Tongue & Lip Ties Consult Process

Consult Process

Consults can be scheduled at your convenience and are available in each of our 5 locations.
(Procedures are, however, done only at the Glendale and Chandler locations.)
● Consults are done in a holistic manner and include a symptomatic and anatomical diagnosis of tongue/lip tie by one of our certified pediatric nurse practitioners or Dr. Agarwal.
● Your baby will be thoroughly examined with additional attention to the structure and function of the baby’s oral cavity including the characteristics of the tongue and lip; attachment of the frenulae; muscular tightness; a midline assessment of the baby’s spine and diaper area.
● Family history of tongue-tie will be noted.
● Feeding history and difficulties will be thoroughly reviewed.
● Breastfeeding difficulties will be noted including information from your IBCLC. ​ To arrange for a consult, please contact us.



Treatment Options

Various treatment options exist for tongue and / or lip ties. These may include the laser guided 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 have shown that a tongue tie corrective procedure (frenectomy) is safe and effective; and it usually helps improve breastfeeding, speech or other difficulties. ​ Tie Corrective Procedures at Agave: 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, often 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 post tongue-tie 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.



Pre-Procedure Exercises

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) and/or Speech Language Pathologist (SLP), because they can assess your baby’s suck and show you exercises specific to your 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. ​ Pre-Procedure: Playful Exercises​
● Start when your baby is in a quiet alert state or early active alert state.
●Talk in a pleasant voice, smile, sing, laugh, and make eye contact with your baby so this is playful and reassuring for them. ●Stroke the baby’s upper lip to encourage them to open their mouth. It is a respectful way of “asking permission” to do the exercises.
● Try to do the exercises 3-5 times a day before a procedure.
●Be sure to start with clean, well-rinsed hands!
● If your baby fails to respond or looks away, baby is telling you he or she wants to be done and this should be respected. If your baby becomes distressed or upset, please respect their cues and stop the exercises.
●Make sure to provide comfort and console them. ​ Facial Massage This can help decrease sensitivity or defensiveness and can also help increase awareness of the face muscles. ● Cheek massage: Place your thumb inside the lower corner of the mouth with the thumb pad in contact with the inner cheek. Place the pad of the index finger on the outer cheek. Gently follow a “c-shaped” movement pattern to stretch this area. If you feel resistance, pause for a few secs and you may feel the tension release. If your baby resists having one finger inside their mouth, you can start with drawing a “c-shaped” line from their nostril to lower jaw bone (chin). You can also draw lines from their nostril towards their ear – similar to drawing whiskers. Use slow and long movements with firm pressure. Fast movement with very light touch can sometimes create more aversion.
● Upper lip stretches: Place pad of index finger along philtrum 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. Fast movement with very light touch can sometimes create more aversion.
●Follow the Finger (Functional Lateralization 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 or 4 times. As you do this, use your thumb to support your hand and the baby’s jaw to increase stability. ​ Desensitizing the Palate:
● Some babies with a high or bubble palate resist a deep latch because they have a hyper-sensitive gag reflex that is provoked much closer to the front of the palate than usual gag reflexes. Systematically desensitizing can be helpful.
● After stroking baby’s upper lip and they open their mouth, the index finger is gently slid back along the hard palate (roof of the mouth). Start by massaging the child’s palate near the gum line (immediately behind where their teeth would erupt). Progressively massage deeper but avoid gagging the baby. Repeat the exercise until baby will allow a finger to touch the palate while sucking on a finger. It may take several days of short exercise sessions to be effective. ​ Tug-o-War (Strengthening Exercise)
● Touch baby’s philtrum or upper lip to encourage them to open wide. When baby does, slide your index finger in their mouth, pad up, gently stroke palate, then flip over and apply gentle pressure while stroking from the back of the tongue to the front of the tongue. While your baby sucks and you press down on their tongue slightly, gently play tug-o-war, pulling your finger out slightly. Baby’s response should be to suck harder on your finger and pull it back in. This can be especially helpful just before child feeds since it helps baby learn proper tongue movement for breastfeeding.
● You can also do this with a narrow, cylindrical shaped pacifier like the Soothie brand. Cylindrical shaped pacifiers help the tongue. Gently pull it back out – just until you feel resistance as the baby sucks harder, trying to hold on. You may need to support their jaw a little as they learn to use their tongue more effectively.



Tongue Tie Kids is a wholly owned subsidiary of Agave Pediatrics

© 2020 by Agave Pediatrics 

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