If the baby has a posterior tongue tie suck training prior to the release is crucial. If it is an anterior tie, therapy before may not be helpful. Post frenectomy, some form of suck training is important. Some providers suggest myofascial work prior to a tie release. This truly depends on the age of the patient and the type of tie. After the release, the tongue is weak, and the baby is trying to relearn how to suck, which is where the art of suck training comes into play. If the parent is uncomfortable using a pacifier, a clean finger can be used.
What is Suck Training and why might I need to do it?
Prior to latching:
Hold your baby in your lap in a sitting position, supporting the head in the palm of your hand. With clean hands, or using a glove, insert your free index finger, palm side up, into your baby’s mouth, resting comfortably in the soft curved palate on the top part of the mouth. Be careful not to insert your finger too far into the baby’s mouth, as this can cause him to gag. Simply go as far as the first knuckle joint. The tip of your finger should be touching the palate, which feels “squishy” on the roof of the mouth. If you find that the palate is high and arched, that is a good indication that there is a posterior tongue tie.
Gently stroke the roof of your baby’s mouth to encourage the infant to begin sucking. Once you feel your baby sucking on your finger, extend your finger straight.
Your baby should be wrapping the sides of his/her tongue around your finger. With your finger straight (applying gentle pressure onto the back of the tongue), pull down on the baby’s lower lip. The baby’s tongue should be on the floor of his mouth with the sides of his tongue curled against your finger. After you have checked the position of the tongue, make sure that the lips are rolled out around the finger as well. If the baby’s lips appear to be tucked in, do your best to flange them out. After a lip tie revision, they should flange out like a fish. If they are not able to because a restriction is still there, then I would follow up with the doctor who performed the frenectomy.
Allow the baby to suck on your finger for one to two minutes while pulling down on the chin to help the tongue extend out further. Gently push down and forward with your finger while the baby is sucking.
Once you feel that the baby’s tongue has relaxed into a down and forward position and has a good sucking rhythm, your baby should be ready to latch onto the breast. Be sure to have good pillow support. Bring the baby to your breast and lean back when latching.