Frenulum Stretches

After a Frenectomy procedure, it is important to perform the following stretches in order to prevent the tissue from reattaching. Post-procedure stretches are key to obtaining optimal results.


Aftercare Stretches (Infant):

Dr. Robles’ recommendation is that these stretches be done 6x/day for the first 3 weeks, and then spend the 4th week quickly tapering (i.e. 6 to 5 to 4 to 3 to 2 to 1x/day).

The Upper Lip: is the easier of the 2 sites to stretch. For the upper lip, simply place your finger under the lip and move it up as high as it will go (until it bumps into resistance). Then gently sweep from side to side for 1-2 seconds. Remember, the main goal of this procedure is to insert your finger between the raw, opposing surfaces of the lip and the gum so they can’t stick together.

The Tongue: Insert both index fingers into the mouth (insert one in the mouth and go towards the cheek to stretch out the mouth, making room for your other index finger). Then use both index fingers to dive under the tongue and pick it up, towards the roof of baby’s mouth. The tongue needs three separate stretching motions:

  1. Once you are under the tongue, try to pick the tongue up as high as it will go (towards the roof of the baby’s mouth). Hold it there for 1-2 seconds and then relax. The goal is to completely unfold the diamond so that it’s almost flat in orientation (remember, the fold of the diamond across the middle is the first place it will reattach). The key to the success of this stretch is that your fingers are placed deep enough prior to lifting the tongue up. Picture how a forklift works: If you don’t get the forklift tynes completely under the pallet, lifting the pallet up will cause it to tip backwards. If you get the tynes completely under the pallet, you can lift the pallet straight up. Push your index fingers together to prevent them from separating, push towards the diamond and then make sure the tongue goes up and not backwards. If your fingers separate and go on either side of the diamond, your lifting pressure will be directed at the sides of the tongue and not at the diamond itself.
  2. With one finger propping up the tongue, place your other finger in the middle of the diamond and turn your finger sideways and use a lifting motion from front to back to try and keep the diamond as deep as possible. Use a lifting motion when you sweep through the diamond, trying to separate the horizontal fold across that diamond. Make sure your finger starts within the diamond when doing this stretch.
  3. Massage on either side of the diamond (outside the diamond) to loosen up the musculature of the remainder of the floor of mouth. You can use more pressure when doing these stretches because you aren’t in the wound at this point.

Sucking Exercises:

It’s important to remember that you need to show your child that not everything that you are going to do to the mouth is associated with pain. Additionally, babies can have disorganized or weak sucking patterns that can benefit from exercises. The following exercises are simple and can be done to improve suck quality. Start these on the 3rd day following the procedure, and spend 30-45 seconds on each exercise prior to the wound stretches.

  1. Slowly rub the lower gumline from side to side and your baby’s tongue will follow your finger. This will help strengthen the lateral movements of the tongue.
  2. Let your child suck on your finger and do a tug-of-war, slowly trying to pull your finger out while they try to suck it back in. This strengthens the tongue itself. This can also be done with a pacifier.
  3. Let your child suck your finger and apply gentle pressure to the palate, and then roll your finger over and gently press down on the tongue and stroke the middle of the tongue. Alternatively, once the baby starts to suck on your finger, just press down with the back of your nail into the tongue. This usually interrupts the sucking motion while the baby pushes back against you.
  4. With one index finger inside the baby’s cheek, use your thumb outside the cheek to massage the cheeks on either side to help lessen the tension.

It is essential that you follow-up with your lactation consultant after the procedure to ensure optimal results.

Call our office for any of the following:

  • Questions regarding the stretches
  • Signs of healing
  • Uncontrolled bleeding
  • Refusal to nurse or take a bottle
  • Fever > 101.5

 

*** This page was adapted from Dr. Gaheri’s Aftercare website: http://www.drghaheri.com/aftercare/***