Dear Claudia,

Suggested these exercises to a mom who has an older tongue-tied baby who may or may not get clipped in the near future.  I believe they originally come from our very astute colleague Cathy Genna.  Moms in this situation need a lot of patience to keep working to achieve optimal latch at each feed which will facilitate better use of the tongue and jaw.  I think that these exercises, used regularly throughout the day can help as well.  Do not dismiss the possiblity that there may also be more than tongue tie which is causing problems for this dyad.  Try to do a completely unbiased evaluation of the pair the next time you see them to check if there might be something you are missing.  That said, it is not unusual for babies who are clipped "late" to hang on to poor latch/suck patterns for some time.  Good luck.  This mom will need a lot of support during the next couple of weeks.

Post-tongue-tie exercises
      "Stroking the tongue down and out" to stimulate tongue extension (tickle lips to induce baby to open mouth, slide finger in along palate with finger pad on palate, let baby suck a moment, turn finger pad down onto tongue, press down and slide your finger along the central groove
of the tongue as you remove the finger).
    "Walking back on the tongue" which gives vibratory stimulation (a fingertip placed on the tongue is wiggled imperceptibly but rapidly - small amplitude, high frequency movement) beginning on the center of the tongue-tip and moving back gradually to just before the point where the baby's gag reflex is triggered (usually anterior 1/3 to 1/2 of the tongue is "safe" in a young baby.  This one seems to increase baby's awareness of the tongue and it's position in space, along with slightly increasing the tone of the anterior tongue, which can remain pretty flacid when it is restricted by a tight frenulum.


Warmly,
Sharon Knorr, BSMT, ASCP, IBCLC
Newark, NY (near Rochester on Lake Ontario)
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