Question 1

Consult Process

Accepted Answer

A consultation with a Tongue Tie Team provider is the first step. This is done in an appointment separate from the procedure to allow parents adequate time for informed decision-making. While the procedure itself is very quick, it IS a surgical procedure requiring a parental commitment to aftercare in the recovery period.
 
This appointment begins with a thorough assessment of your child’s health, oral restrictions (ties), and related symptoms and challenges with feeding, speech, sleeping, dental, etc. There will also be a discussion of exercises you can start immediately, the procedure, aftercare, risks and benefits.
 
Bring your questions! We have found that the best results happen when parents are fully empowered, informed and prepared for aftercare; and do not feel rushed into a decision.
 
Before the consultation, please watch our video on what to expect a(https://www.youtube.com/watch?v=s0XBjsGSHrI)s well as our video on the exercises.(https://www.youtube.com/watch?v=YwCOVeAXqE0) You can also join our Facebook group (http://www.facebook.com/groups/tonguetiekids)for support, and check out our videos on Instagram.(https://www.instagram.com/Agavepediatrics) 
 
Consults can be scheduled at your convenience and are available in each of our 5 locations. (Procedures are, however, done only at the Glendale, Goodyear, and Chandler locations.) To arrange for a consult, please contact us.(javascript:void(0))

Question 2

Treatment Options

Accepted Answer

Various treatment options exist for tongue and/or lip ties. These may include the laser release procedure (frenectomy) or just careful watching and follow up.
​
A treatment recommendation appropriate for your child will be made at the consult appointment.
​
Various studies (javascript:void(0))have shown that a tongue tie corrective procedure (frenectomy) is safe and effective; and it usually helps improve breastfeeding, speech, or other difficulties.
​
If both tongue and lip tie co-exist, we generally recommend doing tongue tie procedure first. Most feeding difficulties in a child diagnosed with both tongue tie and a lip tie arise only from the tongue.
​
We have a large number of successful stories but we cannot guarantee that the procedure with be 100% successful. At the consult we will discuss the pros and cons of the procedure and assist you as you make an informed decision for your child.
​
A follow-up appointment is scheduled 2 weeks after the procedure to evaluate the healing process and address any feeding issues that have not improved. If an upper lip tie is present and is affecting feeding, an upper lip tie frenectomy may be performed on this day.
​
Consultation notes will be sent to the referring provider, if requested.

Question 3

Pre-Procedure Exercises

Accepted Answer

When the tongue tie is released, the muscles of the mouth may need retraining and strengthening. It is best to work with an International Board Certified Lactation Consultant (IBCLC), Osteopathic Manual Medicine (OMM) provider,(javascript:void(0)) and/or aSpeech Language Pathologist (SLP),(javascript:void(0)) because they can assess your infant’s suck and show you exercises specific to your infant or older child.
​
Exercises will be reviewed on consult day and on the day of the of procedure. After the procedure, it is of utmost important that you do the tongue/lip stretching exercises at regular intervals. Here are the tongue exercises for infants, which you can start before the procedure in order to get your baby used to them:
​
1. BEEP, BOP, BOOP Game (Desensitizing the Palate and Gag Reflex): Some babies resist a deep latch because they have a very sensitive gag reflex. Systematically desensitizing it can be helpful. Begin with touching baby’s chin saying “BEEP” - Touch baby’s nose; saying “BOP” - Touch baby’s upper lip; saying “BOOP” (touching the upper lip will tell baby to open mouth) - Press down on the center of baby’s tongue saying “BEEP”. If baby does not open mouth when upper lip is touched, tickling the lower lip may help. (Catherine Watson Genna: Supporting Sucking Skills in Breastfeeding Infants)

2. Cheek Stretches: Gently hold the inside and outside of your child’s cheek and gently stretch outward while gliding/moving your fingers up and down. Gently follow a c-shaped movement pattern to stretch this area. If you feel resistance, pause for a few seconds and you may feel the tension release. If your baby resists having a finger inside their mouth, you can start with drawing a c-shaped line from their nostril to chin, and lines from their
nostril towards their ear as if you were drawing whiskers. Please use slow and slightly firm movements.

3. Follow the Finger (Lateralization/side to side Exercise): Slide pinky or index finger along baby’s lower gums, massaging from one side to the other, encouraging baby’s tongue to follow your finger from side to side with the tongue. Repeat 3-4 times. As you do this, use your thumb to support your hand and the baby’s jaw to increase stability.

4. Lifting the Tongue: After the procedure, this exercise elevates the tongue toward the roof of the mouth to stretch the frenectomy site vertically to keep the diamond open and tall, lessening the risk of re-attachment. Place the pads of your pointer or pinky fingers on the left and right edges of the diamond shape. Sweep your fingers up and down swiftly and firmly for 4 or 5 strokes. (This takes about 5 seconds.) This can also be done using just one finger/one side at a time. If child becomes upset, return to “Follow the Finger” game or allow the baby to suck on your finger. When child is calm, proceed to the next exercise. For tight or reattaching tongues, it may be helpful to push your finger deeper/firmer on the sides of the tongue for the lift. Avoid pushing too deep and causing gagging or choking.

5. Push Back the Tongue: This exercise stretches the tongue toward the roof of the mouth, further improving its ability to lift by stretching along the midline. Place the pad of your pointer or small finger on the underside of the tongue. Firmly push back on the tongue 3-4 times.

6. Tug-o-War (Strengthening exercise): Touch baby's upper lip to encourage them to open wide, then slide your finger in their mouth, pad up, on top of their tongue and allow them to suck. While your baby sucks and you press down on their tongue slightly, gently play tug-o-war, pulling your finger out slightly and letting them suck your finger back in. This may sooth baby after the other exercises. It can be especially helpful just before baby breastfeeds since it helps baby learn proper tongue movement for breast and bottle feeding.

7. Tummy Time: You may have heard about tummy time helping with motor development and head control. Tummy time is also the BEST position for a baby to engage in strengthening tongue and oral skills for optimal latch and feeding. Many babies do better with suck training and pre/post exercises when in tummy time vs. on their back. More info can be found at 
www.tummytimemethod.com(http://www.tummytimemethod.com)
 
---
 
Here are the tongue exercises for older children (2 years and older):
For children at least 2 years old, in addition to doing #4 and 5 from the above exercise, below are fun ways to increase tongue movement, especially if your child is older and therefore potentially more resistant to the manual lifting and pushing-back tongue exercises.

1. Put a small dab of nut butter or something with a similar texture (please be mindful of any food allergies) on the alveolar ridge (gum line immediately behind the teeth) and try sweeping it off with the tongue. You can help increase tongue elevation by helping to hold the jaw stable while the child’s mouth is open and their tongue is sweeping peanut butter.

2. Put a dab of nut butter on their upper lip, and have them extend and lift their tongue to lick it off. Make sure that their mouth is wide open and the tongue is coming out independently to do this.

3. Put a piece of cheerio or meltable puff on the tip of the tongue. Have the child elevate the tongue to make contact with the palate/roof of the mouth. Hold the piece of cheerio in place or mash it to dissolve. Please be mindful of your child’s age and skill while using this exercise, to avoid choking risks.

4. On a plate, or in a small shallow cup, like a 1/4 c measuring cup, spread easy cheese/whipped cream/jelly etc., and have your child lick it off. Make sure that their mouth is wide open and the tongue is coming out independently to do this.

5. Place cheerios, puffs, popcorn (if age appropriate) on a plate, and have your child pick them up with just their tongue, by sticking their tongue out.

6. Have your child stand in front of the mirror with you and have them mimic your tongue movements (stick your tongue out, curl your tongue, tongue to top teeth, tongue to molars).

7. Use a vibrating toothbrush or Z-vibe to stimulate the roof of the mouth and have the tongue follow the vibration.

8. Reward cooperation with stickers, small toys, reading a favorite book, etc.
 
We have videos of these exercises here.(https://www.instagram.com/p/CLcoFlsHEYB/?utm_source=ig_web_copy_link)
 
---
 
Here are the lip exercises:
 
1. The Mustache: Place pad of index finger along philtrum (space between nose and lip) and follow the boundaries of the lip towards the chin. It will look like you are drawing a mustache on your baby’s face and can become a fun activity. Please use slow and long movements with firm pressure. Again, fast movement can sometimes increase the chances of aversion.

2. Fish Lip: Also referred to as the grandma squeeze, gently pinch on either side of the upper lip frenulum (tie), to raise the center of the lip up and away from the gums. If your older child is able to pucker and round their lips themselves, have them do that instead.

3. Flip the Lip: This is really exactly what it sounds like. Take two fingers and place between the upper gum and the upper lip on either side of the released tissue (below right photo), and flip the upper lip up toward the nose. Hold for 5 seconds. This stretches the upper lip, and makes the wound visible to check the progress of healing.

Question 4

Frenectomy Procedure

Accepted Answer

Dr. Agarwal at Agave Pediatrics has performed thousands of tie release procedures for tongue (lingual frenectomy) and lip (labial frenectomy) ties over the years. On the day of the procedure, Dr. Agarwal will assess your child once again and discuss the procedure and any possible complications with you. The procedure involves little to no pain for the child and has improved feeding and speech for many children.
 
●  Tie release is a brief and minor procedure done in a treatment room in our office (at either the Chandler, Goodyear, or Glendale location).
●  The child is given a local anesthetic injection to numb the site. 
●  A laser is used to release and cauterize the tissue under the tongue or lip. As the tissue is being released, it is continually checked for any bleeding, as well as for appropriate range of motion such as lift and extension.
●  After the procedure Dr. Agarwal will show you the results. 
●  Exercises and wound care will be reviewed with you 
●  Pain management will be reviewed with you.
● If you are breastfeeding or bottle feeding, we will encourage you to complete a full feeding cycle while in the office so that both infant and you are as comfortable as possible for your trip home.

Question 5

Same Day Consult/Procedure

Accepted Answer

There are families who prefer a briefer consultation and a procedure done on the same day. These are often experienced parents, who recognize the symptoms in a new baby, or first-time parents who’ve had another health professional recommend an appointment. Many parents study the information on our website and determine that this amount of information is adequate for them to have a solid base of working knowledge toward a fully informed decision.

Question 6

After the Procedure

Accepted Answer

Immediately after the procedure, our staff IBCLC (javascript:void(0))will guide you to a lactation room and assist you in latching your infant. If you are working with a lactation consultant, you will be referred back to your IBCLC for follow-up approximately 3 to 5 days post-procedure.
​
You will be encouraged to complete a full feeding while in the office so that both mother and infant are as comfortable as possible for the trip home.

Please take note of what the incision looks like immediately after the procedure. Take a photo of the white diamond shaped wound that becomes visible under the tongue in the first 24 hours after the procedure. The white diamond should remain the same size; it should not get smaller or disappear.
 
The aftercare handout can be found here.(javascript:void(0))
https://static.wixstatic.com/media/undefined
With every set of exercises, check for re-attachment by noting the size and shape of the white diamond. The white diamond should remain the same shape with distinct, straight edges. It should be even from side to side: the edges should not look muddled or “tucked in.” You should not see tissue protruding from the base.
​
If you detect re-attachment, please call the office for further instruction. Some reattachment is expected, but minimizing it is important for over-all improvement.
​
Possible Bleeding:
At times, the exercise sessions can cause a small amount of bleeding. If this occurs apply firm pressure to the wound with a clean cloth or cotton ball. Breastfeeding your infant will also help bleeding to stop. If bleeding does not stop, the child needs to be evaluated immediately.
​
If you have questions, check out our FAQs,(javascript:void(0)) contact us,(javascript:void(0)) or visit the tongue tie support clinic.*
*The in-person tongue tie support clinic is currently on hold due to COVID-19 precautions, but we offer support via text, email, or phone. With a lactation consultation, you can bring your infant for in-person guidance, support, and discussion with our IBCLCs.

Question 7

Pain Management

Accepted Answer

Proactive pain management is very important. For most children, the first 72 hours are the hardest. The use of Tylenol or Ibuprofen based on your child’s age and weight and Arnica 30 C, (a homeopathic remedy) will be helpful.
Dosage information is included in the packet you received at your consult, as well as in the email that was sent to you, and is also available on the aftercare handout.(javascript:void(0))
​
● Initially, your child’s mouth will be numb at the site of the procedure. This will last for approximately 2 hours.
● Please prepare to ease your child’s discomfort by having pain medication on hand before procedure day.
● If you have traveled a distance of a couple of hours, please bring Tylenol or Ibuprofen so that you can give a first dose before traveling home.
● If your child is uncomfortable with the exercises, be sure that their pain is being managed.

Question 8

What symptoms are related to a tongue tie?

Accepted Answer

https://static.wixstatic.com/media/undefined

1.    For babies:  most moms will complain of difficulty in breast feeding. These difficulties include painful feeding sessions, cracked and possibly bleeding nipples, baby being fussy at the breast, baby is unable to drain the breast due to a lack of transferring milk, baby eats frequently for long periods of time (30-45minutes), lack of weight gain, reflux symptoms, overly gassy and uncomfortable from gas, swallowing difficulties and possible torticollis.
2.   For older infants: you might see issues with developmental milestones regarding feeding. Babies might have a hard time transitioning to solids, they may gag on pureed foods, gag and choke on puffs or wafers, and a lack of wanting to try new textures of foods. Some babies can still experience reflux, lack of good sleeping habits by waking frequently at night, and difficulty transitioning to sippy cups.
3.    For toddlers:  you might start to notice that all the above symptoms were present, and now your child is experiencing difficulty articulating certain sounds. Toddlers will also continue to be hesitant on trying new textures of foods. Kids at this age can start to show symptoms of hyperactivity due to lack of proper sleep cycles. Some toddlers or young kids will be very noisy breathers as well
4. For additional details check out the signs & symptoms page(javascript:void(0))

Question 9

What grade is my baby’s tongue tie and when is it bad enough to be released?

Accepted Answer

The degree or grade of a tongue tie is not the deciding factor in whether a procedure is indicated. If you are experiencing symptoms related to the ties, that is when a procedure is warranted. Doing a procedure when symptoms or complications are not present only to prevent potential issues later, is not a cause for a procedure at this time.

Question 10

How do I know if my baby needs a lip tie release?

Accepted Answer

1. Lip releases are not always needed. Signs that a baby still needs a lip release include continued reflux symptoms, excessive gas and baby is uncomfortable from gas, continued clicking, gulping, baby popping on and off the breast, fussy at the breast, slides off the breast easily, frequent spit ups or vomiting. A lip tie causes the mouth to be tight and therefore unable to properly create a seal around the breast or bottle and therefore air is swallowed with each feeding.
2. On a side note, babies can have worsening of these symptoms after the tongue release because as their suck gets better they end up swallowing even more air.

Question 11

What will I experience on the day of the appointment of the procedure?

Accepted Answer

1. On the day of the appointment, please arrive at your designated time. You can feed your baby upto 30 minutes (or earlier) prior to your appointment, but please do not in the office. You can feed the baby immediately after the procedure.
2. Dr. Agarwal will come in and see you and the baby, the medical staff that assists with the procedures will take the baby into the treatment room and get the baby swaddled.
3. Dr. Agarwal will inject a small amount of numbing medicine (lidocaine) into the area being treated for release by laser. The laser is used  for ~10-20 seconds and then the same medical staff brings your baby right back to you.
4. Dr. Agarwal will come back to see you and answer any questions. He will show you how the tongue moves and let you know how the procedure went.
5. You will be encouraged to feed the baby immediately after the procedur

Question 12

Why does Agave Pediatrics have us come for a consult and then a procedure and subsequently a follow up?

Accepted Answer

Agave Pediatrics, under the direction of Dr Agarwal, is one of the leading specialists in the country in management of tongue and lip ties. We have developed a standard of practice that is now followed by other practitioners too. Tongue / lip tie releases are considered surgical procedures, and while the procedure itself is very quick, there still needs to be a full assessment of your baby or child prior to performing any surgical procedure. This standard of practice of having a consult done by one of our very knowledgeable practitioners to fully assess your child, assess their symptoms related to the tie is necessary to  fully assess the function of the tongue and lip, and to discuss the entire procedure and the after care. We want all of our parents to be completely informed of why or why not the procedure is indicated, risks and benefits, and take the time to answer any questions. You then have the ability to go home and make sure you are comfortable proceeding with a surgical procedure and your appointment is scheduled. You then come back for a follow up, just like you would any surgical procedure to make sure things have healed well, and to make sure symptoms have improved. While we know it can be a very stressful time having a baby who is struggling to breast feed, or feed in general, we want to make sure we are providing procedures safely and each baby or child is looked at from all angles, not just their tie.

Question 13

How is the lip tie release different than the tongue tie release?

Accepted Answer

The procedure itself is very much similar, and local anesthetic (lidocaine) is still used. Majority of babies do better after the lip release because it is a piece of skin that is opened versus muscle tissue. Also, the stretches are a bit easier since you are not opening their mouth, and not messing with muscles.

Question 14

Why is Dr. Agarwal hesitant about doing both the lip and tongue release together?

Accepted Answer

Many babies do have a tight lip tie that goes along with their tongue tie, although not all babies will need the upper lip released, so why have an added procedure done if it is not needed. Many of the symptoms that are causing the difficulty feeding can be eliminated by just performing the tongue release. So, allowing one procedure to be done and see how things improve before adding another to the recovery process. Also, some babies are sensitive and do sometimes have a difficult time relearning to eat after the tongue release, adding two painful areas can slightly increase the chances of oral aversion, reattachment, and longer difficulties breast feeding, so if we can avoid that by spacing things out, in most cases this has provided the best feeding success. Although every case is different, and Dr. Agarwal will weigh the risks for each patient and decide with the family the best approach.

Question 15

Post-Procedure Exercises

Accepted Answer

You will be shown the post-procedure exercises immediately after the procedure is done, and there are explanations of the exercises in the aftercare handout.(javascript:void(0)) There are also videos of the exercises (https://youtu.be/YwCOVeAXqE0)in the email you received regarding the procedure.
 
Stretches should begin 6-8 hours after the procedure, and should repeat every 4 hours (6 times a day) for the first two weeks. At your follow up appointment, you will be told how often to do the stretches for the next two weeks. This part of aftercare can feel overwhelming and challenging for parents, but they are incredibly important.
 
The goal of these exercises is to keep the healing tissue open and separate, in order to prevent reattachment, and to encourage the movement of the tongue. These exercises do not need to be forceful: they should be gentle but firm. You do not need to touch the wound during the exercises, as all the stretching is done by lifting around the wound, NOT directly on the wound. However, if you do touch the wound, it is fine, and does not increase the chances of infection.
 
Talk to your child, make funny sounds and faces. You can do the exercises randomly so your child doesn’t negatively anticipate them. They can be done before or after a feeding, nap, diaper change, etc.
 
Position your baby on a stable surface such as your lap or a changing table so that you can see into baby’s mouth. If helpful, place a rolled-up hand towel or receiving blanket behind their neck to help their head flex back, making it easier to see the inside of their mouth. You can do these exercises facing the baby, or from above the baby’s head, with their feet pointing away from you. Sometimes when the baby is crying and their
tongue is raised, a quick set of exercises can be done. Some babies will sleep through the stretches.

Question 16

What problems can a tongue tie cause?

Accepted Answer

Tongue tie can cause restriction of movement of the tongue which can cause various problems throughout a human’s lifespan. In infants it can cause problems with breastfeeding and/or bottle feeding because the tongue is restricted in its natural movement of sucking and transferring of milk from the breast or the bottle. With breastfeeding it can often cause nipple pain, latch problems, and poor weight gain amongst many other symptoms. Different problems may also occur later in life, such as speech problems, dental complications and breathing problems. For more information, please see the references section.(javascript:void(0))

Question 17

What are some considerations for releasing a child's tongue tie?

Accepted Answer

Thre are a number of signs and symptoms which can be relieved or significantly improved by clipping of the tongue tie (also called frenotomy or frenectomy). This is a safe and effective treatment for tongue ties and several studies h(javascript:void(0))ave shown that it usually helps improve breast feeding in babies. The procedure can also help with issues related to speech, breathing/sleeping, and/or dental complications.

Question 18

What does a tongue tie release procedure involve?

Accepted Answer

Frenectomy (also referred to as the "procedure" for tongue tie), is done at the bedside in our office and entails the following steps and possible risks.
 
For Infants: The infant is restrained in a papoose board and then given local anesthesia prior to the procedure to numb the site. The tongue tie tissue (frenum) under the tongue of the infant’s mouth is then cauterized using a laser. The procedure itself is very brief and the infant can go straight onto the breast afterwards (or bottle as the case may be). Many mothers feel less nipple pain and a better latch almost immediately. After the procedure, no special care (other than exercises) is needed, though most infants may feel pain for 1-3 days, which is resolved with Tylenol and/or Arnica (a homeopathic treatment).
For older children: The child is restrained in a papoose board or made to lie on a table (depending on their age) and given a local anesthesia prior to the procedure to numb the site. The tongue tie tissue (frenum) under the tongue is, then, cauterized using a laser. The procedure itself is very brief and the child is taken straight back to the parents. After the procedure, no special care (other than exercises) is needed, though most children may feel pain for 1-3 days, which is resolved with Ibuprofen (Motrin or Advil) for children older than 6 months of age, Acetaminophen (Tylenol) and/or Arnica (a homeopathic treatment).
Risks: Although it is a minor procedure, as with any surgical intervention, it does have some risks, including but not limited to, infection, bleeding, pain, allergic reactions, temporary numbness, injury to the mouth, or reattachment.

Question 19

Up to what age do you do tongue and lip tie releases?

Accepted Answer

Here at Agave, we release tongue and lip ties up to age 18.

Question 20

Can you recommend books about tongue tie? How can I further research them?

Accepted Answer

We have collected some articles in the references section.(javascript:void(0)) There are many informative articles, abstracts, and reviews in scientific literature about tongue ties. To find more material such as this, try searching Google Scholar (or other academic search engines) for keywords such as “lingual frenectomy”, “ankyloglossia”, or “tight lingual frenulum”.
A book that we recommend is “Tongue Tied,” by Richard Baxter, DMD. Dr. Agarwal has written the foreword for this book.
Many families, rather than reading scientific articles or authoritative texts like the book above, gather information on tongue ties from Facebook support groups and friends. There is value discussing issues like tongue ties in these “mommy communities”. However, such conversations lack the scientific rigor associated with clinical investigation and experience. In fact, many of these Facebook groups are hijacked by a few very vocal responders who advertise their biased viewpoints as the truth. These opinions are often not clinically sound. We strongly recommend that you seek the opinion of professionals who are well-versed and have experience in the diagnosis and management of issues related to tongue ties.

Question 21

How should I prepare for recovery after the procedure?

Accepted Answer

Initially, your child’s mouth will be numb at the site of the procedure. This will last for approximately 2- 4 hours. Please prepare to ease your child’s discomfort by having pain medication on hand. Stay ahead of pain for the first day, using Tylenol and/or Arnica (and Ibuprofen for children older than 6 months of age) as needed.
We recommend having at least 2 of the 3 medications on hand so that you are already prepared on procedure day!
If you have traveled a distance of a couple of hours, please consider bringing Tylenol or Ibuprofen (depending on what is appropriate for your child) so that you can give a first dose before traveling home.
You can time the medications so they will be at peak effect for the therapy sessions. Also make sure to not skip the stretches after the procedure has been done, as these are essential to prevent reattachment of the tie(s).

Question 22

When can I do the post procedure exercises?

Accepted Answer

You may start these exercises 6-8 hours after the revision, unless given different instructions by Dr. Agarwal. If there is any bleeding after the procedure, Dr. Agarwal may have to use silver nitrate locally to control it and you will be instructed to not do exercises for at least the next 24 hours.

Question 23

Can I breastfeed or give my child a pacifier after the procedure?

Accepted Answer

Of course! You may feed your baby directly after the procedure and give them a pacifier if needed. If you are bottle feeding, have your bottle ready post-procedure. After the procedure, our staff IBCLC will guide you to a lactation room. Our Staff IBCLC can also demonstrate the exercises if needed. Pain management and wound care will be reviewed with you, as well. You will be encouraged to feed while onsite so that baby is as comfortable as possible for the trip home. 
Older children can be given their regular diets after the procedure. Cold foods and beverages, ice creams and popsicles are particularly comforting to children as they temporarily numb the area.

Question 24

What is a tongue tie?

Accepted Answer

Tongue tie (TT) is a small band of mucous membrane (a frenulum) and/or a fibrous tissue that connects the middle part of the tongue to the bottom part of the mouth. Some children are born with fusion (either partially or completely) of the tongue to the bottom of the mouth. People often refer to this abnormality as being "tongue tied." The technical name for tongue tie is ankyloglossia.

Question 25

How long before the white patch of skin under the tongue/lip stops looking so prominent? What is the white stuff?

Accepted Answer

Right after the procedure, the wound is going to look slightly reddish and may have a very small amount of bleeding which can be seen as pink saliva. Very often, you cannot even see the wound because there is no bleeding and the red color associated with the procedure is minimal. However, starting the next day or so, you will start seeing the wound covered with a whitish or yellowish membrane. If your child is significantly jaundiced, this film may appear almost look fluorescent yellow or even sometimes slightly greenish. This is the healing tissue of the body which you would see covering any kind of oral ulcer. This area usually looks like a diamond and serves as a good landmark for where to stretch the wound.
Sometimes during the stretching exercises, there may be minimal bleeding, but other than this, bleeding almost never seen. You don't need to go over the wound to remove the white tissue. If you happen to go over it, either by accident or during exercises, the whitish film may slough off and you will see a clean looking wound below it with a whitish base. Do not panic - this is normal.
Over the next 4-5 days, the white diamond tissue will start getting smaller. If it starts looking like a straight horizontal line you will know there is some reattachment happening, You should do more stretching to keep the diamond shape.
By about the 7th or 8th day, the film usually sloughs off and you will start seeing light, pink area below the tongue. What we want to see is a diamond shape, though lesser in size. You still need to do exercises after the wound is not seen and takes the color of the normal mucosa. This can happen anywhere between 10 days to 3 weeks.

Question 26

Is my child's personality going to be affected by the procedure? Are they going to be miserable during the healing process?

Accepted Answer

In the first 3-4 days after the procedure the baby may show signs of pain and discomfort. We suggest aggressive pain management with appropriate medications and other modalities including skin to skin contact, soothing activities like baths, breast feeding, singing and cooing, gentle touch, and light swaddling. This seems to work very well for the majority of the babies.
Many families do not want to use any medications for pain and that is an option. However, we suggest that if the child seems to be in pain, medication should be administered so that we minimize the chances of breast aversion or later feeding difficulties. Pain associated with the procedure is a normal phenomenon and does not mean that there is a complication or infection. Once the pain associated with the procedure subsides, babies usually get much happier as they are able to feed better.
Every child is different and some do not need any medications, while some need around the clock medications for the first 3-4 days. There is no way to see beforehand which category the baby will fall into. Pain after the 5th day is unusual. If they seem to be in significant discomfort after the 5th day we suggest you call the frenectomy provider and get the child evaluated.
We have often seen that when parents change feeding patterns from exclusive bottlefeeding to exclusive breastfeeding, if the babies do not adapt well, the frustration the baby expresses may be perceived as pain. 
The baby will continue to have some discomfort with the exercises for the remaining 6 weeks, but should not be in frank pain and shouldn’t need any medications unless the wound has been reopened for any reason.
It is very important that parents be emotionally ready to handle the baby’s pain as we have often seen that parents react negatively to the perceived pain in the baby and in turn, will stop doing exercises. This results in increased chances of reattachment. It is extremely important that parents are aware of and comfortable with the pain management strategies after the procedure.
It is very interesting that in a large percentage of cases babies who were perceived as fussy and clicky pre-procedure over the long run become very happy and amiable afterwards. This is a frequently noted observation in our practice.

Question 27

My child had the procedure a few days ago, but has started becoming more fussy today and resisting the exercises. Is this normal?"

Accepted Answer

Yes, this can still happen because the nerve endings are still irritated. For most children, the first 24- 48 hours are the hardest, however after day 3, the discomfort usually begins to subside as the inflammation starts decreasing.
Staying on top of pain management is very important. Call if you are still having to use Acetaminophen or Ibuprofen 4 times/day, past 3 days, as we may need to change the after-care instructions.
After the first 3 days, we still suggest giving medication for the pain, (Tylenol, Arnica, Ibuprofen), but only as needed.

Question 28

My pediatrician/family does not know about tongue/lip ties. What can I do to help other parents and babies avoid going through what I had to go through?

Accepted Answer

Advocacy is a very important part of our tongue tie program. The connection between a mother and the maternal community is extremely strong and invaluable. We suggest that you reach out to other mothers through social media mom groups, friends, and family and share your experience. This does not mean judging your pediatrician (as they have not been trained for handling tongue ties). Sharing the information is vital, in this day and age you can become an agent of change and help many other mothers to breast feed or help children to improve their speech. You can also talk to your pediatrician and share your story with them.
We have been very fortunate already from moms sharing their stories with the community. In the past years, some of the fiercest critics of Agave have become some of our strongest supporters. We often ask mothers for testimonials, attendance to summits/lectures because they are able to share their personal experience with the audience. If you would like to help out with this, please reach out and let us know. It can be very important for other providers and mothers to hear your story.

Question 29

Should we use coconut oil after the procedure?

Accepted Answer

After a tongue and/or lip tie revision, we do not recommend using coconut oil because this may cause faster healing of the tissue and the tongue tie might re-attach. In addition, the application of coconut oil requires you to go onto the wound, but we want you to go AROUND the wound when dealing with the tongue tie site.
In the past we were suggesting the use of coconut oil on the wound and one of our older videos on exercises still has it there, but since we have not found this practice to be useful and do not suggest that anymore.