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Newborns: What to know about mouth structure, breastfeeding and tongue-tie

Newborns: What to know about mouth structure, breastfeeding and tongue-tie

Did you know that the structure and function of a newborn baby’s mouth can affect the child’s lifelong processes of feeding and even speech?

In this article we will talk about face, mouth and throat characteristics in newborn babies and infants, which will help you as parents to identify normal versus abnormal physiology. This can really help your baby with feeding and speech in the long term as it develops in its early years. We will also talk about positioning and attachment for breastfeeding, as well a tongue-tie in newborn babies. 

Newborn mouth and throat characteristics: 

Newborns have several unique mouth and throat characteristics: 

  • Limited open space within the mouth and throat areas
  • A small, slightly pulled back lower jaw which grows over time
  • A wide “U” shaped palate
  • A flexible palate (roof of the mouth)
  • A tongue that fills the mouth when resting
  • A deeply cupped tongue when suckling
  • Gums that enlarge to assist with the latch when suckling
  • Ample sucking pads in the cheeks

A newborn’s mouth and throat structures are close together, so there is limited open space within the mouth and throat areas. This helps typically developing, full-term newborns to safely feed and swallow. As the baby develops feeding skills, there is increasing open space within the its mouth and throat areas.

Therefore, the mouth and throat areas of a newborn are different from a three or six- month old baby. Feeding therapists (for example, lactation consultants) must keep these changes in mind when helping parents develop feeding programs.

Positioning and attachment for breastfeeding

Positioning and attachment, or latching on, are the terms used to describe how you hold your baby at your breast so they can feed. Correct positioning and attachment is the most important thing for successful breastfeeding which is comfortable for the baby. 

In the early days of breastfeeding, you may feel nipple tenderness or sensitivity at the beginning of a feed as you get used to the new sensation. Breastfeeding should not be painful.

How to position and latch: 

  • Hold your baby close with their nose level with your nipple
  • Let your baby’s head tip back so their top lip brushes against your nipple - this should help them open their mouth wide
  • When your baby’s mouth is wide open, bring them to your breast
  • Aim your nipple to the roof of their mouth
  • When they attach, your nipple and most of the areola (the area around your nipple) should be deep in your baby’s mouth
  • When your baby is attached properly, their chin will be pressed into your breast
  • Your baby's nose should be at a tilt when attached correctly, for easy breathing. Newborns are nose breathers, and if they cannot breathe freely, they will come off the breast
  • If your baby's nose appears to be blocked, move their bottom closer to you. This will create a head tilt and free up their nose
  • The deeper the attachment the more comfortable you will feel and the better your baby will feed
  • More of your areola will be visible above their top lip than below their bottom lip
  • Their cheeks will appear fuller
  • They’ll suck quickly at first, followed by longer sucks
  • You will hear them swallowing


What is tongue-tie?

Tongue-tie, or ankyloglossia, is an oral condition which affects a newborn baby’s ability to open their mouth widely enough to breastfeed, and affects about 4 – 11% of babies born each year. The condition develops in the womb as a result of a genetic mutation passed on as a dominant trait.

If your child has been diagnosed with tongue-tie, here’s what you need to know in order to figure out next steps.

A baby born with a tongue-tie will have an overly short or thick frenulum that restricts the tongue’s movement. The frenulum is a small band of tissue that extends from the floor of the mouth to the bottom of the tongue.

Who diagnoses a tongue-tie?

Your child’s pediatrician or primary care doctor can diagnose a tongue-tie. A lactation consultant may be the first person to notice a tongue-tie when evaluating for breastfeeding issues.

Signs and symptoms

Some of the more common signs and symptoms of a tongue-tie include nipple pain and trauma in the mother, as well as infant issues such as trouble staying latched, clicks when breastfeeding, and poor milk transfer, which can lead to issues with weight gain and milk supply.

How is tongue-tie treated?

Depending on the severity, some care providers will take a wait-and-see approach for very mild cases, while others will recommend a frenotomy (also called frenectomy), which is a quick and simple procedure used to release the lingual frenulum.

While a frenotomy is usually a fairly simple procedure, parents or caregivers have to physically stretch the tissue that’s been cut or lasered every day for at least 3 to 4 weeks afterward. This prevents the tissue from regrowing too tightly during the healing process.

If a frenotomy is not recommended, there are other ways to manage tongue-ties which include craniosacral therapy, lactation interventions, physical and occupational therapy, and oral motor therapy.

How does tongue-tie affect breastfeeding?

Tongue-ties can cause pain with breastfeeding, and can also interfere with latching due to the tongue not being able to extend and elevate to effectively latch onto the nipple and remove milk. Both pain and an ineffective latch can lead to a decrease in milk supply, aerophagia (swallowing too much air), and poor weight gain. 

Long-term effects of an untreated tongue-tie

We know that tongue-tie can contribute to weight gain problems and failure to thrive in infancy. But the potential problems with an untreated tongue-tie don’t end when your baby stops feeding at the breast. Other than feeding issues, tongue-tie can also cause problems with dental occlusion (misalignment) and orthodontic health. 

Speech articulation and oral biomechanics may also be impacted by tongue-tie, and an untreated tongue-tie may cause issues with the way a child pronounces words.

Still, in some cases, there are no long-term effects of leaving a tongue-tie. As a child grows, their oral functioning can compensate for the restricted movement of the tongue.

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