ORAL AVERSION AFTER TONGUE-TIE REVISION
September 12, 2019~Dr. Lee
A baby’s mouth is the center of their little universe (Mom is too, of course!). For newborns, much of their daily activities and stimulation comes from feeding and the mouth. So, it is understandable that when something pleasant, like breastfeeding, is happening, there is a positive association and learning taking place. On the other hand, painful or upsetting stimulation will create a negative association. Most newborn learning and development comes from association in those early days. With the uptick in tongue-tie revision surgeries, we are now seeing more oral aversion afterward. An oral aversion is when a baby refuses, cries, and shows discomfort with mouth stimulation, like feeding, stretches, pacifiers, etc. Adults have reported pain and discomfort for up to 14 days after laser revision, so we can assume that some babies are experiencing the same, and do not understand what has happened to the center of their universe. We also know that adults feel pain differently from one person to another, so every baby’s experience will be different from another. Oral aversion can come from many things after revision: too deep of cut (yes, that diamond we all look for may be cutting into the muscle), pain during and after, emotional distress, scrubbing the wounds after, de-stabilization of the tongue, or maybe an unnecessary revision to begin with. So… what do you do?
1. Have a provider who has been trained to functionally assess the tongue. Classifying the appearance of the tongue frenulum by lifting the tongue is not an accurate way to diagnose. Nor is it acceptable to diagnose based on symptoms.
2. Before surgery always, always, always, in the case of a suggested “posterior tie “see a qualified bodyworker like a CST, OT, Chiropractor, infant massage therapist FIRST. If you see a chiro or OT make sure they do soft tissue/fascia work. The reason this is so important is because recent studies are finding that the frenulum (which everyone has) is actually a fascial fold, and restrictions in the area can decreases its movement and functionality, spinal manipulation usually will not address this problem completely alone. Then follow up with that provider shortly after to help calm things down.
3. Don’t cut the lip too, just in case, or because it is a little tight, or because the provider says its best just to do them both at one time because 95% of tongue-ties have a lip tie. This is misinformation. The lip frenulum is entirely different then the tongue, it is more vascular and innervated. It also migrates and stretches over time. This is just an additional source of pain and discomfort.
4. Do NOT scrub the wound, this is most likely causing more pain, slowing down healing and creating more scar tissue. This brushing or scrubbing interferes with phase 2 healing and will actually generate thicker, denser scar tissue, therefore, decreasing mobility. Breastfeeding is the best way to lift and stretch the tongue and nicely line up those fibroblasts. Continually putting fingers in the mouth, creating painful stimuli is laying down negative associations in their brains.
5. Ask your family medical provider for recommendations on pain relief for your little one.
6. Your baby may need some suck training along with bodywork to relax the overused, tight muscles, and get the correct muscle groups back in action.
7. Remember that though it may seem like a small procedure to an adult, it is still a surgery and to your baby is probably a big deal. If your intuition is telling you not to do it, don’t do it, and seek out other options and opinions first.