In older babies, children and adults with a tongue tie, compensatory oral habits may be present. During pregnancy, a baby swallows amniotic fluid with a tongue tie, which means that hiccups may already be present. An older child and adults have exhibited compensatory behaviors for years as surrounding muscles and tissues compensate for the limited functional movement of the tongue. Think of moving food in the mouth from side to side, swallowing well without choking, wiping your teeth after eating and talking. Often the patient swallows with his tongue forward instead up and back, which is called a tongue thrust. This can affect the position of the teeth, jaws and the overall body posture.

The preparation for a treatment is therefore twofold:

1. Compensatory movements in the head and neck region can be quite “stuck” and therefore better checked and treated by a special therapist before a tongue tie release. We hear from patients that they have this done by a physiotherapist, manual therapist, orofacial therapist, chiropractor or osteopath for complaints such as incorrect posture, stiff neck, jaw clenching, grinding and headaches. Treating a tongue tie alone is not sufficient if the surrounding muscles keep the compensating behaviour and restrict functional movements.

2. Treatment also improves if the patient goes to a specialized speech therapist in OMT (oromyofunctional therapy) before and after the treatment. This can help to analyze incorrect oral habits and swallowing and train or unlearn these. If an OMT speech therapist is not available, the Kieferfreund app is an option to train and practice (see www.kieferfreund.com and https://www.tonguetieclinic.com/tongue-tie-therapy/https://www.tonguetieclinic.com/tongue-tie-therapy/)

At the Tongue Tie Clinic we regurarly get the question why a child (still) drools after the treatment. Or that baby has little bubbles of saliva on the lips.
About 2000 times we swallow on reflex day and night. To be able to swallow saliva properly, a fully mobile tongue is required. With a tight tongue tie, the tongue cannot move up and back properly and swallow food, drink and saliva in a wave motion towards the esophagus. When the tongue becomes more mobile due to the treatment, a tongue has in fact never been able to make this movement (completely) and it still has to be learned. In a baby up to about 3 months everything goes on reflex but it can still take weeks to months to learn to swallow properly. After 3 months, a baby or child has already found its own way to swallow food and drink. It therefore takes some time before the tongue has learned a good / new swallow and drooling can occur or become worse. The brain has to also learn to control these movements. Oromyofunctional therapy OMFT can help the older child besides speech therapy. See the FAQs about OMFT. In addition, it is important that a child closes their mouth properly and breathes through the nose, and that they can close their lips properly. Parents can close their mouth when they see that their baby or child has an open mouth position by gently moving their chin up when he or she is sleeping or playing, for example. It is important that a pacifier is only used for comfort and falling asleep because when using a pacifier, the tongue is prevented from (learning to) properly swallow upwards and backwards towards the throat.

The baby still needs to learn how to use the tongue optimally. It is therefore advisable to do stimulate more movements by exercises.

The Tongue Tie Clinic has the following videos with possible exercises:

and this video for training a good tongue rest position against the palate:

Do not immediately expect the baby to understand what he can do with his tongue, sometimes it takes a few weeks for results. Keep short nails and clean fingers, you can use a medical glove or finger condom (these are not necessary). A cold finger could be more pleasant for your child. Anesthetic gel (teething gel) can also be used to make wound aftercare more comfortable for the baby:

The video https://vimeo.com/55658345 takes 3 minutes and can also serve as an example for young babies. The following video is also available for older babies: https://www.youtube.com/watch?v=q9Io3Ush-S4.

Make it a fun game, sing or chat with the baby. Do not immediately expect the baby to understand what he can do with his tongue, sometimes it takes a few weeks to see results.

Short sequence of exercises in the video:

1: Massage palate (rubbing palate)

2: Suck finger, pull it a little so that he tries to hold on even more tightly (“tug of war” game)

3: Middle tongue rub, finger out to stimulate “cupping”, holding the nipple in the mouth.

4: Massage the jaws, as if the teeth are being brushed with the tip of the finger, to stimulate the movements to the side, because the tongue wants to follow the finger.

5. Touch the chin, tip of the nose, upper lip to stimulate wide opening of the mouth.

6: Stretching / lifting lip and tongue and rubbing the wounds, on the video you can see how she turns her finger into a “rolling pin” (rolling pin).

Further guidance and help with drinking, eating or talking:
The Lactation Consultant can help with breastfeeding, in addition the Pre-verbal Speech Therapist for bottlefeeding and learning to eat solids. For the older children the speech therapist who is specialised in oromyofunctional therapy (OMFT).

There is not much scientific evidence on how much aftercare and exercises should be done. Internationally, it is generally advised to do aftercare for 4 weeks to prevent rapid, or to much reattachement. The tongue and lip at rest and while drinking are not actively stretched, which means that the original anatomical position can quickly be reestablished . To prevent another release, our advice for wound aftercare in young children is as follows:

The wound aftercare is advised to do 4 times a day (approximately every 6 hours) for 4 weeks. But to taper down the frequency slowly in the 4th week before you stop. The aftercare consists of horizontal swipes and vertical stretches.

Horizontal

Five to six times rub the wounds of the upper lip and / or under the tongue (if treated), you use the same pressure as rubbing in your eye.

Vertical

Lift the tongue two or three times towards the palate from the mouth with fingers in “V-shape”.

Push tongue up two or three times in a rolling pin like movement  with the indexfinger , you make a “J-shape” under the tongue

Three times lip stretching, you make a “duck face” (if lip is also treated)

A Lactation Consultant IBCLC is present at the time of the release. After the release, the Lactation Consultant will assist with feeding. She can help with preparing a bottle or latch on to the breast. It’s all about helping mother and child get started again. It is not a lactation consultation.
During the half an hour aftercare appointment you see the Lacation Consultant where more questions can be answered. There usually remains some time to observe feeding at the breast or bottle, but the aftercare appointment is mainly to check the wound healing and to see how the symptoms are developing and where the Tongue Tie Clinic can help you more specifically.

Before the release the baby usually had to drink in a different and compensating way for a long time. The baby already drank the amniotic fluid in the womb with a tongue tie. Sometimes a baby has a lot of tension in the jaws, the baby seems to bite the breast or bottle. Possibly there is a quivering chin (because of the muscle tension) present and the baby could not open his mouth  to latch on. In this video (link) you can see how you can help the baby relax the jaws.

During feeding, a baby can also overstretch or have a preferred position. These sometimes very tense jaw muscles and other muscles in the mouth, throat, and neck area can be helped to relax. You want to give the baby a signal that compensation is no longer needed and that he or she can start drinking differently. Babies with colic or babies who cry extensively also benefit from the possible treatment of a professional such as a physiotherapist, chiropractor, osteopath or manual therapist who has completed a degree at the university. These therapists can help to overcome compensating behavior. Check if the therapist sees many babies and that they check the mouth / neck area especially.

Also look at this page of therapists for addresses of other care providers who use their expertise to further assist the baby in motor development such as the physiotherapist (fysiotherapeut) who teaches you how to apply therapy in your daily care at home, the speech therapist (logopedist) for further development of ​​use of the tongue and mouth with (bottle) drinking, eating solids and talking, the lactation consultant IBCLC (lactatiekundige) for further remediation of breastfeeding problems.

Case studies and research chiropractic and manual therapy:

Dutch case study, breastfeeding problems and chiropractic treatment.

http://www.enhancedentistry.com.au/wp-content/uploads/2015/02/Chiropractic-and-Breastfeeding.pdf 114 case studies.

More articles:

http://www.ncbi.nlm.nih.gov/pubmed/19836604

http://www.ncbi.nlm.nih.gov/pubmed/22014911

http://www.ncbi.nlm.nih.gov/pubmed/19066699

http://www.ncbi.nlm.nih.gov/pubmed/23158465

http://www.ncbi.nlm.nih.gov/pubmed/22675226

Here we added some links from colleagues who made the effort of recording and sharing aftercare! Watch them several times, you also see how you massage the jaw muscles and cheeks. Help your child to relax more and stop compensating behaviour.

The older baby resists more, so try to do it as playfull as you can. An older baby also had to compensate for much longer with other muscles to be able to drink, therapy to let go of the compensation behaviour is often needed. In addition, guidance from a lactation consultant IBCLC or a speech therapist is recommended to improve feeding.

Lactation consultant IBCLC, Melissa Cole. This video , and this video to.

Older baby video Lactation consultant IBCLC Jennifer Tow.

Your milk production could have suffered from ineffective milk transfer. Because your baby’s tongue wasn’t mobile enough. Your baby couldn’t hold on to the breast well. After the treatment your baby can learn to keep a better latch, so that he can empty the breast better.
In order to adjust the production to the needs of your baby, you often need extra stimulation, for example, by switching the breasts more often. Also apply breast compression. It is better to supplement extra milk at the breast with a tube/syringe or using the SNS, (breastfeeding supplementary system). It stimulates milk production at the same time. This video shows how. Here’s how you can use the SNS.

Watch this video from pediatrician Jane Morton how you can pump with compression and massage and also how you can hand express in order to increase your production. Also power or cluster pumping helps.

There are also herbs that help to increase production and the drug Domperidone. Ask the  Lactation Consultant IBCLC for a consultation.

After the release, you may notice things that may last a little longer, such as lip swelling, drooling, gagging, or other discomfort or peculiarities.

* Granulation tissue; This is a small lump of extra scar tissue that can form on the wound. If you suspect you see this, send a photo, it is not serious and if it is a hindrance to drinking it can still be removed.

* Drooling; Because the swallow has to be learned again after tongue tie release, it is possible to notice drooling for a while in a child or baby.

* Reattachment; After the treatment, the wound simply wants to heal with scar tissue.  With doing aftercare you hope the wound does not close too quickly or too tightly. If too much reattachment occurs, the tongue or lip mobility can be limited again. When you live abroad it is the adviceble to check the healing with somebody knowledgable in a week, that can also be done at our clinic if you can stay a few days, but has to be arranged with making the appointment for treatment. In The Netherlands you can call the Tongue Tie Clinic for an appointment.

* Muscle pain; After the treatment the adults and older children notice (muscle) pain or discomfort in the jaws, tongue and throat sometimes as well. See the FAQ about pain relief.

* Baby spits more; Because the baby drinks more effectively, it may be that the stomach is not used to the amounts and it spits back up, but it may also be that the baby is still drinking air for a while.

* Smelly breath / mouth; We sometimes hear this from parents and can last from a few days to a week, it’s ussualy no problem whatsoever.

* Swollen upper lip; This can last for up to 5 days after lipband treatment.

*  Quivering jaws remain visible longer; Because the tongue, after it has come loose, many of the muscles still need to be trained, it may be that the compensation continues with the jaw muscles, but compensation behavior may also need a chiropractor or manual therapist to remedy it. See the FAQ about compensation behavior and videos explaining this.

* You have to help lips flange out; The baby is not used to flanging the lip, this may be helped.

* Suction blisters still present; They can be present for longer, especially on the upper lip.

* Crying doing aftercare; What we hear from parents and notice at the aftercare consultation that the baby cries with the aftercare exercises, but stops as soon as you stop or start feeding or changing diaper and such.

* White plaques/debris on tongue still visible; Because the palate is often high and the tongue is not well trained to stay up, even at rest, the white plaques/ debris on the taste buds remains.

* Bottleteat; We notice that the teats with a broad base cannot go deeper into the mouth, so a teat that can go deeper and gives more mouthfilling, such as the smaller, narrower types, is often better.

* Baby stays upset longer than 48 hours, crying, drinking worse. In the older baby who has had to compensate for a long time with a tongue tie. Before the treatment, often these babies were fussy and drinking poorly and found there own “technique”. Treatment of compensation behavior is often necessary. See FAQ compensation behavior. People often give painkillers for longer. But one also has to take into account a normal virus infection occurs at the same time. You can go to the doctor with a fever, see the FAQ about fever.

* Gagging may still be present after the release.

* A baby cannot swallow the tongue after the release.

* Apnea are also observed in babies . It is not directly related to the release. Tongue tie can be related, read the research.

No fever is expected as a result of the treatment. A wound infection or inflammation either. Fever is a body temperature above 38 degrees Celsius. In the event of a fever in babies under 3 months of age, you should consult your doctor. It is possible that your baby has a virus or other infection. In case of muscle ache or discomfort after the treatment you can give acetaminophen.

To get an optimal result after a tongue tie release you can do these exercises at the speech pathologist who is specialized in OMT or OMFT. It is best to exercise before and after the release. Older children and adults work on improving tongue movement, tongue rest posture, mouth breathing, lip seal and swallowing properly.  It is best to start one or two weeks before the release. It is also advisable to see a manual therapist beforehand to release any tension from compensating mechanisms build up over the years of living with a tongue tie.

There’s a list of speech pathologists (logopedisten) who are specialised in OMFT in The Netherlands who can help you or your child to improve your tongue function.

Here we have some videos of excellent providers from around the world.

Dr. Rishita Jaju and Smile Wonders staff in Reston, VA show you what post-Waterlaser Frenectomy exercises will work for your little ones.
Tongue Release Therapy Days 1-14 OMT of Stanley Dentistry
Tongue Release Therapy Days 15-21 OMT of Stanley Dentistry
The Four Goals of Myofunctional Therapy by Sarah Hornsby RDH, BS.
Carol Vander Stoep of Mouth Matters OMFT indications for problems and tongue tie.

There is not much scientific evidence on how much aftercare and exercises should be done. Internationally, it is generally advised to do aftercare for 4 weeks to prevent rapid, or to much reattachement. The tongue and lip at rest and while drinking are not actively stretched, which means that the original anatomical position can quickly be reestablished . To prevent another release, our advice for wound aftercare in young children is as follows:

The wound aftercare is advised to do 4 times a day (approximately every 6 hours) for 4 weeks. But to taper down the frequency slowly in the 4th week before you stop. The aftercare consists of horizontal swipes and vertical stretches.

Horizontal

Five to six times rub the wounds of the upper lip and / or under the tongue (if treated), you use the same pressure as rubbing in your eye.

Vertical

Lift the tongue two or three times towards the palate from the mouth with fingers in “V-shape”.

Push tongue up two or three times in a rolling pin like movement  with the indexfinger , you make a “J-shape” under the tongue.

Three times lip stretching, you make a “duck face” (if lip is also treated)

Children have to learn to use their tongue optimally again after the release. It is advisable to do specific exercises. This video gives you a good idea of possible training.

Kinderen moeten nog leren om de tong optimaal te gaan gebruiken. Het is daarom raadzaam oefeningen te doen ter stimulatie. Dit filmpje geeft een idee van mogelijke oefeningen:

https://www.youtube.com/watch?v=FTuCiOfPgdY

In very rare cases there is a coagulation disorder or anatomical variation that causes bleeding and will be solved immediately after the treatment.

One does not go home after the treatment before the wound is checked. In a baby, it is not expected that the wound starts bleeding at a later stage. In adults and older children, this may happen incidentally after the anaesthesia has worn off (anaesthesia contains vasoconstriction components). Most patients find that the numbness from the injection wears off after about two-three hours.

What can happen at home is that some scar tissue comes loose, scar tissue contains blood vessels. The wound wants to heal, and it should heal, but at the same time you don’t want too much scar tissue, which may restrict the mobility of the tongue again.

What to do: Slowly remove any clot or blood with a gauze before doing something similar to the one below. Keeping a baby upright and make sure that he or she is not too hot.

Do not rinse with water.

Press dry with a gauze for 3 minutes without letting go. If the wound is not dry another 5 minutes with small pressure.

Options for on the gauze: Strong tea is blood vessel narrowing and also xylometazoline (regular nasal spray).

A baby may immediately drink milk again.

If the wound is not dry after 10 minutes of pressure, please call the mobile number of the lactation consultant at the Tongue Tie Clinic (number on the card given to you). You must then return to the clinic after consultation with the therapist (1-way).

For treatments at a location other than the the Tongue Tie Clinic, the agreements with that doctor apply.

Pain and discomfort, see this FAQ.

Temporarily more throwing up because the baby drinks more effectively, the stomach may not yet have been used to the new amount so quickly.

There may be some swallowed blood after the treatment. That doesn’t do any harm. A little green / black solidified blood  can be in the diaper.

More saliva.

Temporarily bad smell from the mouth. This is because the ties are removed and scalded at the same time.

Temporarily more difficult to latch on, more painful latching on, refusal of breast or bottle, also look at the FAQ about remedying compensation behaviour.

Suction blisters can stay for a while, your child is used to drinking in a compensatory way and it can take some time before it is gone. It does no harm.

Your baby can be very grumpy the first 24-48 hours. Also read the frequently asked question(link) about it.

Fever; in fever, the body temperature is 38 degrees or higher. It is very unlikely that this is due to the treatment, rather though another infection. It is important that your child is not drowsy and continues to drink well. If refusing milk give milk from a bottle or with syringe.

For children under 3 months with a fever you should always warn your doctor.

After the procedure you will receive an aftercare card with the mobile number of the Lactation Consultant present at your appointment. You can contact her with any questions regarding the procedure. She will then contact Dr. Kirsten Slagter,(DSS,PhD), or Dr. Suzanne Wink (GP).

These questions may include:

• day or night about bleeding that cannot be stopped by applying pressure on the wound
• concerns about the healing of the wound
• the appearance of the wound.

Any concerns about (breast) feeding please contact the Lactation Consultant.

If you are worried about the appearance of the wound you can send a video or photo to whatsapp or messenger of the Lactation Consultant or info@tonguetieclinic.com.

If you are worried about the general health of your child, always contact your general practitioner as well.