What Breastfeeding Taught Me About the Developing Mouth

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What Breastfeeding Taught Me About the Developing Mouth 

With my first daughter, I didn't experience any major breastfeeding challenges. Our second daughter is now five months old and was born early term after a challenging pregnancy. Breastfeeding started off smoothly, but over the past couple of months it became increasingly challenging. We had been seeing a paediatric osteopath who then referred us to an incredible lactation consultant. What followed was an unexpected journey into the developing infant mouth and the remarkable role one small muscle plays in feeding, breathing and facial development: the tongue.

I am still very much learning in this space, but I wanted to share some of what I've discovered so far. Partly because I think it's an area of infant development that deserves far more attention, and partly in the hope it might help another mother who finds herself in a similar position.

One question the lactation consultant asked me when I attended the drop-in clinic was, "How would you describe breastfeeding?"

I replied, "Uncomfortable."

As we continued talking, I realised just how much I had been adjusting my own body to make feeding work. I had begun contorting myself to help Winnie latch. Somewhere along the way, those awkward positions had become my new normal.

Breastfeeding can be challenging for many different reasons, and I know it can also be quite a sensitive topic. Every feeding journey is different. But this experience taught me that there is often so much support available and, in many cases, so much potential for improvement.

A baby's ability to breastfeed starts developing long before they are born. Well before birth, babies are already practising. Throughout pregnancy they swallow amniotic fluid and make rhythmic sucking movements, strengthening the muscles and coordination they'll need once they enter the world. By the third trimester, they're swallowing hundreds of millilitres of amniotic fluid each day, essentially rehearsing for their very first feed.

During the final weeks of pregnancy, babies also develop specialised fat pads within their cheeks, often called sucking or buccal fat pads. They're not just there to make your deliciously chubby-cheeked newborn even more irresistible. These fat pads help stabilise the cheeks and create an effective seal around the breast, making it easier for newborns to generate suction while the muscles of the tongue and face are still developing.

These fat pads are particularly prominent during the newborn months, helping stabilise the cheeks and prevent them from collapsing inward during sucking. As a baby grows and the shape and proportions of the mouth and face change, the fat pads become less prominent and feeding continues to depend on the coordinated work of the tongue, jaw, lips and cheeks.

The tongue is central to feeding from the beginning, so it isn’t quite that it suddenly “takes over”, however, the extra stability provided by the newborn fat pads may sometimes help compensate for subtle difficulties with tongue movement or suction. As babies grow and feeding patterns change, those difficulties may become more apparent.

Understanding this helped make sense of our own experience. It made me wonder whether the support Winnie had as a newborn had helped feeding begin relatively smoothly, only for an underlying difficulty to become more noticeable as she grew. This is only one possible explanation, breastfeeding can become more challenging for many different reasons, but it helped us understand why a problem might not always be obvious from the beginning.

When we aren’t eating or talking, the tongue is designed to rest gently against the roof of the mouth. This position is more than simply somewhere for it to sit. Throughout infancy and childhood, the tongue’s gentle resting pressure helps guide the growth of the palate, which forms the floor of the nasal cavity. In doing so, it supports healthy jaw development and helps create the space needed for the nasal airway to develop well.

The developing mouth and face are also shaped by genetics, good nutrition, breastfeeding, nasal breathing and, later, learning to chew a wide variety of textured foods. As children grow, chewing firmer whole foods encourages the coordinated use of the tongue, jaw and facial muscles, another reason why progressing beyond soft, highly processed foods is an important part of oral development.

It is fascinating to consider that almost a century ago, Canadian dentist Weston A. Price travelled the world documenting the diets, dental health, and facial development of traditional communities. He frequently described broad dental arches, well-developed jaws, and minimal dental crowding among populations consuming traditional diets. Although we now understand that craniofacial development is shaped by many interacting genetic, nutritional, functional, and environmental factors, modern research continues to investigate the roles of nutrition, breathing, and muscle function, particularly the influence of preconception and in utero nutrition.

When we breathe through our nose, air is filtered, warmed and humidified before reaching the lungs. The nose also produces nitric oxide, a naturally occurring gas that plays an important role in airway health, helps improve oxygen uptake and supports healthy blood flow throughout the body. Mouth breathing bypasses many of these important steps. It also dries the mouth, reducing the protective effects of saliva and altering the oral environment that supports a healthy oral microbiome, which may increase the risk of dental cavities and gum disease over time.

Because the tongue is connected to the muscles of the jaw, face and neck, the way it rests and functions also influences how those muscles work together. If the tongue isn't able to rest where it should or move efficiently, other muscles often step in to help. Over time, this may contribute to tension through the jaw and neck, altered swallowing patterns and, in some children, influence speech, facial development and breathing patterns.

Babies are incredibly adaptable. The tongue is a muscle, and like any muscle, its function can often improve with the right support and guidance. Every baby is different, which is why a thorough assessment is so valuable. Rather than focusing on one small piece of anatomy, experienced practitioners look at the whole baby: how they latch, transfer milk, move their tongue, use their jaw, breathe and coordinate feeding before deciding what, if any, intervention may be helpful.

At the time of writing, we’re doing tongue exercises recommended specifically for our daughter by our treating practitioner, two to five times a day. These exercises are not appropriate or necessary for every baby and should be individually prescribed following a functional feeding assessment. It is still early, but I’ve noticed encouraging improvements in her latch and feeding over the past couple of weeks.

Simple Things to Start Noticing

One of the biggest takeaways from this experience has been paying attention to how we breathe and where our tongue rests. Most healthy babies are naturally nasal breathers. During quiet sleep and throughout the day, their lips will generally rest together, with breathing occurring comfortably through the nose.

You may notice whether your baby generally sleeps quietly with their lips together or regularly sleeps with their mouth open, snores, breathes noisily, seems persistently congested without a cold, or breathes through their mouth during the day. These observations cannot diagnose an oral restriction or airway problem, but they can be helpful to share with a qualified health professional. The same general signs may also be worth investigating in older children and adults.

Where to Start

If reading this has raised questions about your child or yourself, remember that feeding, breathing and oral development can be influenced by many factors. No single sign automatically points to a particular cause, so seeking an appropriately qualified professional assessment is a helpful first step.

For babies, an experienced lactation consultant is often a good place to start. Depending on what they observe, they may work alongside a paediatric physiotherapist, osteopath, GP, paediatrician or another health professional.

For older children and adults, a GP or dentist can be a good starting point. Some dentists have undertaken additional training in airway health, oral function and facial development and are sometimes described as airway-focused or holistic dentists. They may work as part of a multidisciplinary team, collaborating with orthodontists, myofunctional therapists, physiotherapists, osteopaths, ENT specialists and other healthcare professionals when appropriate.

References

Academy of Breastfeeding Medicine. “Position Statement on Ankyloglossia in Breastfeeding Dyads.” Breastfeeding Medicine, 2021.

Geddes DT et al. “Tongue movement and intra-oral vacuum in breastfeeding infants.” Early Human Development, 2008.

Elad D et al. “Biomechanics of milk extraction during breast-feeding.” Proceedings of the National Academy of Sciences, 2014.

Peres KG et al. “Effect of breastfeeding on malocclusions: a systematic review and meta-analysis.” Acta Paediatrica, 2015.

Zhao Z et al. “Effects of mouth breathing on facial skeletal development in children: a systematic review and meta-analysis.” BMC Oral Health, 2021.

Lundberg JO et al. “High nitric oxide production in human paranasal sinuses.” Nature Medicine, 1995.

American Speech-Language-Hearing Association. Orofacial Myofunctional Disorders: Practice Portal.

American Academy of Pediatric Dentistry. Policy on Obstructive Sleep Apnea. Latest revision, 2021.

Price WA. Nutrition and Physical Degeneration. 1939. A historical work that should be read alongside contemporary research into nutrition, breathing and craniofacial development.