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The Great Debate: Tongue Tie Aftercare May 7, 2014

“My baby screams so hard when I perform stretches, are they really necessary?”

 

“My doctor/dentist/IBCLC told me that I can manually rip open the revision site after it has reattached, but, that feels barbaric.”

 

“My baby seems to have an oral aversion . . . at least to my fingers.”

 

“My IBCLC/doctor/dentist said oral aversion is worth the risk of aggressive aftercare.”

 

“My toddler is so strong, I can’t seem to get under the tongue without being bitten.”

 

“I was told my baby’s tongue/lip tie reattached because I didn’t stretch aggressively enough (or did not stretch at all).”

 

“I stretched aggressively and the ties still reattached.”

 

“I did not stretch and the ties did not reattach.”

 

To be perfectly honest these sorts of comments make me angry. I am not angry at the parents, but, angry at the professionals that keep insisting aggressive aftercare is the only way to prevent reattachment, when we are not even sure it prevents it at all!

 

To back up briefly, not even professionals seem to agree one what reattachment is when it comes to tongue and lip ties, or when it becomes problematic. The thoughts seem to range from any frenulum with any symptoms mean problematic reattachment, to some frenulum and reattachment is normal and even some remaining symptoms are normal. It is important to realize that not all breastfeeding problems are caused by tongue tie and that even if a particular baby’s problems are all tie related, it can still take a long time for the symptoms to improve after release.

 

I am going to share my story, with names of professionals intentionally left out, and conclude with some links to aftercare articles written by professionals that I trust understand the emotional and physical trauma aggressive aftercare can cause.

 

I have two children that have had their ties released. My son, C, (3 years old at the time) and daughter, N, (several releases during her first year).

 

I started out stretching C’s revision site aggressively, but, he was strong and fought hard so I quickly reduced the frequency of stretches and performed them more and more gently until I stopped. His tongue healed perfectly and 18 months later he has no symptoms.

 

N has had multiple “revisions.” Her tongue tie was first released at 7 weeks old and I used gentle “sweeps” under her tongue (no stretching or bleeding and she hardly flinched). Her tongue healed without any reattachment.

 

At 10 weeks old N’s lip was released, I did not touch the wound, it reattached, though it was closer to a class 3 than class 4.

 

When N was 5 months it was determined she had remaining frenulum (not reattachment!) under her tongue and remaining symptoms so it was released again. I did slightly former stretches. At this point I had joined some tongue tie support groups online and had connected with some professionals (one in particular) that put significant emphasis on stretching to avoid “reattachment.” When I saw frenulum under N’s tongue again I panicked and broke it open (looking back I am not even sure if it was true reattachment). I called the dentist who released the tie and he suggested not stretching, but, using a gentle massage. My understanding of what he said that reopening the wound would slow down the healing process and increase the risk of reattachment. I am not sure he still advises that or maybe I misunderstood him, but, when I switched to the gentle massage her revision site healed within 2 weeks without reattachment. I did not consider at that time that the gentle massage may have been more beneficial in preventing reattachment than aggressive stretching.

 

Over the next few months I followed the professional that was placing major influence on aggressive stretching to prevent “reattachment” and insisting it did not cause oral aversion and any upset or pain to the baby was worth it. Much to my shame I followed and participated in the person’s advocacy of aggressive aftercare. I became literally blind to the trauma it was causing parents and children and followed this person like a cult.

 

N still had many symptoms at 10 months so we returned to the dentist, this time he released the lip and the tongue (which had not reattached, but, he released deeper). I had become so consumed by the paranoia of reattachment that I was terrified of it happening to my baby and willing to do anything to prevent it. I blindly followed the advice of a professional whom I trusted . . . ignoring some of the blogs which had begun to pop up warning against aggressive aftercare.

 

The professional watched me and instructed me stretch/rub the revision site to the point that I removed more tissue from the lip frenulum than was revised. I continued to stretch, rub, and break up tissue multiple times a day for 14 weeks. N was so traumatized she would cry as soon as I begun preparing to stretch her. Symptoms had briefly improved but began to get worse and worse and it seemed the more aggressively I stretched the more it reattached.

 

I stopped stretching and rubbing at 14 weeks, within about 2 weeks her tongue and lip had healed. Her lip did reattach some (but even less far down the gum line) and her tongue did not reattach at all. All of her symptoms improved significantly within the first few weeks after I stopped stretching and continue to improve 18 months later.

 

N must have broken her lip frenulum on her own a few months later because one day I noticed it was completely gone . . . since I had no idea it had even ripped I had not touched it . . . yet it was perfectly healed.

 

The worst part is that N still has not forgotten, she still does not fully trust fingers near her mouth, or being put in “stretching position.” I no longer believe stretches prevent reattachment, but, even if I thought they did, I feel it would be less traumatic to have more revisions than endure aggressive aftercare.

 

How to avoid oral aversion from aftercare: Tongue Tie – Gentleness and Compassion for the Baby Part 1 and Tongue Tie – Gentleness and Compassion for the Baby Part 2

 

The danger of and lack of evidence for stretching: What Is Appropriate Aftercare Following Tongue Tie Treatment? PART 1 and What Is Appropriate Aftercare Following Tongue Tie Treatment? PART 2

 

***I will have no problem approving comments from the apposing point of view, but, personal attacks against me, especially without real contact information of the person commenting will not be approved.***

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5 Responses to “The Great Debate: Tongue Tie Aftercare”

  1. Hello Heather
    Thank you for posting this. As an IBCLC who deals with a lot of tongue tied babies I have decided to give the parents I work with both side of the argument and let them decide what they feel is right for them. I have put a link to your article on my website, as I feel it will support parents in this difficult process. If you are not happy with your link being on my website – please let me know and I take it down.

    thank you.

    Petra

    • I have a lot of respect for professionals like you who are willing to give ALL of the information for parents to make an informed choice, and I am more than happy for you to have linked this article – it was written to be shared!

  2. Chelsea Says:

    Hello,
    I recently had my babies tongue and lip tie released 3 weeks ago. I was told to do the aggressive stretches. I found it very difficult at first and I thought I hadn’t done them hard enough as after about a week I noticed her lip tie had reattached. The same day she fell and bumped her mouth and tore it back open. I spoke to the dentist and they said to make sure I keep doing the stretches as hard as I could. Because I was so paranoid I was doing them very hard. My babies tongue has reached but it hasn’t seemed to affect feeding too much. This morning I woke up and went to do a stretch and her lip tie has reattached, my worst nightmare! The dentist is over 1000km away and I don’t have the money to pay to get it released again. I haven’t spoken to the dentist again yet.
    Bub seems to now be slipping off when feeding, I am not sure what to do?? I am not sure I can go through it all again and I don’t think the stretches have even helped it not reattach.

    • I’m so sorry you are going through this also! It is heartbreaking and so hard to know what is right. My daughter is 3 years old now (just over 2 years since her last revision) and over the past few months we have uncovered some other possible causes of her symptoms which might not be related to ties at all. I do believe ties cause breastfeeding and other problems, but, I am learning there are many causes of the same set of symptoms. I mention that because, maybe the tongue and lip tie are just part of what is going on with your little one? I do not know this for a fact, so please take with a grain of salt, but, I do wonder if sometimes the pain from aggressive aftercare makes them not feed as well too…it seemed like once my daughter was full healed she fed a little better, though it never was great (probably because of her having other issues as well).

      Recently a well known dentist examined my daughter and felt there was some restriction, but, he could not tell me if that was the cause of the remaining symptoms or not, and he was as concerned as me about her oral aversion, though he was willing to do it if we really wanted him to. We have decided not to have another tongue tie release done at least for the foreseeable future.

      As hard as it is to make decisions like this, trust yourself. You are THE expert on your baby, and you know better than anyone what steps you should or should not take.

      Some things that might help and do not cost money, are letting your baby mouth object of different shapes and textures, letting the baby control putting objects and maybe eventually even your fingers in her mouth. If you are bottle feeding you can place your thumb and finger on her cheeks while drinking to offer extra support and if breastfeeding, it might help to give firm support right between her shoulder blades as well as holding the breast in her mouth (though sometimes it is hard to do both at once!)

  3. Ashley Pickett Says:

    Thanks for this article! Breastfeeding parents really do deserve to know all sides, especially the part that we don’t know if stretches or massages actually work.

    In my chat about aftercare, which I have multiple times a day, we discussed the pros and cons of the procedure, the immediate risks of the procedure, expectations surrounding what it should look like while it’s healing, and the possibility that aftercare exercises can help prevent reattachment. We then also talk about how some people don’t do any exercises and see no we attachment, some people do aggressive exercise and see loads every attachment, and that the opposite of those are seen as well.

    Parents are always so worried about the procedure, but it’s usually the aftercare that upsets the most – and we always talk about listening to their baby, and trying to validate their babies concerns around the stretches. Anything that teaches a parent to disregard their babies cues, even if what they’re doing is necessary, not only undermines the babies voice but also undermines the parents ability to listen to their strong attachment to their child.

    If parents are going to do aftercare, I think we also really need to start teaching parents how to talk to their babies and validate their babies. To say “I know that this is uncomfortable – I’m sorry that we will be doing this but I’m trying to prevent reattachment so you and mommy can breast-feeds as long as we want to.” Or “ouch that hurts, those exercises are nasty – lets get you a Breastmilk Popsicle so you can feel better”. Validate their feelings while explaining why… Offer comfort.

    When we do this through a TT procedure the baby is often calmer, less of a fight to hold in place, and calms quicker. They just feel like we’re doing this with and for them, not TO them. I truly believe that the feeling of helplessness is worse than the pain, for a lot of these babies.


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