Parents often find themselves in crisis after their toddler has already undergone a tongue-tie release—overwhelmed, unprepared, and unsure how to support healing and function. This article reframes that experience by making a clear, evidence-informed case for pre-habilitation: preparing a toddler’s body, brain, and support system before a frenectomy is ever scheduled. Drawing on clinical experience, functional assessment, and dynamic systems theory, this post explains why a successful release is never just about cutting tissue—and how intentional preparation can dramatically improve outcomes, recovery, and long-term development.

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Regularly I receive frantic phone calls, texts, and Facebook tags from parents in support groups. Usually they are in a panic and

seeking emergency information because their toddler had a frenectomy to release a Tongue-Tie that day.

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"Help! My toddler had a tongue-tie release, what should I do?"

"What do I do for pain?"

"What can they eat?"

"How do I take care of the sites?"

"How do I get inside their mouth!?"

"My child will not let me do the exercises!"

"Do I do stretches if the doctor used stitches?"

"How do I know if it has reattached?"

 

 

 

Here's the secret to ALL of these great questions:

They should be asked BEFORE a tongue-tie release is even scheduled.

 

Why?

 

​Because what the toddler body really needs is PRE-HABILITATION.​​​​​​​​​​​​​​

​​​​Actually, EVERY body needs Pre-Habilitation before a Frenectomy, but right now our focus is on toddlers.

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The decision to do a frenectomy on a toddler is usually not one taken lightly. There are often significant medical issues

presenting that warrant the procedure:

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• Weight loss or failure-to-thrive

• Gagging and/or choking related to the inability to handle food

• Speech delays related to lack of tongue movement

• "Airway issues" related to jaw placement that show up in sleep

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It is not uncommon for a dentist or physician to screen your child, diagnose them “tied, " and offer a list of all the health

issues a tongue tie may cause in the future. Many parents find this scary and overwhelming. But before jumping to a

frenectomy, ask your provider for a list of the tie's impact on your child's health right now. Learn what your provider's

treatment plan is, as well as their sequence to resolving your child's presenting issues, and how resolving the issues now will

help future growth and development.

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When it comes to treating a tongue-tie, there is a tendency to simply expect a release of tissue to bring about normal function.

Some providers instruct parents to follow-up with stretches or exercises -- some providers don't. But to enter into a surgical

procedure with no thought to preparing the toddler, parents, or family makes the process difficult, and it can limit the overall

success of the procedure. This is where pre-habilitation can help create beneficial outcomes beyond symptom resolution.

 

Studies show that using pre-operative activities, such as exercises, decreases the amount of time spent in post-operative

recovery. In the thousands of cases I have been involved with, I have found pre-habilitation to be imperative. I am not the only

one, as this is repeatedly noted by practitioners who work with tongue-tied people of all ages -- the value of preparing ahead of time for a frenectomy pays off in dividends in recovery and the future. Doctors who regularly perform frenectomy on pre-

habilitated patients consistently remark how clear the lines of demarcation around the frenum create a sense of completion

and greater opportunity for a full release. As an Intra-operative RN who regularly assists with the treatment plans around this

surgery, I only work with those who pre-habilitate and recover with an outcome-based strategic plan.

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​"Would you put new tires on a car without a

front-end alignment?"

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A father was struggling with the pre-release appointments: the money, the time, etc. I knew he needed a way to understand the process, so I asked him: "Would you put new tires on a car without first performing a front-end alignment?" He is a very

well-known TV car mechanic. His emphatic response was, "Heck NO! Putting new tires on a car that needs an alignment is

a waste of money!" Exactly my point. So is doing a tongue-tie release on an unprepared child. Even after you put those new

tires on there is routine maintenance in the form of regularly rotating your tires. Maintenance post-release through

anticipatory guidance and "watching while growing" is a whole 'nother blog and a very important subject I educate my

patients/parents on daily. While tires are a base analogy, think of releasing a child's tongue as installing a new Operating

System on a car -- it will literally affect every other system.

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Infants, Children and Adults have their own sequence of preparation

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Infant Preparation: Evaluation of their presenting issues, their anatomy, their movement, and their goals are all part of

a Functional Exam. A Functional Exam should be done in-person with a trained specialist:

• International Board Certified Lactation Consultant (IBCLC — if infant is breastfeeding)

• Speech Language Pathologist (SLP)

• Occupational Therapist (OT)

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Infants are dependent solely on the intervention of the parent and practitioner to get their outcomes; this means the infant's

support team needs to have a solid, workable plan before the release is performed. Exercises are done by placing our fingers

in the infant's mouth, and we teach parents to do the same so they can continue exercises at home during the initial six-week

healing period. Plans for post-operative feeding, pain management, and learning new feeding patterns are also established prior to release.

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Child & Adult Preparation: A Functional Exam is performed by someone trained in Oral Myology, as well as someone who

understands the related body structures and how they work together with oral restriction. All of this information is put

together to sequence the care-plan for optimal results pre- and post-op. Children over the age of three can do Orofacial

Myofunctional Therapy (OMT) voluntarily by copying or mimicking a practitioner doing mouth movements, such as

sticking out the tongue, tongue pops, and other exercises. Once again, plans for post-operative pain management, body and

movement integration, post-operative feeding, and learning new mouth patterns are addressed prior to release and not just after. 

 

Release of the Oral Frena creates connection in the mouth that ripples throughout the body. The more connection created on all levels, the more profound the result from the release of “Ties."

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Toddlers are unique

Toddlers (ages 12 months to 3 years) are not quite adept at mimicking, and while they want to do all they can on their own, they still require the help and care of parent and practitioner to reach their functional goals. They still need the same type of Functional Exam -- evaluating oral function, body structure integration, neurology, and how all of these aspects are related. SLP or OT for the non-breastfeeding toddler, IBCLC for the breastfeeding toddler cover the oral function aspect. Some Occupational Therapists, Chiropractors, Physical Therapists, Osteopaths and Licensed Massage Therapists are trained in the body movement, structure and neurology aspects.

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The Four Engagements

Here's a brief outline of the hows and whys of getting a toddler ready for release and preparing for success. I like to use

Dynamic Systems Theory (DST) as a tool to understand frenectomy preparation and habilitation. In simple terms, there is:

• a person

• task

• environment

 

For there to be integration and success, all three must be accounted for in the setup of the preparation. The more we can

help create new brain and movement pathways prior to release, the better! Creating those new pathways takes time and

repetition. It's necessary to take time to prepare -- the parent needs to learn the routine, and the child needs to adjust prior to

scheduling the release. I love the application of DST since it is ever-changing because the child is ever-growing and develop-

ing. There is no real endpoint or full completion; stabilization, de-stabilization and self-regulation patterns are ever-present in

all of us, and especially in the developing child. In life, we are continually in one of these DST phases.

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1. Engage Their Minds

Toddlers are so curious and can often outsmart their adult counterparts. It comes naturally! When I am involved with preparing someone for frenectomy, I talk to everyone. I talk to babies, parents, practitioners, caregivers. Literally everyone. Even the environment! We all want to know what is going to happen to us and why. Age matters not.

 

This is the process of addressing the person in the DST tool:

• Talk to them about what will happen

• Tell them how you are going to help them get ready

• Talk to them about their significant struggle, and

• Explore their "economy and currency. " What type of reward system and routine will you create to get the job done? Let

your child choose.

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This is an example of what a Myofunctional Therapy

session might look like for a child 3 and older

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2. Engage Their Hands

Children love to help! Most are even incredibly independent. As parents we hear "I do it!" And as often as possible, we

acquiesce to allow them greater independence.

 

This helps us address the task in the DST model:

• Some children want to do the exercises on the parent, a stuffed animal, or try on themselves

• Creating a routine is the best way to comfort a toddler so they know what to expect and when

• Establish safe, comfortable oral access for the child and caregiver

• Empower the child by asking them to help decide the routine, place, and sequence of the oral work

• Allow them to see their progress by holding a mirror

• Know exactly what oral movements need to be done and have them fully rehearsed prior to release​

 

3. Engage Their Bodies

Toddler middle name is PLAY!

Movement and engagement is my favorite part of toddler frenectomy preparation. We address the environment in DST

theory. Parents share it's worth every penny to work with a trained toddler bodyworker who helps create a movement strategy that addresses the global movements that are so healing to toddlers --

before release and after. When we play, we learn faster! Laughing and moving is both therapeutic and healing. Working with thousands of tongue-tied people, experience has taught me:

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• Preparing the body and brain to move together in new ways helps neurological integration following the surgery

• Children develop body awareness and confidence by combining movement with the procedure

• The effects of our container society on children is huge and has long-lasting effects

• The impact from lack of global body movement can show up anywhere in the body and especially effect the tongue

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4. Engage Their Outcomes

When it comes to addressing a tongue-tie or having a frenectomy, parents want optimal results, including the best return on their investment of time and money. There are ways to make sure your toddler is a winner:

• Get an in-person Functional Exam by a qualified professional who can evaluate your child orally, neurologically, and physically

• Set concrete goals to recover any lost or missing function in the mouth and the body

  • Lick an ice cream cone

  • Chew new foods

  • Sleep better to wake up happy

  • Greater stability with walking or running

• At each point of the preparation and recovery, continue to ask your provider, "What remains?" Success can be measured by oral/physical changes, as well as resolution of symptoms

• Good preparation prior to a release can be very eye-opening. Many parents are surprised to see function return that they (or their provider) felt was related to a tie, when it was actually related to something else in the body

• Address contributing factors: birth trauma or difficult birth, injuries, and chronic illness are all stressors that can impact oral function and breathing. By addressing these prior to release, it becomes easier to determine what part of an oral dysfunction is related to the tie, and what are related to something else

• Have a pain management strategy for post-procedure pain

• Have a feeding strategy for a range of foods that your toddler can tolerate

• Know what to look for when evaluating progress or regression as the area heals

• Chart a course for future growth and development of the face, jaws and airway

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Creating the right team for your toddler makes doing "all the things" feel easy and fun.

If it feels too hard, reconsider your strategy!

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Michale Chatham

RN, BSN, LMT, IBCLC, OMT

michalechatham.com

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Resources for Help:

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Tongue-Tie Education:

www.tongue-tie-education.com

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Dynamic System Theory:

www.sciencedirect.com/topics/psychology/dynamic-system-theory

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MyoWild resources:

www.myowild.com

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Other MyoWild Blog Posts:

Is Your Baby a Tether-Berg or a Tether-Flow?

Ride the Bull: Hope for Healing After Frenectomy

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Michale Chatham, RN, BSN, OMT, LMT, IBCLC, saw a need to help overwhelmed families navigate the options for tongue-tie

and airway orthodontic treatment, along with their related multitude of therapy options. Using her vast background

in Dentistry, Nursing, Movement, Nutrition and Natural Lifestyle, Michale has spent over 10 years creating transformational and revolutionary paradigms that walk on the "wild" side of the status quo. Watching families experience the compounded

stress of appointments, therapies, and professionals, Michale views her practice more as a lifestyle-approach. She

encourages long-term healing and creates an understanding for parents to easily make decisions regarding any recommended

therapy or treatment. By educating parents on the ultimate end-goals, families acquire a toolbox of ways to expand and

improve their lives by making simple and effective choices in the things they do every day. Her passion is helping families create personalized strategies, learning by connecting with nature, themselves, and each other in ways that are fun and satisfying as defined by the family.

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