This is a great question that parents and providers ask us frequently. If a tongue-tie release was correctly done (a complete release) with a diamond-shaped wound, then stretches or wound care is needed to prevent it from sticking back together (reattachment). Many tongue-tie clips or snips are not performed correctly, and the tongue is still restricted and does not have full mobility. This may help some patients (maybe less nipple pain). Still, many patients need full mobility to see improvement in most symptoms – colic, reflux, gas, efficient feeding (not falling asleep), sleep quality, etc. However, even with a proper release, many patients have a hard time doing wound care exercises, or they are done with insufficient pressure or duration.

Proper wound management involves separating the tissue so it does not re-adhere. With a gloved finger, lift the lip or tongue to the most elevated position, ensuring the wound is fully extended, and hold it in that position for 5 (real) seconds. For infants under 12 months, we recommend 3 times a day, and for children over 12 months, 2 times a day. For all patients, we recommend 4 weeks of stretches. We have a video demonstrating a proper stretching technique that is easy and effective. Stretching more often does not seem to lower reattachment risk and can lead to more struggles for both the patient and parent.

Assuming that the procedure was done properly, and the stretches were done correctly and with sufficient pressure (firm but controlled), then to determine if a revision (a second procedure) is needed, we will assess the wound healing. If there is a horizontal “T” shape with a line across the wound, it has stuck back together (see below). If it’s really thick and the tongue cannot elevate fully, it’s reattached. Our first attempt is always to try a good stretch at the provider’s office. We call it a “deeper stretch,” but it’s really just a normal stretch: firm and slow, and holding the tongue elevated for at least 5-10 seconds. If it has been less than a couple of months, often the tongue will just open back up (minor bleeding will occur). The lip can only be stretched out for maybe two or, at the most, three weeks by this method. If the deeper stretch does not open easily, or it would require even more pressure to re-open, then we will consider a revision or lasing it again.

We do not jump to lasing at first to minimize trauma to the tissue and not to have to do a second procedure on the baby or child. But if symptoms improved after the first release (feeding, speech, sleep, etc. improved) but then worsened, that’s a sign that it has likely stuck back together. If a patient comes back, and symptoms are all improved, but there is just a string there, and the tongue has decent mobility, then a revision is NOT needed. If we do decide to laser it and do another procedure, or even with a deeper stretch, we need to do something different to ensure it does not reattach again. The definition of insanity is doing the same thing and expecting a different result!

So after the second procedure, we will recommend more pressure, more time (make sure it’s a full 5 seconds of stretching each time), and stretching for the entire 4 weeks. We will have them come back for two follow-ups in person instead of one in person or just a virtual follow-up. This is why we prefer an in-person follow-up to a virtual email follow-up because when we feel the tissue, we can ensure it is not reattaching at one week post-op, and it will open back up if it was already reattached.

Catching reattachment early ensures we don’t have to extend our stretching any more than usual. When it’s been a month already, and parents return because symptoms worsen, and we do a deeper stretch, now they have three more weeks, so there are seven total. That could increase our risk of a temporary oral aversion, and at the very least, it places significant additional stress on parents and the child.

So to summarize: do a good release, high-quality stretches, an in-person follow-up, and contact your provider if symptoms worsen. We hope and pray for a resolution for 100% of our patients, and we want the babies and children to have lasting results. When the procedure and protocol are done properly, we have a very high success rate. If you’re concerned about your child’s procedure reattaching or are unsure if you need another release, please call us at 205-419-4333 or message us. We would love to serve your family and help your child thrive.