After the release babies need time to adjust, it can feel really different now that the tongue can move freely and can result in the baby being fussy or irritable for a day or two.

Having a tongue tie release may be compared to getting a leg out of plaster, you have to learn to walk again. Remember the baby also drank amniotic fluid with a tongue tie for months in the womb.

The older the baby at the time of the release, the longer they may need to let go of compensating (nieuwe link) behaviour and begin to  drink in a “new” way. Tongue exercises need to be done before feedings to help the tongue to be more flexible.

Stretching the whole body of the tongue to the palate helps the upward movement to the palate which is essential to create a proper vacuum and to prevent reattachment.

The way to get the baby to drink a little before getting back to the bottle is by finger feeding you can use a syringe of any type to put milk in the mouth as shown on this video. This may calm the baby, so that he or she will latch on better with something already in his or her stomach.

Let him or her drink with paced bottle feeding.

When refusing the bottle a pantyhose around the teat, try using a cuddly toy or sock to cover up the bottle. You can also warm the teat, or use a narrower and longer nipple (with paced bottlefeeding), or a bigger or smaller hole. Side lying works well when babies find it hard to drink sitting upright.

Parents who noticed their baby sucked on the cuddly toy, they then covered the teat with it and the baby learned to drink from the bottle again.

It is possible that 24-48 hours after surgery, babies can be irritable and tearful.

Rarely, it may take longer. If babies refuses the breast or bottle, you can give milk orally with a spoon or syringe, or a small medicine cup placed to the lower lip so that you can gently drip some milk into the mouth. A baby will ultimately want to drink again, but may have trouble getting used to the new mobility of his/her tongue. Temporarily the baby may also latch on with a nipple shield (watch this video).

If the baby is still very upset an acetaminophen (paracetamol) suppository can be given. 60 mg depending on the weight. When in doubt about the amount of medication always consult a doctor.

If you have any questions do not hesitate to call your Lactation Consultant.  (Or the lactation consultant present if you had an appointment at the Tongue Tie Clinic, you will find her telephone number on the aftercare card.)

• Signs of restricted mobility of the muscles of the tongue and the upper lip:

Due to the tie the tongue can only move the front and sides a bit. The tongue cannot go up and back properly, difficulty latching on, drawing in the nipple deep. While very often at the same time the upper lip cannot flange out over the breast, because the tie pulls it inward. So the baby slides off easily. Resulting in small latch, letting go of nipple. Latching on and drinking difficult or only works with a nipple shield or bottle. Falling asleep at the breast or bottle, frustrated, doesn’t seem to want to drink, doesn’t empty the bottle.

• Signs of compensating due to restricted mobility of the tongue and lip tie:

Tries to hold on to the breast by clenching jaws together. Uses cheek muscles to draw milk. Mother experiencing pain especially at latching on. But not always painful, also just sucking really “hard” or “strong”. Chin quivers from jaw muscles tension. Sucking blisters on lips from friction. This compensating is weary for the baby and especially in compromised growth or premature babies it’s a shame it costs energy. Sometimes babies are called lazy drinkers.

Nipple should come out round, but comes out flattened, with blisters, discoloured and sore. “Raynaud” like symptoms from diminished blood flow to nipple.

• Signs of compromised ability to get sufficient milk:

Due to the baby’s restricted mobility, only suckles at the nipple and hardly at any breast tissue. There is too little milktransfer as a result. The baby draws in the nipple as if sucking in spaghetti, hangs on nipple like a “cliffhanger”, often pulling and moving the head in an attempt to pull out the milk, sometimes using hands to pull the breast in older baby’s, drinking suddenly painful when teeth come.

Baby doesn’t “empty” the breast (or bottle), drinks often to get enough milk. Plugged ducts, overproduction from drinking often, compromised production in the end.

Baby loses weight more than 7% in the first days, getting back to birth weight takes more than 10 days. Growth stagnates after weeks or months when production decreases. Babies don’t always show; they save energy by sleeping long for example. A sign could be very few poop diapers.

Baby only drinks the “easy” milk, during the milk ejection reflex.  Drinks short or very long. Only making the chin tug and drinking when MER or giving breast compression or supplementing at the breast.

• Signs of compromised possibility of making a good seal:

Due to the low tongue position, often high palate and the upper lip not flanging out completely over the nipple, bottle or breast, your baby cannot make a good seal and loses suction, you can hear clicking sounds. Also very loud drinking, gulping it down and choking. Complaints of swallowing air.
The swallowed air needs to go somewhere; it goes up or down. Burping, hiccough, spitting, windy, colic.  GER or reflux with or without spitting (hidden reflux). In hidden reflux the baby tries to keep the milk down by swallowing again, sometimes forgetting to breath momentarily. During feeding it can be very uncomfortable for the baby and can become restless.  It’s difficult to put the baby down to sleep. Parents walk with their baby until symptoms subside. The baby can experience pain from the stomach acid in the oesophagus. GERD. Sometimes medication is given which lowers stomach acid.

Thrush is often confused with tongue tie problems. Although you can see it both at the same time. The tongue may have debris in the papilla (from day of birth) due to the fact that the tongue hardly touches the palate so it doesn’t “rub clean”. Pinching and stabbing pain can be from thrush or compensating behaviour from tongue and lip tie. In tongue tie you can see white debris on the posterior part of the tongue behind the tongue tie, the front of the tongue rubs clean against the inside of the upper maxilla. Thrush is a “pearl white” shine or white plaques on the inside of the lips and on the mucous membranes of the inside of the mouth.

*Note that not all symptoms have to be present at the same time.

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.