons why a baby might not have good mobility in their tongues which also includes things like thrush, so if you are still having issues with the symptoms, please get in contact and we can throughly assess and help.
Day 4 onwards:
Some babies are still taking the time to build the strength in their tongues. Every baby is different and some babies take a good couple of weeks to really get the hang of new movement. Even though for a lot of babies day 3/4 post release seems to be the day when they are most disorganised with their tongue (and possibly just a bit more grumpy) this fussiness or reluctance to feed well can persist even. for a few days more. You know your baby best, and your usual ways of comforting baby will be beneficial, and if your baby is old enough for some baby paracetamol or ibuprofen, then that can help too. Please be reassured that it is very normal for them to be grumpy and out of sorts following the procedure.
Signs of infection:
Your baby is so beautiful that I bet you cannot stop kissing them! Luckily, our lips are very sensitive and so when we kiss our babies we are actually subconsciously also checking their temperature! Because as adults our temp is usually between 36 and 37 degrees centigrade, if our babies are warmer to the touch of our lips-this could be an indication of them having a temperature. Post release tongue tie temperature checks involve kissing your baby as often as you like! If at any time they feel warmer to the tough of your lips, please take their temperature with a thermometer. Any reading over 37.7 degrees centigrade - please seek medical advice.
Please also be reassured that the risk of an infection post release is 1:10,000 babies, made even less so by being breastfed and normal hygiene feeding routines.
There are some 'non direct wound' exercises that potentially could help your baby to organise their tongue movement following a tongue tie division. In general, talking to your baby, singing to your baby, pulling faces at your baby...essentially encouraging normal facial expressions...can help your baby's brain to trigger the instinctive tongue movement needed for feeding, and I encourage all parents to do this.
Occasionally, a baby may need some guided exercises which can be additional help. If your baby needs these, I will talk through which ones are best fro your baby, how to do these, and how often.
They DO NOT involve touching the wound site under the tongue.
DO NOT MASSAGE UNDER THE TONGUE:
· This increases the risk of infection,
· Is stressful for mum and stressful/uncomfortable for the baby,
· Increases the presence of scar tissue which can restrict the tongue worse than the frenulum itself. (which may result in general anaesthetic at Southampton Hospital needed to excise the scar tissue in order to release the tongue)
The Association of Tongue Tie Practitioners DO NOT recommend Direct Wound management and have a statement available here: https://www.tongue-tie.org.uk/does-postoperative-wound-massage-improve-outcome-of-frenulotomy-for-br...
Re-occurrence of the Tongue Tie
If your baby is less than 3 weeks old, there is a possibility that more frenulum will come forward under the tongue with normal rapid physiological growth. You might feel that some of the original symptoms may come back. In my experience about 3% of babies who were less than 3 weeks old at the time of the original division, will need to have a further division.
Please note that it is not recommended for any further divisions to happen within 4 weeks of the original division-this is to ensure that the mouth has healed completely from the first division, and to avoid further scarring at the original wound site.
What to do:
· Come to the Clinic or have a follow-up consultation as soon as you feel the symptoms returning
· If a re division is needed/required this is done at NO FURTHER COST TO YOU (home visits are charged at the normal home visit rate, 2nd divisions in a clinic session are charged the consultation fee)
If your baby is older than 3 weeks but has had slow weight gain, then suddenly increases weight after the tie release, more still may come forward due to rapid physiological growth.
Rarely, more tie comes forward in older babies too. I cannot guarantee that this will not happen, therefore it is essential for improvement for you to seek continued Lactation Consultant support.