Myofunctional Issues Start in Infancy

Last month we featured an introduction to myofunctional therapy, and today we’re continuing on this topic as we focus on myofunctional issues beginning in infancy. These issues are very common – in fact, 3 out of 4 children show early signs of malocclusion by the time they are 5 years old. The implications of myofunctional issues go much further than the child’s smile and, as we will discuss, will affect growth & development, airway, learning, and behavior. So how can parents tell if their child has myofunctional issues?

Signs of tongue tie in baby and myofunctional issues are almost identical

Mother’s challenges related to either baby’s tongue tie or myofunctional issues:

• Creased, flattened or blanched nipples after feeding
• Cracked, bruised, or blistered nipples; bleeding nipples
• Severe pain when your infant attempts to latch
• Poor or incomplete breast drainage
• Infected nipples or breasts
• Plugged ducts
• Mastitis or nipple thrush

Symptoms of myofunctional issues found in breastfed babies:

• Poor latch; sliding off the nipple when attempting to latch
• Falls asleep when attempting to nurse
• Gumming or chewing of your nipple when nursing

Symptoms of myofunctional issues found in all babies (both breastfed and bottle-fed):

• Colic symptoms
• Reflux symptoms
• Poor weight gain
• Poor transfer of milk
• Unable to hold a pacifier in their mouth
• Swallowing issues
• Ear infections
• Gas
• Nasal obstruction or breathing issues; cyanosis
• Aerophagia
• Interrupted sleep
• Lethargy and sleeping too much

Symptoms of myofunctional issues found in older babies:

• Gagging
• Throwing up
• Refusal of certain food textures

Anatomical factors

Tongue-ties

Development of the swallowing system begins early – in fact, babies start to swallow in utero from around 16 to 20 weeks – and myofunctional issues can already begin at this stage. One anatomical condition which can lead to myofunctional issues is tongue-tie. This is thought to be a largely genetic condition in which the band of tissue connecting the tongue to the bottom of the mouth is too short, which restricts the movement of the tongue. The change in swallowing due to a tongue-tie can lead to conditions where the palate is not correctly shaped, such a “bubble palate” or “narrow palate”. This makes breastfeeding difficult, as it can be hard or even impossible for the baby to latch properly. In previous times, not being able to breastfeed could have been fatal. Often, midwives performed a quick technique to release tongue ties. In the 1900s, when births moved into hospitals, this knowledge and practice was lost.

Swallowing

Even some babies who do not have tongue restrictions can develop myofunctional problems early on. Some mothers are unable to or choose not to breastfeed, and being fed from a bottle creates a completely different swallow in the baby. Bottle feeding promotes a low tongue posture which is similar to that found in tongue-tied babies, and it has a similar effect on the development of the face and mouth. Whether from a tongue-tie or from a habit like bottle-induced low tongue posture, problems are often introduced in these swallow habits.

When a baby swallows correctly, the tongue pushes behind the upper front area of the mouth. This area is called to incisive papilla. Just under the gums there is a significant foramen, or hole, in the palate, which has a large nerve and blood vessels running through it which lead directly into the skull. When swallowing properly, the tongue puts around 500g of pressure on this tissue, which activates the pituitary gland and releases endorphins. If the tongue fails to exert this pressure correctly, often the baby will resort to sucking on a digit or pacifier to activate this endorphin release, which can become an almost addictive-like habit.

Joy Moeller, an expert in myofunctional therapy, explains that without the tongue reaching the roof of the mouth during swallowing, the sphenoid bone is not properly rotated and so the pituitary gland is not activated. Without this activation, critical growth hormones are not released from the gland. So proper swallowing is essential for optimal health.

Nasal breathing

The final anatomical issue to discuss that occurs in infancy and greatly affects growth and development of the face, jaw, teeth, and airway, is nasal versus mouth breathing. Babies are born as nasal breathers. Nasal breathing is ideal for many reasons: breathing through the nose cleans, warms, and humidifies the air before it passes over the lymph tissue (adenoids/tonsils) and before it enters the lungs. Nasal breathers have fewer allergy and asthma symptoms, and they rarely have problems with enlarged tonsils or adenoids, ear infections, or sleep apnea. For more information on these problems, see the articles from the Buteyko Institute which specializes in the treatment of chronic diseases which are caused by improper breathing.

Babies and children who are mouth breathers, unlike those nasal breathers, are the ones who most frequently suffer from these ailments, and mouth breathing is disastrous for the growth and development of the face, jaw, and airway. In many other countries which have not yet been investigated, you can see that mothers close their babies’ lips and encourage nasal breathing, and that children are expected to keep their lips closed while at rest. To see a relatively common example of the change which mouth breathing can cause, view these photos taken by Dr. John Mew.

These photos show a boy over several years of his development. In the first photo on the left, he is 10 years old and shows good facial development with handsome, well-defined facial features. In the photo in the middle and on the right, the boy is 17 years old. You can see that his face has changed considerably to become long and narrow, and he has an open mouth and a double chin. This change occurred after the boy was given a gerbil as a pet for his fourteenth birthday which caused him to experience problems breathing through his nose. As he began breathing through his mouth instead of his nose, his growth pattern was interfered with and his facial structure changed. Imagine the effects of starting mouth breathing as an infant!

Avoiding myofunctional issues

So, what can parents do to avoid myofunctional issues? Breastfeeding is the best option to avoid these problems. You can get help from a lactation consultant, known as an IBCLC (International Board-Certified Lactation Consultant), if you are having trouble breastfeeding. It isn’t just that breast milk is good for babies, but also that the effect of proper latching and nursing helps with growth and development.

Parents can also encourage nasal breathing in their babies by avoiding bottles, pacifiers, and preventing babies from sucking digits as much as possible. There is no judgment here – sometimes there will be reasons, issues, or concerns that completely prevent breastfeeding, and bottle-feeding will be necessary for the baby to eat, grow, and be happy.

Go to a provider who can help get your child back on track with their swallowing and rest posture from a young age. In our office we start myofunctional retraining and habit elimination with some children as young as 2 years old. So if you or your baby are experiencing the symptoms listed here and you are interested in learning more about myofunctional therapy, you should call us on 281-394-7040 for more information or to make an appointment.

In our next blog we will discuss the signs and symptoms of myofunctional issues in toddlers and elementary aged children.