Dealing with tongue tie is f*cking hard. 

Not only do you see your baby struggle with feeding, but the feelings of grief at the loss of the breastfeeding relationship you dreamed of may be overwhelming.

Finding answers can be near impossible, not to mention how much energy, time & money you put into fixing your baby's feeding issues. 

Many parents go into the release feeling like the surgery is both their last hope of fixing things and the key to their breastfeeding future. No parent plans for or expects their baby's tongue tie release worsening their symptoms. 

This post will cover why some symptoms may worsen after the release & if it's a problem & what your next best step may be. 

Why do tongue tie symptoms worsen for some babies after surgery?

The impact ties have on oral function is complex. Similarly, the impact that body tension, oral tone, and reflexes have on feeding can't be overlooked. An increase in symptoms after tongue tie release is often due to the interplay between all of the required movement & skills needed for feeding.

Sometimes babies have worsening symptoms because they have a new, increased range of motion but still lack strength or coordination of the tongue. 

Other times babies' symptoms worsen after tongue tie surgery because the changes in the mouth can make babies compensate in new ways.

For some, worsening symptoms are due to pain, discomfort, or muscle fatigue in the days following the procedure. 

An increase in symptoms after a release is not uncommon and is typically temporary. An increase in any symptom is not particularly concerning, nor is noticing new ones that your baby didn't struggle with before.

One major caveat to that: If your baby is coughing or choking with feeds, it's important that you schedule with an IBCLC ASAP to get tailored feeding strategies that make feeding safe for your baby. 

Does an increase in symptoms after tongue tie release mean that the procedure was unsuccessful?

An increase in symptoms, while alarming, does not mean that the release was unsuccessful or done incorrectly. In fact, an increase in certain symptoms, such as clicking, occurs as a direct result of the new range of motion from the release.

Similarly, a lack of improvement in symptoms in the days following the release does not mean that the procedure was unsuccessful. Most babies with tongue ties require oral rehabilitation after the procedure to see improvements.

In the weeks after the release, it often feels like 1 step forward and three steps back. You may find that good days gradually become more common and occur more frequently as your baby gains strength & coordination. 

Does an increase in symptoms after tongue tie release mean that there was reattachment?

If your baby's symptoms improve but return, it may be due to reattachment. There are many factors to consider, including your baby's age, how long after the procedure the symptoms return, and if your baby has any other issues contributing to your baby's feeding issues.

 It can sometimes take some detective work to determine if it's due to reattachment, another cause, or both. 

Tongue Tie Symptoms That May Worsen After Release 

Feeding Frequency: Baby eats more often

Your baby may breastfeed more frequently after a release & are many potential reasons for this post-release cluster feeding. 

• Sucking releases feel-good hormones, and your baby may request the breast more often to help with the post-op pain or discomfort. 

• Your baby's tongue and mouth muscles may become tired from working in new ways, leading to shorter but more frequent feeds. It's not uncommon to feel tongue or jaw jitters toward the middle or end of the feed before your baby begins to fall asleep or unlatch. 

• Your baby may be eating more often because they can feed more comfortably. I see this often for babies that have struggled with weight gain before the release. 

More frequent feeds are typically not an issue but may be frustrating if nursing is still painful or if you're already touched out. As you work with your baby with the oral strengthing exercises, feeding may spread out and become longer.

Frequent feedings may be alarming since short, constant feeds are often a red flag for feeding challenges. For any babies who are feeding 10+ times a day, feed for shorter than 10 minutes or longer than 40 minutes, or/or doesn't have a long stretch of 3-4 hours between feeds, it's important to monitor intake closely by monitoring rate of weight gain & diaper output. 

If your baby is gaining appropriately & stooling daily, more frequent feedings are a nonissue, even if your baby eats more often after the release. 

Leaking: Baby is messier during feeds

The causes of leaking during breast or bottle feeding after a tongue tie release are generally the same as before. Leaking typically occurs because milk flows out over the sides of the tongue because the tongue and lips don't create a good enough seal. 

Before the release, the poor seal may be due to the tongue being anchored to the floor of the mouth, whereas after, the poor seal may be due to weak oral muscles or fatigue. Fatigue is more likely if the leaking starts midway through the feed or toward the end. 

Leaking may also worsen if your baby has trouble with fluid management post-release. Your baby has to learn how to use their tongue in new ways while still protecting their airway during feeds. One strategy your baby may use is pushing the milk out of their mouth rather than coughing or choking. 

As your baby gains more tongue strength & coordination, leaking should improve. If your baby's leaking is due to hypotonia (low tone) of other oral muscles or jaw asymmetry, it may take more time to notice an improvement in how messy your baby eats. 

Clicking: Baby is noisier while eating

Clicking is a common sign that leads parents to suspect their baby has a tongue tie. It can be very confusing when it gets worse or starts after the release. Luckily clicking in-of-itself is not an issue, outside of potentially leading to your baby being a bit gassier. 

Clicking noises occur when the tongue is quickly pulled down from the roof of the mouth after suction has been generated. The clicking may occur before the release because of limited lifting ability. After the release, while your baby may be able to lift their tongue better, they may not have the strength or coordination to main the lift required during feeds. 

Another possible cause of clicking may be related to a high bubble or channel palate. The mechanics behind the clicking remain the same, but because of the height of the palate, the tongue is unable to maintain suction.  

Typically, exercises that strengthen your baby's tongue muscles and that work to widen the palate lead to a decrease in clicking. 

Gagging: Baby gags more frequently 

Many babies with tongue ties have a hyperactive (very sensitive) gag reflex, which can become more pronounced or more frequent post tongue tie release as they gain the ability to open more widely for a deeper latch. 

Unlike the other symptoms on this list, gagging can pose significant challenges for your baby and can directly contribute to bottle or breast refusal for some babies. 

It's crucial that you work with an oral-function savvy IBCLC to develop a plan to desensitize the gag reflex in ways not associated with feeding, especially if you're bringing your baby back to the breast (or to the breast for the first time) post-release. 

Drooling: Baby drools a lot more

Drooling after tongue tie surgery is very common and may be beneficial for the healing process. 

An increase in salivation (drooling) often occurs because the better movement of the tongue can stimulate saliva production and release. Excess saliva production may also be due to your baby's body trying to reduce the inflammation at the wound site. 

The drooling can make the stretches a challenge. Using gauze to help grip the tongue can make getting deep stretches easier. 

Reflux: Baby spits up more often 

Rarely does reflux get worse post-release; however, the fact that it persists and may be one of the last symptoms to resolve can be very concerning for parents. Increased salvation the days post-release may lead to increased reflux symptoms, as can an increase in clicking. 

Reflux isn't always an issue- if your baby is happy and content when spitting up, any increase in reflux is not a concern.

If your baby has GERD, an increase in reflux can be very stressful. Positional changes during feeds can help with feeding coordination and reduce air intake. 

Conclusion

Seeing your baby struggle with worsening symptoms after tongue tie release can be very disheartening, especially since many parents are unaware that symptoms may worsen or take a while to go away.