Jaws

 

Issue : Jaw tension, poor gape

 

Exercice : Jaw massage + chin tug

 

• Use finger pads to massage both sides of the jaw (from TMJ to base of mandible), When you reach the chin, pause and gently `tug’ downward.

• The `tug ‘is simply holding gentle pressure for a few seconds and waiting for the mouth to relax open. Repeat 2-4 times if baby is enjoying the work. 

 

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Exercise: Magnet fingers 

 

• Place fingers inside and outside the TMJ area, like they would be connected `magnetically`, gently massage. 

 

 

Exercise: “Beep Bop Boop Bip”

 

• Use some silly sounds to associate touching chin, nose, philtrum, then chin tug.

• This will help baby open wider and associate playful touch, especially teat/nipple near philtrum, with open wide. Repeat 2-4 times. 

 

 

Floor of the mouth

 

Issue: Floor of mouth tension, jaw tightness

Exercise: Floor of the mouth massage

 

• Use finger pad, massage floor of mouth, circular movement work well. 

 

 

Lips

 

Issue: Suboptimal lip strength, frequent open mouth posturing due to lip tone/strength

Exercise: Lip pulses

 

• Use finger pads to work around lips, giving input with a little ‘push’ side, middle, side of upper and lower lips. Repeat 2-4 times. 

 

Issue: Lip tension (lip blisters)

Exercise ‘Moustache, Beard’

 

• Using index finger, massage over upper lip ‘moustache’ back and forth 2-4 times then rub under lower lip back and forth ‘beard’ 2-4 times 

• Can add in some massage ‘circles’ to the moustache/beard exercise too. 

 

 

Cheeks

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Issue: Suboptimal cheek strength

Exercise: Cheek pulses

 

• With the pad of index finger (or pinkie finger if baby is very little) gently insert inside baby’s cheek, gently pulse up to 10 times, repeat on the other side.

 

Issue: Cheek tension

Exercise: Cheek stretch

 

• Using thumb and index finger to form ‘magnet’ fingers, gently grasp cheek near TMJ are and slide to corner of lips. 

 

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Tongue

 

Issue: Suboptimal lingual lateralization

Exercise: Gum rub side to side

 

• With the pad of index finger, start in middle of lower gum, then travel/rub lower gum to back molar area. Repeat on both sides 2-4 times. 

 

Issue: Suboptimal lingual strength

Exercise: Side of tongue pushes.

 

• With the pad of index finger, push against side of tongue, baby should try to `push back. Repeat 2-4 times each side. 

 

Issue: Suboptimal lingual cupping and extension

Exercise: Tug of war: 

 

• Introduce finger to infant’s mouth. Elicit some lingual extension playfully. Encourage suckling on finger. With the pad of finger turned up toward palate, have infant suck and then start to tug to encourage cupping, extension, and maintenance of both. 

• You can try to turn finger over for some stroking forward of the tongue periodically. Repeat for 2-4 times or to infant’s tolerance/enjoyment. 

 

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Overall exercises

 

Issue: Overall development, healthy sensory input, nervous system regulation

Exercise: Baby and facial massage 

 

Tummy time (Method by Michelle Emanuel)

• Every time you change baby’s nappy turn baby to her tummy

 

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Suck training

 

Issue: Suboptimal sucking patterns, fatigue with feeds, poor seal​

 

Let baby invite finger in (pad side up)

Let baby initiate sucking.

 

Add in movement if baby allows

• Tug of war

• Rotate finger to pad side down, gentle pressure

• Explore finger pressure to palate or pushing on tongue 

 

 

Post frenotomy exercises

 

Currently, there is no evidence that wound massage is effective. However, with clean fingers and short nails, there are some gentle fun exercises to encourage tongue mobility 

1. Stick your tongue out for your baby to copy

2. Run your fingers along your baby’s gums to encourage sideways movements

3. Encourage sucking on your finger and attempt a tug of war game’

4. If baby does not lift his tongue high enough when crying of playing for you to see the wound, you will have to lift the tongue all the way up in order to visualize the wound.  Please watch the following video for instructions. 

5. https://www.youtube.com/watch?v=ZXFJHqgawNw

6. https://www.youtube.com/watch?v=2JMcbF85ehs  (Melissa Cole)

7. (4-6 times a day for 3 weeks)

8. Massage under the chin when baby is sleeping to encourage the tongue to lift up. You can check if the tongue is up by lowering the chin and having a look where the tongue is resting.

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