What Parents Need to Know
Mouth development begins in utero and progresses very quickly in the first six-months of life. It is during the first year of life that health and development issues can arise due to negative changes in face, mouth, and airway structures. While many traits are inherited, parents can help their children develop the best possible face, mouth, and airway structures through the use of appropriate feeding and mouth development techniques which include appropriate oral play. You will find specific interviews/articles about these techniques in the section entitled So, What Can Parents Do? But first, we are going to talk about what can go wrong and why.
Mouth and Airway Development in the First Six-Months to One-Year of Life
At birth, most babies have similar structures such as a broad eye area, open nasal area, a flat roof of the mouth, and a pulled back lower jaw. With appropriate feeding and mouth development activities, these structures will grow properly. However with improper feeding and mouthing, children can develop a myriad of structural and health concerns. Improper feeding and mouthing includes late introduction of feeding skills and food textures as well as excessive immature sucking on pacifiers and thumbs/fingers.
Structural Concerns at Birth: Ties and Missing Sucking Pads
Tethered tissues/ties and missing/reduced sucking pads are structural concerns with which a baby can be born.
Tongue, Lip, and/or Buccal (Cheek) Ties: These are structural anomalies commonly seen at birth. At times, these tissues can be stretched with the use of appropriate feeding and mouth development techniques. However, many children require carefully applied revisions of tongue, lip, and/or buccal ties (also known as tethered oral tissue). The reason I say carefully applied is that:
- The revision needs to be done by a skilled practitioner with experience in this treatment area.
- There needs to be proper wound care immediately following the revision to help avoid the formation of detrimental scar tissue.
- There needs to be an appropriate feeding and mouth development program in place to help the baby or child change compensatory habits used while mouth movements were restricted.
It only takes approximately three weeks to develop a good (or bad) movement pattern/habit. When looking at ultrasounds of babies in utero, sucking can be observed. So, when a baby is born with a compensatory sucking pattern related tongue, lip, and/or buccal ties, this can significantly complicate breastfeeding.
Missing or Limited Sucking Pads: With scheduled births (which may be near-term and not full-term), babies can have limited or reduced sucking pads, and babies born prematurely do not have these structures. Sucking pads (also called cheek or fat pads) develop toward the end of pregnancy when other fat is forming on the baby’s body. These help a baby attain the pressure needed within the mouth to properly feed. Babies with limited or missing sucking pads often use atypical compensatory feeding patterns (e.g., tongue humping and thrusting, biting down on mom, etc.) to compensate for missing or limited sucking pads. Carefully applied cheek support is one technique parents can use to facilitate more typical feeding movements when a baby has limited or missing sucking pads. This is best taught by a professional (e.g., Lactation Consultant, Feeding Therapist, etc.) who can observe the effect of the cheek support, as cheek support can also be inappropriately applied.
Structural Concerns that Can Develop with Improper Feeding and Mouth Development Activities After birth, there are a number of structural problems that can arise in the first few months of life related to improper breast feeding, bottle feeding, as well as excessive pacifier use and thumb/finger sucking.
Improper Breastfeeding: If a baby has a tongue, lip, and/or buccal restriction and/or inadequate sucking pads, it is often difficult for the mom to properly breastfeed the baby. In appropriate or proper breastfeeding, the breast is drawn deeply into the baby’s mouth to help maintain the nice broad shape of the palate (i.e., roof of the mouth). If the breast is not drawn deeply into the infant’s mouth, extra space is created in the mouth that may lead to tongue humping and/or thrusting patterns to occupy the additional space. Moms can work with appropriately trained lactation consultants and/or feeding specialists to help resolve this issue.
Bottle and Pacifier Use: While there are some appropriate uses of bottles and pacifiers, parents must be aware that bottle feeding is a medicalized way of feeding a baby. Bottles and pacifiers use different movement patterns than breastfeeding with backward forces that may negatively affect mouth development. Bottle and pacifier nipples do not help to maintain the broad shape of the palate (i.e., roof of the mouth). For parents who need or choose to use bottles and/or pacifiers, guidelines can be found in my parent-professional book Nobody Ever Told Me (or My Mother) That! Everything from Bottles and Breathing to Healthy Speech Development.
High, Narrow Palate: In addition to proper breast feeding, an appropriate tongue resting position helps a baby maintain a good palate shape as the palate hardens over time. When the baby’s mouth is closed at rest, the tongue fills the mouth and rests lightly suctioned against the roof of the mouth. This tongue position/posture helps maintain the palate’s shape. If a baby’s mouth is open at rest, the tongue tends to reside in the lower jaw and does not help with the shaping of the palate. This posturing leads to a chain reaction:
- The palate (i.e., roof of the mouth) becomes high and narrow.
- Since the palate is the floor of the nasal cavity, a high, narrow palate decreases the size of the nasal area making nasal breathing increasingly difficult.
- Small nasal areas are often difficult to clear of mucous or congestion particularly if the mucous membranes are swollen.
As one problem manifests into another, health concerns such as sleep apnea and chronic upper respiratory concerns often occur. Additionally, a high, narrow palate can inhibit midface growth and cause narrowing across the eye area. A turned-down or “frowny” mouth is usually indicative of a high narrow palate.
Poor Lower Jaw Growth: With appropriate feeding and mouth development activities, the lower jaw tends to grow forward in the first six-months of life. When the lower jaw does not grow forward, the baby’s face will have an atypical appearance with the forehead appearing high, the jaw appearing small, and the baby’s airway being compromised because the tongue is forced to stay toward the back of the mouth along with the jaw which can block the airway.
Poor Upper Jaw Growth: Excessive thumb/finger-sucking and pacifier use can lead to irregular upper jaw growth. This commonly causes a very tipped up nose, an overbite, along with other dental problems.
So, What Can Parents Do?
Parents can be proactive in learning appropriate feeding techniques and mouth development activities. The best practice is to begin this process at birth. However, if problems exist, there are many techniques that can be applied at any age. In addition to my parent-professional book (which contains detailed information on proper feeding and mouth development activities), I have free literature/clinically-based articles/interviews on my website to help parents and professionals learn about feeding and mouth development. Here are a few articles/interviews I did with Dr. T of Kids A to Z:
Feeding 101: What Baby Food Jars Don’t Tell You (AKA: What do parents need to know when feeding their children from birth to 12-months of age?)
Sippy Cups, Bottles, and Straws – Oh My! Feeding 201 (AKA: What do parents need to know when feeding their children from 12 to 24-months of age?)
Get That Mouth in Shape: The Scoop on Pacifiers, Thumb-Sucking, & Mouth Toys (AKA: How do you keep your child’s mouth in shape from birth?)
Teething and Drooling: What Every Parent Should Know (AKA: What should every parent know about teething and drooling?)
Other Related Resources: Bahr, D. (2015). Everything You Need to Know about a Baby’s Mouth for Good Feeding, Speech, and Mouth Development: E-Course for parents and professionals about structures and functions of a newborn baby's and young infant's mouth that can affect the life-long processes of feeding and speech.
Gatto, K. (2015, May). Tethered oral tissue: What is that?: Article discusses tongue, lip, and buccal ties/revisions.
Ghaheri, B. Is the diagnosis of tongue-tie a fad?: Article discusses breastfeeding problems related to tongue tie and the genetics of tongue-tie.
Gomes, C.F., Trezza, E.M., Murad, E.C., & Padovani, C.R. (2006, Mar/Apr). Surface electromyography of facial muscles during natural and artificial feeding of infants. Jornal de Pediatria, 82(2), 103-109. http://dx.doi.org/10.2223/JPED.1456.
Huang, Y., & Guilleminault, C. (2012, Jan.). Pediatric obstructive sleep apnea and the critical role of oral-facial growth: Evidences. Frontiers in Neurology, 3(184). 1-7. doi: 10.3389/fneur.2012.00184.
International Lactation Consultant Association (ILCA): Association where parents can find properly trained lactation consultants.
Kotlow, L. (2014, Jan.). Why does lip-tie cause pain and discomfort during breastfeeding?: Article describes lip tie, related breastfeeding problems, and other potential mouth development issues.
Sum, F.H.K.M.H., Zhang, L., Ling, H.T.B., Yeung, C.P.W., Li, K.Y., Wong, H.M., & Yang, Y. (2015). Association of breastfeeding and three-dimentional dental arch relationships in primary dentition. BioMed Central Oral Health, 15(30). doi: 10.1186/s12903-015-0010-1.