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Hot Topic Blog - Mouth Development & Function


By Patricia Pine, RDH, Orofacial Myofunctional Therapist in Fountain Hills, Arizona

September 2015


It’s very frustrating to any parent when a newborn infant has trouble sucking post-frenectomy/frenotomy (i.e, tongue-tie release/revision). However, a re-training suck technique can be taught once the tongue is “free.”  Remember the movie Free Willie?  Once Willie was released, he was free to do as he wished. Prior to a release or revision, the baby’s tongue has been tethered to the floor of the mouth and restricted in movement.  After the revision, the infant doesn’t automatically know what to do with the tongue. So, suck re-training is usually needed.

Here are some ideas to help a baby learn to use the tongue in a typical manner for sucking after a release or revision. First of all, be sure to follow the doctor’s instructions for proper wound care. See Dr. Bobby Ghaheri’s June 22, 2015 blog for one example of wound care following frenotomy.

When ready to work in a baby’s mouth, trim your fingernails to prevent cutting the baby’s delicate mouth tissue with your fingernails, wash your hands, and wear gloves (if you are not the baby’s parent). I feel that playing with the baby’s nose, lips, cheeks, and chin while producing silly sounds/faces and having fun with the mouth makes suck training fun for the baby and the parents.

Re-training the baby’s tongue to suck properly takes time and patience.  Suck training/retraining can be used to prevent sore, damaged nipples for the mother as well as to encourage nutritional sucking for the baby.

Facilitate sucking by placing your index finger (pad side up) into the baby’s mouth. Once the baby begins to suck, you can turn your finger over (pad side down) and let the baby suck. When the pad of your finger is placed on the baby’s tongue, you can help the baby learn to cup or groove the tongue. This cupping and grooving of the tongue is needed for an effective suck and swallow. If your index finger is too large for the baby, try your little finger. Make sure all of your fingernails are short.

After 5 or 6 sucks with tongue cupping and grooving on your finger, move the baby to the breast. If this hurts after 3 or 4 sucks, remove the baby from the breast and repeat the suck re-training with your finger.  Repeat this activity 3 to 4 times. If the pain continues, place pre-pumped breastmilk on your index finger by dipping your finger in the milk and allowing the baby to suck on your finger – you should feel the tongue cupping around your finger with the sucking pressure, even front-back tongue movement, and a slight wavelike motion in the tongue.  The baby should not gag if this is done properly. The baby lips should also be closed (i.e., latched) around your finger, because the combination of the lips and tongue should make tight seal.

You can also use a pacifier with a rounded nipple such as the Avent Soothie to teach a baby to suck using a cupped/grooved tongue. Dipping the pacifier into already extracted breast milk or formula is an option. Place the rounded nipple into the baby’s mouth onto the tongue. Then, gently pull it away from the lips and you should feel the sucking pressure. Play with the pacifier, make it a game, and teach the baby to suck on the tip of the pacifier as you pull it slowly out of the mouth. It is best to use a relatively short pacifier, so it does not gag the baby. It is also important to remember that pacifiers are used for suck training and calming as needed. Overuse of a pacifier can inhibit the development of mature swallowing and vocalization.

If the baby is not responding to the above methods, seek the help of a lactation consultant, feeding therapist, or orofacial myofunctional therapist who is trained in feeding babies. There are methods these professional can teach you such as the appropriate use of cheek support if your baby has limited or missing sucking pads (i.e., fat pads that develop in a full-term baby’s cheeks toward the end of pregnancy). There are also special feeding techniques that can be used such as syringe feeding along with suck training and supplemental feeding systems that may be used along with breastfeeding.

Additionally, babies who have tongue ties may have other ties in the mouth such as lip or buccal ties. Work with a doctor who is knowledgeable about these types of tethered oral tissues in the mouth. Here are a few websites to help you with this process:

-Breastfeeding Expertise of Catherine Watson Genna:

-For Better Health (Dr. Brian Palmer, DDS):

-International Affiliation of Tongue-Tie Professionals:

-International Lactation Consultant Association:

-Pediatric Dentistry/Tongue and Lip Tie (Dr. Larry Kotlow, DDS, PC):

-Tongue/Lip Tie and Breastfeeding (Dr. Bobby Ghaheri, MD):

-Tongue Tie (Dr. Jain, MD):

-Tongue Tie: From Confusion to Clarity (Carmen Fernando):

About the Author:

Patricia (Pat) Pine, Registered Dental Hygienist and Orofacial Myofunctional Therapist, has over 30 years of experience as a dental hygienist. Pat speaks nationally and internationally on topics in dentistry such as OSHA (Occupational Safety and Health Administration) safety and infection prevention.

She has expanded her education and practice to include Orofacial Myofunctional Therapy (OMT). Pat has a passion to help others keep their smiles forever, and this led her to create Muscles in Harmony where she assists patients in teaching unbalanced muscles to become harmonized muscles.

In her treatment, Pat creates a comfortable atmosphere for both adult and pediatric patients to fix their smiles and overall mouth function. OMT can begin as early as infancy and be used with people of all ages. It plays a huge role in correcting orofacial myofunctional disorders caused by inappropriate muscle function and/or incorrect habits involving the tongue, lips, jaw, and face. Unbalanced function and movement can affect muscles at any age. Orofacial myofunctional disorders can be corrected non-invasively for a healthy lifestyle, and OMT is also fun.

Pat believes in collaboration with other professionals for the best interest of the patient - the more knowledge the better. Her practice Muscles in Harmony is located in Fountain Hills, AZ. Additionally, Pat continues her education in both dental and orofacial myofunctional health. You may contact Pat at, and you are invited to visit her website at