POST-OP INSTRUCTIONS FOR FRENECTOMY

Your goal is to have the area heal and give the most mobility possible. You should do the stretches with the baby laying down on a changing table, bed, or couch facing away from you like during the exam. Reference “Infant Aftercare Stretching Video” on www.TongueTieAL.com. Please follow-up with our office within 7-10 days. Begin doing the stretches the DAY AFTER the procedure. Gloves (preferred) or clean hands with nails trimmed should be used for stretches.

1.   If the lip and/or cheeks were released, first put your fingers all the way in the fold of the lips and pull the lip and/or cheek up and out as high as possible, so you can see the white diamond(s) open. Do this 3 times. Then push directly on the area(s), in and up gently, but firmly. Do this 3 times. The wound(s) may bleed slightly (occasionally), but if you notice bleeding that is concerning, call us or Dr. Barnhart.
2.   With one index finger, push down right behind the gum pad in the floor of the mouth, and push into and lift the tongue up and back just above the white diamond to put tension on the wound for a few seconds. Do this 3 times. Use your non-dominant thumb to push down on the gum pad to hold the mouth open. The wound may bleed slightly the first day or two, this is not a concern.
3.   You want to see the “diamond” all the way open on all sites. If you notice the diamond is becoming tight, then stretch/push a little more to open it back up.
4.   Repeat this 4 times a day for 3 weeks.
5.   If you can’t follow-up in person, please do a “deeper stretch” by pushing twice as hard one time 7 days postoperatively to ensure the wound isn’t growing back together. You will notice some bleeding if it reopens or stretches out, which means it was growing back a little bit, and now has reopened. Hold pressure with gauze or a paper towel for 4-5 minutes and it will stop. Symptoms may improve after the stretch.
6.   Play in your child’s mouth a few times a day with clean fingers to avoid causing an oral aversion. Tickle the lips, the gums, or allow your child to suck your finger.
7.   Watch Michelle Emanuel’s YouTube channel for Tummy Time and guppy exercises. Do them daily.
8.   The released area will form a wet scab after the first day. It will appear white and soft. It may change color to yellow or even green. This is not an infection, but is just a scab in the mouth. The white / yellow area will get smaller each day lengthwise, but HEALING IS STILL HAPPENING!  So even though the white scab is not as visible, you must continue stretching or the surgery may need to be repeated. If you have any concerns, please contact our office.

Follow-up with a lactation consultant is critical if nursing. Bottle-feeding babies will benefit from visiting a feeding therapist. A bodyworker (Chiropractor, CST, etc.) is also very helpful. You should expect one better feed the first day, two better feeds the second day, etc. Sometimes there’s an immediate difference in feeding and other times it takes a few days to weeks to notice a difference. Skin to skin, warm baths and soothing music can be very beneficial to calm the baby.

For pain give CHILDREN’S TYLENOL (160mg / 5mL) starting WHEN YOU GET HOME and for the next 2-3 days every 4-6 hours: 

For babies who weigh…

• 6lbs give 40mg or 1.25mL
• 7lbs give 1.5mL
• 8lbs give 1.75mL
• 9lbs give 2mL
• 10-11lbs give 2.25mL
• 12-14lbs give 80mg or 2.5mL 
• 15-17lbs give 3mL

If your child is 6 mo. old and 12-17lbs, you can give 1.25mL (50mg) of Infants’ Motrin (Ibuprofen). If your baby is refusing to nurse or seems to be in pain, please check that the Tylenol dose is correct and find an alternative way to get milk in (bottle, syringe, cup).

Your child’s lip will swell up slightly for a few days if released and the released areas will be sore for a few days. One week postoperatively these areas will look much better and 2-3 weeks postoperatively these areas will look almost normal.

If you have any questions during our office hours please call the office at (530) 222-1400. 

If after office hours please call/text Dr. Barnhart’s emergency line at (530) 334-6736.