Most of our eating and drinking skills are developed in the first 2 years of life. Every 3 months from birth, your baby will have a growth spurt in this area. You can help with this process by using appropriate feeding techniques from birth.
We are going to see how babies accomplish breast- or bottle-feeding successfully. Ideally, your baby should demonstrate the following characteristics, whether you are nursing or bottle-feeding. Most full-term babies are born with the potential for these characteristics as listed in below. Premature and near-tern babies can be assisted in developing most of them.
1) Small jaw movement once latched.
2) Tongues cupping/grooving.
3) Even, front-to-back wavelike tongue movement(50% front and 50% back),with the back of the tongue moving downward to create a vacuum when drinking and suckling.
4) The tongue comes over the lower gum area during front tongue movement, but does not protrude out of the mouth.
5) A stable mouth, with the tongue acting as the lower stabilizer, the sucking pads acting as side stabilizers, and the roof of the mouth acting as the top stabilizer.
6) Adequate pressure in the mouth, so fluid can move safely and efficiently into and through the mouth for swallowing.
7) Good feeding rhythm.
Small jaw movement should occur once your baby is latched onto the breast or bottle. The tongue, sucking pads,and roof of the mouth create the right space for liquid to move safety,easily,and efficiently through the mouth. Therefore, the jaw doesn’t need to move very much.
Baby’s tongue needs to cup pr groove around the bottle or breast nipple and move 50% front to 50% back in a wavelike motion with each suckle. At the same time, the back of your baby’s tongue moves downward to create a vacuum within the mouth. This will pump the liquid from the breast or bottle easily. Babies who move their tongues too far front(sometimes called a tongue thrust or exaggerated tongue protrusion) are working too hard.
Tongue humping(pushing up the middle of the tongue) means that something has gone wrong. Children who hump their tongues and pump the liquid are working too hard and fatigue easily. They usually hump their tongues because they do not have adequate sucking pads, the tongue is tied, and/or their heads and necks are extended back. Tongue humping is an attempt to make the space inside the mouth smaller, which then adjusts the suckling pressure. This is not an efficient method for pressure adjustment within the mouth.
As mentioned previously, baby should have even, front-to-back wavelike tongue movement. The tongue should come out over the lower gum during the suckle but not thrust. Babies often thrust their tongues because their heads and necks are too far back. These babies are working very hard, and tongue thrusting can become a lifelong pattern that is known to affect the development and shape of the hard palate(the roof of the mouth) and teeth(ie,occlusion).
Babies whose tongues do not come out over the lower gum also have a very difficult time nursing and tend to bite down on their mom’s nipples or bottle nipples. They do this because the bite reflex is being triggered. They also learn that biting down can help keep the jaw from moving too much.
Some babies are born with a tongue restriction,which can inhibit proper tongue movements. Small restrictions are often resolved through the use of appropriate feeding techniques. However, some babies have significant restrictions, and the most severe have heart-shaped tongues. The restriction is caused by a structure under the tongue, called the lingual frenum. You might hear the medical term frenulum when a tongue is restricted in this way.
Some pediatricians will recommend clipping the tissue under the tongue if the tongue is so restricted that the baby cannot properly nurse or bottle-feed. See the American Academy of Pediatrics Web site for further information on management of a tongue-tie. Dr Brian Palmer also has information on this Web site regarding tongue-tie at www.brianpalmerDDS.com
There has been some controversy in the professional literature about whether to clip a tongue-tie or not. Clipping is most important to consider if the tongue is significantly restricted and the baby cannot feed properly. This is sometimes done near the time of birth and is a decision that parents need to make with their physicians, because it is surgery.
Babies who have the clipping at a later date(several weeks after birth or later) usually need some therapy to get their feeding back on track. Babies who feed with a restriction for a period of time develop feeding habits that usually lead to feeding and mouth development problems in the future.
If a baby’s tongue is significantly restricted, it is also important to check the baby’s lips for restrictions. There is a frenum system, and each lip also has one( a piece of tissue that connects the lips to the gum). These are called the labial frenums. If lips are restricted or too tight, the breast or bottle latch can be significantly affected. Lip restrictions can often be resolved with the use of proper feeding and some massage facilitation techniques. Clipping is done occasionally, usually in conjunction with orthodontic work if it has not been done earlier for feeding purposes. Any clipping is surgery and is a decision for parents and their physician to make.
Your baby also needs a stable mouth with just enough space inside to effectively nurse or bottle-feed. This stability is provided by the structures with which your baby was born(the roof of the mouth, sucking or fat pads in the cheeks, a cupped tongue, and closeness of the mouth structures). Without this balance in the mouth, your baby will develop patterns that may affect the way she will drink and swallow for the rest of her life.
The roof of the mouth, sucking pads, cupped tongue, and proximity of the structures allow your baby to develop what therapists call good intraoral pressure. Just like so many other systems in the body, the mouth is a “pressure system”. Without the right pressure in the mouth, the liquid cannot move smoothly and easily to the throat for swallowing. This can cause your baby to work harder that necessary when feeding.
Your baby should also have. This means that the entire mouth moves in a rhythmic manner. The nutritive suckle(where your baby takes in breast mile or formula)occurs approximately once per second. As your baby becomes more skilled with the suck-swallow-breathe sequence, she will suckle for longer periods of time without breaks. Nursing or bottle-feeding should occur in a relatively quiet, smooth process. If your baby makes high-pitched sounds,gulping sounds, or other struggling sounds, the liquid may be flowing too quickly from the bottle or breast. Your baby may also be out of position for feeding.
*Refer and quote from Diane Bahr,"Nobody Ever Told Me(or My Mother)That!",2010