Care Post Laser Tongue Tie Release
Caring for you baby post laser tongue tie release has several elements which we will explain to you during your visit. The main points we wish to emphasise with you are
- Pain Control and Soothing your baby
- Preventing Bleeding
- Stretching your babies tongue and or lip tie wound
PAIN CONTROL AND SOOTHING YOUR BABY
Your baby will be upset and “out of sorts ” on the day of the procedure. They may not settle and feed properly until late that night. Their mood should improve the following day and continue to improve over the following days.
If your child is old enough they can and should be given Calpol and or Nurofen for pain relief. It is helpful to give the first dose of analgesic before treatment is carried out if possible. If this is not possible then cuddles, skin to skin contact and frequent small feeds will help to settle baby. Sucrose solution on you finger can offer relief for small babies.
For babies under 8 weeks old the analgesic is the sucrose and other sugars in breast milk.
Most babies will cry during the procedure, faces may go red and there may be some tears. They are not in pain as anaesthetic has been given but objecting to being held and the intrusion into their mouth. Babies settle once they are reunited with their mother and begin to feed. The rapidly absorbed sugars present in breast milk are a very effective pain reliever.
It helps to be hungry at the time of the procedure so they will feed quickly post procedure. Most babies are unsettled for several days after the procedure, The upper lip will swell slightly for 24 to 48 hours. Babies may be difficult to feed for several days as moving the upper lip and tongue may be uncomfortable for baby. On Occasions, when a particularly thick lip tie is released a baby will be upset for 4 to 5 days after the procedure.
If your baby is too young for medication, then cuddling your baby, skin to skin contact between baby and mum, gentle rocking and frequent small breast feeds will help to settle your baby as the rapidly absorbed sugars present in breast milk are a very effective pain reliever.
You will see a small amount of blood in your babies mouth immediately after the release, this is normal and will not last long.
Bleeding may occur in the days after the procedure if a baby accidentally scratches the wound with their finger nails. Sit the baby up on your lap and with a clean tissue apply firm pressure to the wound for several minutes. If you are worried seek medical advise. Bleeding after laser surgery is extremely rare. Placing socks/mittens on babies hands for 48 hours should prevent scratching the wound.
Your baby will have full movement of their lip and tongue immediately and feeding will often feed different immediately. However some baby will be reluctant to feed initially and it will normally takes several days for the pain to ease and for your babies oral movements to improve and return to normal. Day 3 post release is normally the start of real improvement.
There will be some swelling in your babies upper lip (if it has been released) the following morning. This swelling should resolve in 36 to 48 hours. More extensive lip ties will produce more pain after the procedure and these babies will take a few days longer to settle. Sugary syrup on a finger or nipple will often help feeding.
Care Post Laser Tongue Tie Release – stretching
The care after laser tongue tie release that is most important are the stretching exercises. All babies will benefit from stretching exercises which prevent adhesions in the lip and or tongue tie wounds.
For most babies the action of breast feeding itself is all the exercise that is needed.
- Feeding everts the upper lip, stretching the wound preventing adhesions
- Breast feeding will also cause the baby to stick out their tongue under the breast and
- Suckling causes the tongue to rise up and down in peristaltic muscle contraction exercising and stretching the tongue.
If a baby is feeding properly they will be exercising their lip and tongue so adhesions are unlikely. Also breast milk will help with pain control and healing.
The subject of exercises after tongue and lip tie release is much debated and the advise regarding this changes, but the current consensus among professionals releasing tongue ties in Ireland is that
- Stretching exercises are required for all babies to prevent re attachment and scar tissue formation.
- Stretching exercises will not prevent every baby from re-attaching, but they probably limit re-attachment in those babies that do re-attach.
- Stretching exercises are required 6 times a day from the day of release and for one month.
- For babies that re-attach a second release procedure can be considered, but the hope of success is limited.
- A third release procedure is not advised.
- Vigorous, regular areas feeding is an excellent exercise in itself.
When the baby is feeding turn the upper lip up your self, this action stretches the wound preventing adhesions. Breast feeding will also cause the baby to stick out their tongue under the breast and suckling causes the tongue to rise up and down in peristaltic muscle contraction exercising and stretching the tongue. Helping your baby breast feed regularly and properly is the best exercise to aid healing.
If a baby is feeding properly they will be exercising their lip and tongue so adhesions are unlikely, breast milk will help with pain control. If you feel that breast feeding improves then goes down hill again your child may be developing adhesions. It is best to bring your child back to clinic for these adhesions to be assessed and or released.
STRETCHING EXERCISES MUST BE CARRIED OUT FROM THE DAY OF RELEASE AND THEN 6 TIMES DAILY FOR ONE MONTH.
Several stretching exercises will be demonstrated to you in clinic. A demonstration video by Melissa Cole, Lactation Consultant is available on u tube and the current consensus among Irish Tongue Tie Professionals is that this is the most appropriate form of exercise.
Please watch this video and follow it as closely as possible
Dr Lawrence Kotlow based in New York has been releasing tongue ties for over 20 years. His recommended exercises can be seen in this video.
For you and your baby to get the most out of their procedure you will need to carry out wound massage firmly, with a clean fingers twice a day for about 2 weeks.
- Lift the babies upper lip and stretch it up 3 times in quick succession. You should expose and see the wound clearly.
- Put your finger under the babies tongue in the midline and press back into the tongue firmly 3 times. This will stretch the wound and break any developing fibrous tissue.
Babies will find this uncomfortable/ sore and you may also find this difficult. Further massage if continued after 2 weeks may help prevent re attachment, but this is unproven.
Tongue Tie Release Follow Up
Your baby will be offered a review appointment at 14 days or earlier if you request one. Many parents travel long distances for their appointment and will find re attending is not always possible.
All parents will have Dr Murnane’s mobile number and e mail address and can contact Dr Murnane directly if they have any concerns.
At a tongue tie follow up Dr Murnane will review your baby for adhesions and re attachment. If your babies tongue is becoming restricted Dr Murnane will disrupt the wound with a gloved finger. You will be advised further tongue tie massage for your baby for about 14 more days.
Releasing your babies tongue and or lip tie brings a lot of relief to about 85% of mothers and babies, it is not however a magic bullet which will solve all of your breast feeding problems immediately. Tongue tie and upper lip tie release and the associated exercises should be see as part of a process which includes help and advice from your lactation consultants, public health nurse, osteopath and your GP and it is suggested you both see a lactation consultant after about 10 days for follow up.