Tethered Oral Tissues & Post-Frenectomy Support

A Parent's Guide to Post-Frenectomy Care

This guide is for you if you have decided to revise your child's tethered oral tissues, or are considering it for the future. We hope it gives you helpful information, and we are here to customize and guide your care every step of the way. We are only a click away.

Healing Timeline

• First few days Your baby may be extra fussy and noticeably sore, especially in the first 48 hours. This is completely normal. A white patch will begin forming at the site, which is healthy healing tissue, not a sign of infection. Consistent, scheduled pain relief can help, and feeding may feel more challenging at first. If so, reach out to your lactation consultant for support. Comfort measures like skin-to-skin, cuddling, and a calm environment are especially soothing.
• Rest of the first week Discomfort should gradually ease, though some babies stay a bit unsettled. The healing site will keep changing in appearance, and it is an ideal time to start or resume care with a pediatric chiropractor trained in post-frenectomy support. Feeding may still feel inconsistent as your baby adapts to new oral movements. Small improvements take time, and that is very normal.
• Weeks 2 to 4 Most babies show steady progress. The healing patch starts to shrink, stretching becomes less uncomfortable, and feeding tends to improve. Continued visits with your lactation consultant or bodyworker can help if needed.
• Weeks 4 to 6 Discomfort typically resolves completely, stretches are often no longer necessary, and the new frenulum takes its final form. Feeding usually feels much smoother, with ongoing support available for any remaining concerns.

It's completely natural to feel uncertain during your baby's healing. Here are some common experiences, along with reassurance and guidance for supporting your little one.

Increased Fussiness or Crying

Your baby may seem more unsettled than usual, especially during the first week. This is a normal response as they adjust and heal. Offering comfort, closeness, and staying ahead of pain relief, rather than waiting for signs of discomfort, can make a big difference. Regularly scheduled pain management is often helpful for several days, and in some cases up to a week.

Sleep Changes

You may notice your baby sleeping more than usual. This can be due to relief from discomfort, tiredness after the procedure, or the calming effects of medication. Let your baby rest as needed, and trust that this is part of their natural recovery.

Feeding Adjustments

As your baby gets used to new tongue movements, they might temporarily struggle with latching or seem frustrated during feeds. These changes are expected and should gradually improve. Sometimes things seem to worsen before they get better. Staying in close contact with your lactation consultant or IBCLC can offer support and ease this transition.

Drooling and Saliva Bubbles

You might notice extra drooling or bubbles around your baby's mouth. This is very common and simply means their body is responding to healing and increased tongue activity. It usually resolves on its own as they adjust.

Spitting Up or Slight Choking

Some babies spit up more or experience mild choking as they learn to feed with their new oral function. While it can be concerning to witness, it's usually short-lived. Your lactation consultant can guide you through any needed adjustments.

Mild Bleeding After Stretches

A small amount of bleeding during or after stretches may occur. This is normal and often looks like more than it is because saliva mixes with the blood. Rest assured, it is not harmful and does not affect the safety of feeding.

Understanding Your Baby's Discomfort

For most babies, the first 48 to 72 hours after a lip or tongue tie procedure are the most challenging. The good news is that discomfort typically subsides after day 3, and feeding becomes progressively easier. Consistent pain management during recovery is essential for your baby's comfort and successful healing.

Comfort Measures

Try these soothing techniques to comfort your baby:

• Skin-to-skin to soothe baby and promote breastfeeding. This naturally increases oxytocin, which can also help reduce pain.
• Babywearing to provide comfort through closeness and gentle movement.
• Warm bath feeding with Epsom salts for relaxation. Try to latch in the bath together if baby is having a hard time nursing or refusing to nurse.
• Singing softly to your baby.
• Creating a calming environment by reducing sensory input, limiting visitors, and spending more time at home.
• Breastmilk popsicles applied to healing areas.
• Gentle infant massage.

These combined approaches help manage your baby's discomfort while supporting healing after the frenectomy.

Homeopathic & Natural Support

For babies & children

• Bach Kids Rescue Remedy: Use as directed on packaging.
• Arnica 30c: For swelling and healing. Dissolve 5 pellets in 1 oz of breastmilk, formula, or water. Give 5 to 10 drops every 1 to 2 hours as needed (or every 15 minutes during acute discomfort).
• Staphysagria 6c: 1 pellet dissolved in breastmilk or formula, given twice daily to support wound healing.
• Hypericum 30c or 30x: For nerve pain and healing. Give 1 pellet dissolved in breastmilk or formula, twice daily.
• Breastmilk popsicles: Use silicone popsicle molds, or freeze breastmilk flat, break into small chips, and place in baby's mouth to reduce pain.

Topical Pain Relief Options

• Diluted clove oil: Mix 7 drops of clove oil with 2 ml of fractionated coconut oil. Apply 1 drop along the upper gumline and 1 drop under the tongue during each stretching session.

IBCLCs with advanced training in tethered oral tissues (TOTs) play a key role in recognizing and supporting families affected by oral restrictions such as tongue, lip, and buccal ties. These ties can influence feeding efficiency, oral development, and overall function. Identifying them requires more than a quick visual check. It involves a detailed functional assessment to fully understand how the tissues are affecting your baby.

Lactation consultants who specialize in oral restrictions bring a unique blend of clinical expertise and compassionate care. Many have completed extensive continuing education in this area and collaborate closely with other pediatric providers for a well-rounded, integrative approach.

We love to collaborate with IBCLCs and are happy to make a referral based on your child's specific needs.

Gentle & Supportive Pediatric Chiropractic

As your pediatric chiropractor, I provide specialized, gentle adjustments that help reduce tension after the frenectomy. These adjustments are important for releasing tension patterns that can interfere with proper healing and optimal feeding mechanics. Our approach focuses on the whole body and nervous system to support your baby's oral function.

Comprehensive Bodywork

Our bodywork therapies specifically address structural issues that affect feeding. Our office provides:

• Pediatric Chiropractic Care: Gentle, specific adjustments to support nervous system function and structural alignment.
• Craniosacral Therapy (CST) with Sacro-Occipital Technique (SOT): A gentle, hands-on approach that eases deep tension in the cranial system and throughout the body.
• Myofascial Release Therapy: A safe, effective technique using sustained gentle pressure to release connective tissue restrictions that may affect oral function.

Care Plans for Post-Frenectomy

Our care plans are always individualized and designed to help your child reach their goals in a reasonable time. Pediatric chiropractic care is gentle and supportive, and it works best with two things: time and repetition. For the best outcomes, we recommend following the care plan outlined for your child.

Many parents want to know what shapes their child's care plan, so here it is:

• Your health goals for your child, and what you share during your consult.
• How significantly basic activities of daily living are affected. For a baby, this means eating, sleeping, and pooping.
• Physical examination and degree of tension or restriction.
• Neurological scans and nervous system load or stress.
• Your baby's level of adaptability.
• How long the dysfunction has been present.

Equipping You With the Tools You Need at Home

The most important thing we can do as providers is equip parents with the tools and education they need to succeed at home.

Lasered tissue naturally attempts to reattach to its original position during healing. Our stretching protocol guides the healing process to help prevent reattachment at the wound site. Consistency is key.

Please follow the techniques below carefully and diligently, along with your provider's recommended stretches. Feel free to review techniques and ask questions at any time during our care together.

Lip Stretch Technique

With clean hands, gently lift your baby's upper lip toward the nose, hold briefly, and repeat three times. Then massage the gum ridge with your fingertip, reaching into the fold beneath the lip with gentle horizontal and vertical motions.

Tongue Stretch Technique

Place your index fingers at the top of the diamond-shaped wound near the tongue tip. Gently curve your fingers to lift the tongue upward while stabilizing the chin with your middle fingers. When done correctly, you'll see the diamond shape stretch open. Hold for three seconds, then massage inside the diamond with smooth vertical and horizontal movements.

Buccal Stretch Technique

To care for buccal ties, curl your pointer finger with the pad facing outward and insert it along baby's upper gums, pointing out toward the cheek. Using a gentle hook-like motion, sweep back and forth several times to massage the released site.

Perform 1 to 2 times daily for 3 to 5 minutes. Always use gentle pressure.

Facial Massage Guide

• Forehead: Gently massage the skin following the arrows. Light pressure on the green dot for 30 seconds.
• Eyes: Gently massage the skin and eyebrows in both directions.
• Cheeks / Upper Lip: Massage the skin following the arrows. Then place a cheek between your pointer and thumb to gently massage with little circles.
• Mouth: Massage the skin around the mouth in both directions.
• Chin: Light pressure on the blue dot for 30 seconds.

Benefits for TOTs

• Improves facial muscle tone
• Reduces oral restriction
• Enhances feeding abilities
• Supports proper oral resting posture
• Assists with latch
• Reduces overall tension from TOTs
• Supports tongue mobility
• Improves pre and post-frenectomy recovery
• Relaxes fascial restrictions
• Calms the nervous system

Use these exercises as a starting point and combine them with your lactation consultant's custom recommendations. Begin with clean hands and smooth, short fingernails.

Finger Sucking

Select a finger similar in size to your nipple. Position the back of this finger against your baby's chin, with the fingertip touching the underside of the nose to encourage the mouth to open. Allow your baby to draw in your finger with the pad facing upward, gently resting on the palate to stimulate sucking.

Gag Reflex Desensitization

For babies with high or narrow palates who gag on the nipple or maintain shallow latches, gradual desensitization may help. Begin by massaging near the gumline on the palate, progressively working deeper while avoiding gagging. Continue until your baby comfortably accepts a finger touching the palate during sucking. This takes repetition over time.

Lateral Stimulation

Stroke both the lower and upper gums from side to side. The goal is for your baby's tongue to naturally follow your finger's movement.

Down and Out Stroking

Start as above, then rotate your finger and apply gentle downward pressure on the posterior tongue while slowly drawing outward, maintaining downward and forward pressure. Repeat several times.

Circular Stimulation

Brush baby's lips to stimulate opening, then gently massage the tongue tip with circular motions, pressing downward and outward to encourage tongue extension over the lower gums. Continue while slowly moving your starting point backward. Repeat several times.

After a tongue tie release, some babies adapt quickly, while others need extra support to relearn how to use their tongue and mouth effectively. In addition to bodywork, oral motor and sensory therapy can help your baby develop more coordinated sucking, swallowing, and feeding patterns.

Whether your baby would benefit depends on their unique situation, and your provider can help you determine the right next steps. If additional support is recommended, these specialists may be involved:

• OT / PT (Occupational or Physical Therapist): Helpful if your baby has difficulty with feeding coordination, body awareness, or motor function.
• SLP (Speech-Language Pathologist): Can assess and support both feeding and early speech development when oral coordination is an issue.
• OMT (Orofacial Myofunctional Therapist): Helps retrain and restore balance to the muscles of the mouth and face, supporting improved tongue movement and oral function.

Always talk to your care team about who might be the best fit for your baby. We are always happy to make the appropriate referrals.

Babies' neck muscles connect directly to the jaw, affecting oral function. When the muscles around your baby's neck and face hold tension, it can contribute to limited range of motion, flat head concerns, and even reattachment of a tongue tie.

The following exercises support complete healing by addressing the whole body. You can perform them during playtime, after a bath, or at diaper changes.

Tummy Time

Tummy time supports the tongue's optimal range of motion, while movement helps release restrictions and lengthen the anterior chain. Helping your baby become comfortable with tummy time lets them naturally maximize tongue function.

• Use a rolled towel or small pillow to make tummy time more comfortable.
• Start with 3 to 4 sessions daily, 5 to 15 minutes per session.
• Gradually increase duration based on age. A general rule of thumb is 10 minutes per day for each month of life (about 30 min/day at 3 months, 60 min/day at 6 months).

Rolio

This playful activity helps balance asymmetries such as torticollis, plagiocephaly, and shoulder or neck tension.

• Place your baby on their back.
• With your right hand, hold your baby's left hand and left foot.
• With your left hand, hold your baby's right hand and right foot.
• Gently rock your baby side to side, letting their cheek touch the surface on each side.
• Repeat 3 to 5 times on each side.

Guppy Stretch

An essential part of tongue-tie rehabilitation that relieves neck tension and promotes optimal tongue and postural function.

• Lay your baby face up on your lap.
• Allow their head to gently extend past your knee.
• Let them relax in this position for at least 1 minute.
• Repeat several times throughout the day to promote openness in your baby's midline and anterior chain.

Neck Rotation

• Place your baby on their back.
• With one hand, gently hold their shoulder against the surface.
• Place your other hand gently on your baby's cheek.
• Slowly guide their head to turn toward the opposite side. You can also cup the back of the head and gently rotate side to side.
• Hold each rotated position for 5 to 10 seconds.
• Repeat 3 to 5 times on each side.

Neck Lateral Flexion / Tilt

• Place your baby on their back.
• Use one hand to gently secure their shoulder against the surface.
• Place your other hand under your baby's head.
• Slowly bring their ear toward the shoulder.
• Hold each tilted position for 5 to 10 seconds.
• Repeat 3 to 5 times on each side.

Football Carry

• Place your baby across your body in a side-lying position.
• Bring one arm through your baby's legs so the inside of your elbow is at their diaper area, and use that hand to support their shoulder.
• With your other arm, come across their chest and use the inside of your elbow to gently lift their ear toward their shoulder.
• Maintain this position for 2 to 3 minutes on each side.

My team and I are deeply committed to supporting your baby's healing journey through proper bodywork and holistic care. While this process takes patience, combining chiropractic care with frenectomy aftercare helps your child work toward optimal oral function and whole-body wellness.

If you have any questions or concerns at any point in your child's recovery, please don't hesitate to reach out at (952) 452-9712. We're here to support you every step of the way.

Warmly,
Dr. Chrisi Kelly, DC, CACCP, CPM, LM
Pediatric Chiropractor & Midwife