Lots of parents become concerned when planning an oral tether release procedure for their baby if they cannot access hands-on aftercare with a qualified provider. Perhaps the cost is an issue. Perhaps proximity is the problem. Whatever the case may be regarding access, parents are coming to understand that therapeutic care pre- and post-frenectomy procedure can be very beneficial. So understandably, they feel nervous if they cannot access it easily, bringing up concerns over less-than-optimal outcomes.
As a physical therapist providing care to infants with feeding and developmental difficulties, I am sharing what I think are things to prioritize, and where to seek additional help at minimal cost with maximal accessibility!
First, I always recommend seeking out the assistance of an IBCLC if there are difficulties with feeding. Whether you are bodyfeeding or bottlefeeding, an IBCLC is a feeding specialist and when trained in identifying oral ties, they can begin to guide you in many ways:
Supply management if baby is not transferring well
Monitoring weight, growth, voids to ensure health and safety
Screening for oral dysfunction, overall presentation of the infant, and making recommendations/referrals or providing preliminary guidance
Providing recommendations for bottlefeeding to protect breastfeeding, to maximize oral function and transfer, to maintain connection and bonding
Provide positioning and latch assistance to maximize efficiency and participation of infant
…and much more
Many IBCLCs make home visits, and still others provide virtual assistance, in the event an office is too far for you to travel with the baby.
In my opinion the next priority, besides making sure baby is healthy and fed, is addressing the oral dysfunction. Oral dysfunction causes feeding difficulty which can bring a host of issues from gut motility problems (constipation), gas/colic, reflux, and suboptimal growth, to problems with head shape, head and facial growth and development, airway development problems, and issues with feeding down the line. I truly think this is the key to unlocking the rest of the body. Oral dysfunction may cause head turning preferences which can lead to torticollis, which then further compounds the oral dysfunction if left untreated. But you may find that correcting the preference is a bit easier if you are addressing the oral motor function as well. So therefore, this feels like the most important piece of the puzzle, as addressing it can also solve some of the issues described above that your IBCLC is monitoring/treating.
But, what to do if you don’t have an oral motor specialist near you?
I recommend seeking the support of pediatric therapy providers. You can seek private, insurance-based, or early intervention services. Ask your pediatrician for a referral. Remember, any pediatric physical therapist, even if they are untrained in managing oral motor function, understands the connection between the need for proximal stability, strength, symmetry, and range of motion in order for fine motor control (such as oral motor function). Therefore, by supporting the baby in developing trunk and head control, guiding you in developmental play positions, and facilitating developmental progression, this will indirectly lead to improvements in oral motor function.
Another wonderful way to work on facilitating development yourself is to join a developmental play group. Often these are led by pediatric therapists who are giving general guidance and instruction. This will be even less individualized, but again, allows maximal participation for you, your baby’s number one favorite person, whom they will respond to the best!
Lastly, many of the experts in this field have developed online or virtual support platforms to help parents who have access issues to providers near them, including IBCLCs, PTs, OTs, speech therapists, and myofunctional therapists. While not specific to YOUR baby’s individual deficits and needs, they are a great start to working inside baby’s mouth and getting your baby’s tongue, jaw, cheeks, lips, neck and head moving! These providers created these programs for you because they understand that YOU are the expert on your baby, that your baby will respond well to your touch, and that you're perfectly capable to carry out some interventions to support your little. Some support is definitely better than none! And most of these programs and classes are SO affordable! It surely is a great investment to support positive outcomes for frenectomy intervention.
Don’t forget to ask your release provider and other team members who their recommended providers are. Most have lists of providers in the area that they work with. You are definitely not alone on this journey; you’re not the first, nor will you be the last, parent who needs extra support in your baby’s recovery!
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Click here to read what some of the parents I've worked with have to say about how therapy helped their littles!