Infant Frenectomy Post-Operative Stretches
It is essential that you follow-up with your lactation consultant after the procedure to ensure optimal results. It is normal for swelling to occur in the lasered areas. This will usually go down after about a day or two. The baby can be fussy (up to 3 days following the procedure) and may not nurse as much right away. This is normal and will subside. You may use Baby Acetaminophen (Tylenol) as directed on the package, Ibuprofen if over 6 months old or use arnica as a natural alternative.
A small amount of spotting or bleeding is common after the procedure, especially in the first few days. Because a laser is being used, bleeding is minimized. If the lip is bumped, the area may bleed again. Just apply pressure to the area to stop the bleeding with the gauze provided. Make sure it is slightly damp, rather than dry, to avoid tearing the healing wound and skin.
STRETCHES
There are two important concepts to understand about oral wounds:
· Any open oral wound likes to contract towards the center of that wound as it is healing (hence the need to keep it open).
· If you have two raw surfaces in the mouth in close proximity, they will reattach.
Post-procedure stretches are key to getting an optimal result. These stretches are NOT meant to be forceful or prolonged.
The main risk of a frenectomy is that the mouth heals so quickly that it may prematurely reattach at either the tongue site or the lip site, causing a new limitation in mobility and the persistence or return of symptoms. The exercises are best done with the baby placed in your lap (or lying on a bed).
Wash your hands well prior to your stretches (gloves are not necessary). Moisten your finger with aloe, coconut oil, or olive oil when massaging. If you do not have these, you can dampen your finger with breast milk or water. Don’t do the massage exercises with a dry finger. Begin this care today and repeat every day, 3-4 times a day for at least 3-6 weeks. You do not have to wake baby up during the night, however, try to keep the exercises at even frequency, about 6 hours apart.
Stretches or massaging exercises:
· Place the baby’s head in your lap to aid in proper direction and force.
· Begin with a gentle cheek massage, followed by placing your index finger in the baby’s mouth allowing them to acclimate, and even suckle.
· The stretching process should not take more than 20 seconds per site
· For the lip: Lift the lip up to full extension with mild to moderate force.
· For the tongue: Lift the tongue up away from the floor of the mouth to the full extension with mild to moderate force (look for the diamond incision).
The wounds created are typically diamond shaped. This diamond has 3 dimensions - height, width, and depth. This is especially important for the tongue wound, which is much deeper than the lip wound. Maintaining these 3 dimensions is the key to successful healing. The Upper Lip is the easier of the 2 sites to stretch. If you must stretch both sites, I recommend that you start with the lip. Typically, babies don’t like either of the stretches and may cry, so starting with the lip allows you to get under the tongue easier once the baby starts to cry. For the upper lip, simply place your finger under the lip and move it up as high as it will go (until it bumps into resistance). The main goal of this procedure is to insert your finger between the raw, opposing surfaces of the lip and the gum so they can't stick together. Failure to elevate the lip properly will lead to reattachment and improper healing.
The Tongue should be your next area to stretch. If it helps, start with the gentle cheek massage, followed with placing one index finger in your baby’s mouth to encourage suckling. For the stretches, you want to have both index fingers placed under the tongue to lift it up towards the roof of the mouth. The tongue needs three separate stretching motions:
Once you are under the tongue, try to pick the tongue up as high as it will go (towards the roof of the mouth). Hold it there for 1-2 seconds and then relax. The goal is to completely unfold the diamond so that it is almost flat in orientation (remember, the fold of the diamond across the middle is the first place it will reattach). The key to the success of this stretch is that your fingers are placed deep enough prior to lifting the tongue up. I recommend pushing your index fingers together to prevent them from separating, push towards the diamond and then make sure the tongue goes up and not backwards.
Over the next week or two you’ll notice a white (or yellowish) area covering the surgical site which can be very sticky. This is part of the normal healing process. However, as long as you see the white area you must continue with the stretching exercises to prevent the white sticky from adhering to itself and healing back together.
Focus on getting your index fingers mentally glued together. This forces you to stay in the middle, right on top of the diamond. As you push into the diamond and then lift the tongue up, the top half of the diamond will ideally come away from the bottom half of the diamond. It is attention to separating the fold across the diamond that results in a successful post-operative stretching regimen.
We recommend that you follow up with your lactation consultant after the procedure to ensure optimal results. Don’t hesitate to call our office if you have any questions or concerns.
Additional Sucking Exercises
It is important to remember that you need to show your child that not everything you are going to do to the mouth is associated with pain. Additionally, babies can have disorganized or weak sucking patterns that can benefit from exercises. The following exercises are simple and can be done to improve suck quality.
1. Slowly rub the lower gum line from side to side and your baby’s tongue will follow your finger. This will help strengthen the lateral movements of the tongue.
2. Let your child suck on your finger and do a tug-of-war, slowly trying to pull your finger out while they try to suck it back in. This strengthens the tongue itself.
3. Let your child suck your finger and apply gentle pressure to the palate, and then roll your finger over and gently press down on the tongue and stroke the middle of the tongue.