– Hi, I’m Dr. Katie Roy. I’m here today to talk to you about the common tongue stretches that would be utilized following a tongue tie procedure. These stretches can be done whether you’ve had the procedure done by a pediatrician who uses scissors or a pediatric dentist who’s done cold laser. All of these stretches can be done within 24 hours following the procedure.
Before we get started, one of the important things to address is that this is not intended as medical advice. Please refer to your own healthcare provider that has started the procedure with your child in regards to all things health-related for them. The controversial issue right now is whether or not stretches are important or necessary and it seems to revolve around the ability of consistency as well as efficiency of doing the stretches. Doing the stretches three to four times a day and having enough force and pressure when you are doing them will help limit reattachment and help avoid further visions necessary down the road as well as restoring function to the tongue. So it’s oral function is what we’re looking for. In my practice, I have found the parents are the caregivers that are doing the stretches consistently to have least amount of reattachment and the least amount of needing to go for a second procedure down the road, which is ideally the goal. All of these stretches can be done in the first 24 hours following the procedure.
We’re going to start with two external stretches which can be done outside the mouth, and then three internal stretches as well. So the external stretches are
1) GUPPY STRETCH and
2) FISHY FACE.
Guppy stretch is something that you may have heard from a lactation consultant or pediatrician or the dentist – or maybe it’s new for you. It’s a relatively easy stretch to do. For the guppy stretch you can do this in a number of different positions. I find most babies are most comfortable while they’re being held to do the stretch. You make sure you have one hand supporting their back and the other hand goes behind their head and you’re just going to let that head gently relax backwards, so that I’m stretching all of the anterior fascia to enable a nice opening. We can just stretch gently backwards. We can also rotate away from you and rotate towards you. If your baby’s a little heavy or they’re a little squirmy and you don’t want to have them up here you can also lay them across your lap and just allow the head to drop backwards as well. You’re going to hold this stretch for at least 30 seconds but as long as the baby will tolerate it, is a good option.
The other stretch we’re going to do is called the fishy face. So it is exactly what you think it is. Take your thumb and forefinger, and on your baby you’re going to go right in front of their ear s(o right in this sweet spot between the cheek and the jawbone where it’s nice and soft). You’re just going to trace downwards towards the corners of the mouth in a nice gentle motion. You’re going to do this four times. What we are looking for: we do want to see that fishy face expression — I’ll do it to myself now just so you can see what it looks like. So that’s the fishy face. That’s what we want to see With both of these stretches you should aim to do them 3-4 times a day. Those are the guppy and the fishy face. Now, for the internal stretches. First we’re going to practice some clean hygiene. Just as a tip, make sure your nails are nice and short when you’re doing this. If your nails are a little sharp, since you are getting in underneath their tongue and it is a very sensitive area it may be really uncomfortable. So trim those nails and make sure you wash your hands. You can use gloves, you can use finger condoms. Some people use neither and they just wash their hands very well and make sure they clean underneath their nails prior to doing the internal stretches. If you’re doing these stretches with me now is the time that we’re going to put on some gloves.
For baby positioning, while we’re putting on these gloves we are going to make sure that the baby’s on a flat surface and that we are above their head. This seems to be the most ideal position to be in – – where you’re slightly above them. One thing to note is we do want to try to visualize the diamond shape of the tongue, of the released area. In the beginning, it’s going to be white and wet and that is normal for the healing process. We specifically want to work on the outside corners. On the broad portion of that tongue tie, the diamond shape. You may notice that you don’t have a diamond shape you have a linear line, and that’s okay. The linear lines tend to be more common if it was a posterior tie, or if it was a secondary revision, in which they just needed to gain more depth with it. You may find that to clearly see that, you need to grab another receiving blanket. You’re just going to roll it up. And with this, you can place it on your knee, under their neck so that you’re able to get the lean back slightly and you can visualize inside their mouth a little bit better. For the actual stretching, we’re going to use our pinkies and we’re going to go on either side of the mouth and we’re going to get underneath that tongue. I’m going to switch out my dolls right now. This doll has a nice big mouth. With this, we’re going to take those pinkies and we’re going to dive underneath the tongue.
They may fight you a little bit as a protective instinct so we just have to be slow and continuous to get underneath that tongue. You’re going to put your pinkies on either side of that wide portion of the diamond. . We’re going to go down and then lift upwards. and we’re going to do that four times. You may find it a little bit of resistance; if you get a little bit of resistance you will want to push slightly beyond that to make sure that we are opening everything up. In the beginning, you may notice a little bit of blood and saliva afterwards, and that’s okay. A small amount is okay — that’s just a sign that you have reopened something that has started to reattach. That was tongue lift.
If they’ve had a lip tie done we do want to make sure that the lip is also lifting away and not reattaching. You’re going to take that pinky and you’re just going to come along underneath the lip and just lift and roll that upwards. Those are the two major stretches that we’re going to be doing. The third one is if your baby is under three months old we can do a sucking tug of war with them to help facilitate their sucking reflex. I find the best way to do this is to take my index finger and place the pad of it along the roof of their mouth. Typically this will start to elicit the suck reflex. You may need to calm them down before they will do this. If they’ve been crying for a little while it’s not something that they will naturally do. But once they are establishing a suck on your finger you’re going to start to pull that finger out and allow them to continue to suck and then suck your finger back in. And we’re going to keep on working on this as long as you can until they start to fatigue their suck reflex. That’s the tug of war.
You’re going to continue doing these stretches daily, for the two to three weeks following the procedure. After that point, you may notice that the frenulum, has become shiny white in nature — that’s a scarring that is occurring.
Next, we want to check the mobility of that scar. This is something that you can do while your baby is laying down. You are going to take one finger and go underneath their tongue and just push down on that frenulum. And you’re going to see if there’s any dimpling on the top of the tongue. If you notice that it dimples down immediately, as soon as you put pressure, it’s a sign that there’s still some tension in the frenilum that is causing the top of the tongue to come down.
To stretch that, we want to do a very gentle rolling and sweeping motion to stretch out all that scar tissue to get it to line up appropriately. You can either hold your baby while you do this or, they can lie flat on your lap with you above them. This one’s a little easier to do. You’re just going to take your index finger and you’re going to go underneath that tongue and you’re just going to sweep and roll upwards. You’re going to do that three times. It’s a nice, easy stretching action.
Those are the most common stretches you will be asked to do and we just went through those. So again, to recap, we have the guppy stretch, in which your baby is relaxed and head backwards. We have the fishy face, in which you take your finger and forearm and strip downwards towards the corners of their mouth. We have the tongue back and lift. We have the lip curl, and we have the tug of war. And then we have the tongue swooping action once that frenelum has started to heal.
If you have any further questions, please reach out to us at [email protected] and your questions will be directed to the appropriate healthcare provider that is best able to answer them. Have a wonderful day. Bye for now.