A tongue tie, clinically known as ankyloglossia, occurs when the lingual frenulum—the thin strip of tissue connecting the underside of the tongue to the floor of the mouth—is unusually short, thick, or tight. This restriction can limit the tongue’s range of motion, potentially interfering with feeding, speech development, and oral hygiene. A frenotomy is a quick, minor surgical procedure performed to release this restrictive tissue. The success of the frenotomy relies heavily on specialized stretches performed at home, which serve as a form of maintenance to ensure the tissue heals correctly and maintains the full range of motion achieved during the procedure.
The Necessity and Timeline of Stretches
Post-frenotomy stretches are a non-negotiable part of recovery because the mouth heals quickly. The primary purpose of these exercises is to prevent the two raw surfaces of the wound from growing back together, a process called re-tethering or reattachment. Without frequent stretching, the body’s natural healing response can cause the tissue to contract and fuse, potentially reversing the surgery’s benefits.
The typical post-operative regimen involves performing stretches multiple times a day for several weeks. The most intensive period is usually the first two weeks, requiring stretches approximately every four hours, totaling about six sessions over 24 hours. The frequency is often tapered down as the wound stabilizes, but the overall duration typically lasts four to six weeks to align with the body’s wound contraction phase of healing. The exact schedule, including when to drop middle-of-the-night sessions, must always be determined by the medical professional who performed the procedure.
Essential Preparation and Safety Guidelines
Begin by washing your hands thoroughly or consider wearing gloves, as hygiene is paramount when placing fingers inside an infant’s healing mouth. Some providers recommend moisturizing your finger with a small amount of olive oil or coconut oil to help with a smoother movement over the sensitive tissue.
Proper positioning helps keep the infant secure and provides the best view of the surgical site. Common techniques include laying the infant on a firm, flat surface, such as a changing table, with their feet pointing away from you. The “football hold” or cradling the infant in your lap with their head stabilized are also effective positions. Use a headlamp or flashlight to ensure adequate light to clearly visualize the diamond-shaped wound beneath the tongue and lip.
The stretches should be quick, gentle, and firm, aiming for precision rather than prolonged pressure. If pain relief medication, such as infant acetaminophen, was recommended, timing its administration about 30 minutes before the stretch can help manage discomfort. Performing the stretch just before a feeding is often helpful, as nursing or bottle-feeding can immediately soothe the baby afterward.
Step-by-Step Guide for Lip and Tongue Stretches
Lip Stretch
Aftercare involves two distinct maneuvers: one for the upper lip and one for the tongue. The lip stretch is often performed first, as it is generally less upsetting and helps open the mouth for easier access to the tongue. To perform the lip stretch, place a clean index finger high up into the fold between the upper lip and the gumline. Gently pull the upper lip upward, aiming to lift it as high as possible until it touches the nose or fully opens the wound. Hold this elevated position for a few seconds to elongate the tissue and prevent the lip frenulum from reattaching. Afterward, gently sweep your finger from side to side in the fold to massage and maintain separation of the wound edges.
Tongue Stretch
The tongue stretch is the more intricate maneuver. Use two fingers, typically the index and middle fingers, to enter the mouth and gently push down on the lower gum pad to encourage the infant to open wider and prevent biting. Slide your index finger beneath the tongue, moving it back until you feel the resistance of the floor of the mouth, just behind the diamond-shaped wound. The goal is to act like a “forklift,” scooping the tongue up and back toward the roof of the mouth, fully elongating the diamond-shaped wound. Maintain this lifted position for one or two seconds, ensuring the entire raw area is exposed and stretched. A separate motion involves sweeping your finger along the diamond from back to front, separating any horizontal tissue fibers that may be trying to bridge the gap.
Monitoring Progress and Troubleshooting Common Issues
As the wound heals, it will develop a white or yellowish patch, which is not an infection but a natural fibrin covering, similar to a wet scab. This healing diamond will gradually shrink in size over the weeks, but its presence signals the need to continue the stretching routine. The primary sign that the stretches are working is a visible increase in the infant’s tongue mobility and function, such as an improved latch during feeding.
Infant resistance and crying are common during the stretches, but this does not mean the procedure was unsuccessful or that the stretches should stop. A small amount of spotting or minimal bleeding during the first few days is normal and typically not a cause for concern. However, contact your provider immediately if you notice excessive, non-stop bleeding, or if the infant refuses to feed or shows signs of significant, escalating pain.
The most significant complication to monitor is signs of reattachment, which may appear as a horizontal line forming across the center of the diamond. If the wound looks notably tighter or the tongue’s range of motion appears to be decreasing, seek guidance from the operating provider or a lactation consultant. In some cases of minor reattachment, a more firm, slow stretch can re-open the area without needing a second procedure, but this should only be done with professional instruction.