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James G. Murphy, MD, FAAP, FABM, IBCLC
Grace Magill, IBCLC

Todays procedure: Tongue-tie release creates a pink, diamond-shaped wound in the
floor of the mouth. Lip-tie release creates a pink, diamond-shaped wound inside the
lip. As they heal, a white or yellow covering may form over the areas and is not a sign
of infection. This covering may move or come off during wound care and will not
affect the final result. Mild blood oozing may also occur during wound care for the
first few days. Wound care should be done at least 6 times a day for about 2-3
weeks for the best outcome and is best performed when your baby is content and
less apt to notice what you are up to. This may be between breasts, or after a
feeding, when baby is milk drunk. If your baby does awaken and wont settle after
wound care, put baby back to breast or Skin-to-Skin for soothing and calming. No
need to wake baby to do the wound care.

Tongue-tie wound care: Lay baby in your lap with feet towards you. If she is awake, try distracting her
first by talking, singing, music or toys. Gently pull babys chin down with one hand and slip a gauze-
wrapped index finger (or tongue depressor) under babys tongue, gently pushing the mouth floor down
and backward until you see the wound open into a diamond. Hold the diamond open for 3 seconds, then
release. If you see horizontal lines forming in either of the two horizontal corners of
the diamond wound you can roll your finger back and forth over the corners to
break up the wound realignment tissue. All three together should take no more than
about 6 seconds. Applying coconut oil to the areas afterwards helps to suppress
inflammation. A cotton swab can be used to get the coconut oil in the wound area
easier. Essential Oils such as Frankincense and Chamomile for discomfort and
Helichrysum oil for bleeding and oozing are another option. These can be mixed with the coconut oil.

Lip-tie wound care: Use one hand to fold the upper lip back onto itself so that you can easily see the
wound. Place the index finger of the other hand horizontally over the wound and gently push in and roll
the finger like a rolling pin back and forth to break any tiny fibrous bands that have formed. If you feel
any bump on either side of the wound, push on the bump with your finger or the end of a tongue
depressor to break this tiny attachment and restore a smooth sweep under the lip. This should be done
until the wound surface is all pink again. Coconut oil can help reduce inflammation under the lip as well.

What to expect the first few days: Most babies will experience some discomfort while extending their
tongue during nursing and may complain before settling down. This typically peaks the night after the
procedure, then slowly improves over the next 28 hrs. Most infants are nursing very well by 48 hr after
the surgical release. Tylenol and/or Homeopathic Tongue Tie Remedy can help reduce discomfort.
Tongue Tie Remedy often works just as well as Tylenol and can be purchased from our business partner,
Ocean Wellness.
Some babies may tense the muscles of the head and neck area as a way of dealing with the
discomfort of the wound care, causing soreness of these surrounding muscles. Try a gentle massage of
the muscles around the jaw, the neck, and in the soft area under the chin to help baby relax, especially
before doing wound care.

Two steps forward, one step back: A baby who has had difficulty feeding at the breast before today may
become confused or frustrated by the sudden changes in his anatomy. From babys point of view, the
tongue is now free and moves rapidly and farther than ever before with almost no effort. The game has
changed and he must learn new rules! Lots of patient nursing time, especially skin-to-skin, can help
baby relax and re-learn how to use his new tongue effectively. Some babies may benefit from suck
exercises to help correct the suck pattern. If babys progress stalls, there may be other areas of
tightness in muscles or fascia which connects the various areas of the body that are best assessed and
treated by practitioners skilled in the specialty of Cranialsacral Therapy.
Dr Bridget Chelf of Ocean Wellness 858-792-7296 can provide this very specialized service to your

Breastfeeding is important therapy. Breastfeeding requires lots of breast tissue in the mouth and this
positions the wounds for optimal healing. The more baby extends the tongue during nursing, the more
the diamond will be pulled in the desired direction of healing and provide the most improvement in final
tongue extension. A nipple shield does not do this as well as the breast, and a bottle, pacifier or finger
does nothing to help the tongue extend further and therefore are discouraged during the healing

Follow through on follow-up! It is very important that baby be well latched within 48 hours of the
procedure. We will see you 2-3 days after the procedure, but you are encouraged to see your Lactation
Consultant (LC) the day after the surgical release. If you do not have a family LC, our practice now
offers private lactation consults with Grace Magill, IBCLC. Contact our office at 760-533-7953 to make an
appointment. You can also go to the San Diego Breastfeeding Coalition web site
www.breastfeeding.org for a list of IBCLC in San Diego. WIC participants should contact their local WIC
agency for lactation support. Military patients may call 619-532-6914 to speak to an NMCSD lactation
consultant. Our advice is intended to support you during the healing of the surgical wounds created to
correct your infants abnormal oral anatomy and function. Our advice is not intended to and should not
replace the advice you receive from your family Lactation Consultant. If you feel there is a conflict in
advice, follow your LCs advice and please let us know what we told you that created the conflict.

We also provide a Tongue Tie Support Group in our office the first Tuesday of every month from 10-
After Office Hours - if you have further concerns about your babys wound care, you may call our office
phone at 760-533-7953.

Dr. Larry Kotlow video about wound care post clipping

Mellisa Cole:
Explanation for playfulness prior to stretches, needs to be firmer and more often than explained in video

This is for small babies, but still not firm enough opening of the wound. But did like the play and
interaction during wound care

Suck exercises http://vimeo.com/55658345

Explanation of Tongue Tie and Lip Tie