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Still Struggling After Tie Release…

“I did all the things: I found the ties, I found a release provider, I had the release, I did the wound care activities, and my baby and I are STILL struggling! WTH?!”

Yiiiikes. I see this all.the.time. You may be feeling confused, frustrated, and having doubts or regrets. “Why did I go through all of that just to have it not ‘work’?!” Read on to learn about a few possible reasons why you aren’t seeing the results post-frenectomy that you were expecting!

Let’s first consider your baby’s age. If you have a very young baby (under 6 weeks of life), you may not be seeing the results you expected for a few different reasons. In the first weeks of life, you and your baby are barely just figuring each other out. Feeding is a brand new skill that both of you are learning, and this takes time, patience, and sometimes outside help! A release procedure may potentially can disrupt establishing the delicate rhythm that needs to be developed between you and baby in those early days. Early experiences should be considered with regard to how baby is developing. For instance, a preterm baby (even slightly) may be more prone to difficulties with latching and sucking, responding to their reflexes, and staying awake. More support is needed to prepare and support a younger baby and avoid adverse outcomes. 

Reflux, which can be a painful and disruptive condition, especially if it’s longstanding, may cause full body changes and behavioral responses to feeding.

Avoid overstimulation. Young infants may be overstimulated by the frequent oral exercises plus wound care, plus attempts at feeding which may be difficult and require a lot of effort and attention on their part. If you think your baby may not be handling the care protocol well, speak to your provider team about this. A modified plan of care may be required for your baby.

On the other hand, an older baby (4+ months) may also have difficulties post-release. After about 4 months of age, infantile feeding reflexes may start to integrate (this means they are replaced, typically by more sophisticated and intentional movement patterns), making some of the commonly prescribed activities a bit more challenging to implement. In older babies, compensations are often more ingrained. Human brains and bodies will always take the path of least resistance, and often that is what a compensation is. They can be hard to let go of, even when they’re no longer needed. Therapeutic intervention (PT, OT, speech) can help not only identify those compensations, but provide support to work out of them and into a new pattern.

Speaking of holding onto old patterns, residual tension/tightness in the tissues is often one of the primary reasons I see kiddos after release (and why I typically recommend preparatory therapy pre-release!). I often describe a tongue tie like wearing a cast on a broken ankle. The tie is like the cast, restricting movement. What happens when you wear a cast for a long time is the ankle joint stiffens, the muscles and tendons and ligaments tighten or shorten, and the ankle loses strength and range of motion. We often see a limp as well. Releasing the tie is like breaking out of the cast, it removes the thing restricting movement. But we still have to consider the residual effects of the cast: the tightness, weakness, limping… In the tongue tie world, this looks like addressing the tight muscles of the mouth, neck, face, the restriction in jaw, neck, and trunk joints and soft tissues. Getting rid of the limp is like re-learning how to latch, suck, move, rotate, swallow, etc!

Therapeutic intervention can help not only identify those compensations, but provide support to work out of them and into a new pattern.

What if the tongue tie is not the ONLY thing giving your baby trouble? A professional such says a therapist or IBCLC will work with you to assess whether there are other conditions present which can affect feeding and development. Some examples might be GERD (reflux), torticollis or head turning preference, problems with abnormal muscle tone, laryngomalacia, oral sensory processing dysfunction, or a wide range of other developmental or feeding related issues. For example, reflux, which can be a painful and disruptive condition, especially if it’s longstanding, may cause full body changes and behavioral responses to feeding. A professional who deals with feeding difficulties would be able to help you identify things impacting feeding and function beyond just the tie.

This is where you want to start thinking about who might be best to help you navigate the journey after release. If you are missing a piece of the puzzle, the big picture does not come into focus. I often see parents referred for body work, but someone isn’t working in the mouth or there isn’t a movement component (i.e. no one is addressing gross motor development or sensory functions). If you are breastfeeding, please seek the care of a supportive and knowledgeable feeding professional, such as a Certifed Breastfeeding Specialist, a Certified Lactation Counselor, or an International Board Certified Lactation Consultant (IBCLC, the gold standard for lactation care). These individuals are trained in caring for the feeding DYAD, meaning they have the training and knowledge to support the feeding parent and the infant.

If you lack access to someone who can help you, please contact me to schedule a virtual consultation.

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