Tongue-tie changes the mechanics of breastfeeding. The infant tongue does not function as intended so there are compensations in the movement of the head, neck and mouth in an effort to extract milk. The baby is not usually effective so they spend a lot of time trying to feed. This can be a strain on the areas compensating for failure of the tongue to properly extract the milk. Assessment is optimal before a clip as the infant may feel stressed when the next stranger attempts to go into the oral cavity. That said, it is best to get instructions in home care sooner than later.
After a complete history, the baby will be examined and assessed focusing on the biomechanical functioning of the neck, jaw and related structures. Treatment if necessary is safe and gentle during which you will be shown and given instructions for home care. Start home care the day after your visit.
Besides a tongue-tie, some babies present with torticollis or plagiocephaly which can affect the baby finding a relaxed position to feed, they may actually be in pain which can result in struggling while feeding.
Home care starts with using your finger (with a fingercot) in the mouth placing it between the upper and lower jaw on one side. Let the baby chew on it to encourage normal movement of the jaw. Do this on both sides. You can slide your finger up, placing the side of your finger along the space where the cheek meets the upper gums. You can assess tension from the back of the gums to the front. If you feel areas of restriction, hold gently for a short time, you may feel the area soften. You can now slide the side of your finger down between the inside of the lower jaw and the tongue. Feel along the length on the tongue from front to back for areas of restriction and hold. If it has been recently clipped, do not push on the open sore. If the tongue band has been adequately clipped, it can not grow back. It is not uncommon though that web of tissue under the tongue has been cut and not the band itself, which may require a second intervention. Massage the tongue and under the chin where you access the tongue as well.
After the clip, the infant may not be able to properly use the tongue as it has been latched down. Vibration which acts to stimulate proprioception can be used to turn on the inborn reflex of sucking. If the infant is still young, you can stimulate the lower jaw, and gently stroke the lips to help with this reflex. A pacifier can help the infant to train to suck as well.