Self-Assessment Checklist that may identify compromised growth, development, and function
Age group: Newborn – 6 Months
Key Signs and Symptoms that You can Assess
If you have answered Yes to multiple items below, we would encourage you to schedule a comprehensive airway, tongue, and lip assessment for your loved one at Little Bird Pediatric Dentistry by calling 905-876-2473 (BIRD) or visit our website (www.littlebirddental.ca) for further information
*For specific findings, click on “” to see a picture example and the reasoning (or why) behind.
While Baby is Awake
Mouth open/lips apart at rest (when not babbling, playing) most of the day or routinely throughout the day
“Colic” symptoms (e.g. gassy, fussy, inconsolable)
Sensitive gag reflex
While Baby is Sleeping
Snoring with mouth open (more than 3x/week)
Restless sleep (always moving around and/or restless legs/arms)
Frequent awakenings, regular nightmares, and/or night terrors (more than 1x/week)
Sweating heavily (pajamas and/or sheets regularly damp)
While Baby is Feeding (Current* or History of Challenges)
a) Baby Signs/Symptoms
Poor latch (e.g. difficulty achieving or maintaining a good latch)
Gumming or chewing of nipple
Shallow latch (limited wide mouth opening)
Frequent gulping, coughing, gagging, and/or choking
Milk leaks or spills out the side of their mouth while actively feeding
Upper lip folded down (curled inward) and/or lower lip tucked in (curled inwards)
Callous or blister on upper lip
Dried milk residue/coating on back of tongue
(e.g. vomiting, regurgitation, frequent spit ups, crying after feeding, etc.)
Swallowing air regularly (increased gassiness, belly discomfort)
Insatiable baby (e.g. feeding every hour, falls asleep quickly when feeding and wakes shortly to feed again)
Poor weight gain, failure to thrive, and/or slows down weight gain
b) Mom’s Signs/Symptoms (if applicable)
Creased, cracked, bruised, flattened, blanched, cut, and/or bleeding nipples after nursing
Severe pain when attempting to latch and/or while nursing
Poor and/or incomplete breast drainage
Plugged ducts, infected nipples or breasts and/or mastitis
Drop in Mom’s milk supply
*For families with current feeding challenges (breast/bottle/solids), we would encourage you to seek assistance
from either your local lactation consultant or occupational therapist (OT)
Why: Prior to 6 months of age, baby has not yet developed the coordination involved in an adult breathing/swallowing pattern. Baby is however able to nose breath and feed simultaneously (either by breastfeeding or with spoutless open cups, syringe-finger feeding, etc.) because of the overlap between the epiglottis and soft palate.
Milk is able to pass this overlap through two channels, directed downwards towards their stomachs, and the upper passage to the middle ear known as the Eustachian tube is protected to allow for its opening and drainage with each swallow. This optimized feeding prevents or reduces the likelihood of baby developing an ear infection. (See Image 1: Optimized positioning for breastfeeding/nose breathing).
© Natalie Cormier with Little Bird
IF however, baby’s tongue or lip is restricted (tie), or tongue is pushed back from certain products, it may impede the ability for baby to latch and nurse, causing separation of the soft palate/epiglottis seal. Milk and saliva can therefore be directed downwards and upwards towards the Eustachian tube. As the Eustachian tube is unprotected, it can become irritated, inflamed, and develop an ear infection. (See Image 2: Compromised functioning).
If mouths are open (whether due to muscle memory, tongues trained to be down, tongue and/or lip tie, nose obstruction, etc.), it increases the likelihood of mouth breathing. Mouth breathing, snoring and/or heavy breathing are all possible audible signs of a compromised airway. In order to achieve optimized growth, development and sleep, the lips must be sealed at rest with the tongue up against the roof of the mouth (a.k.a. palate).
Why: A possible reason for frequent “clicking” could be that the baby has restricted/tethered oral tissues (tongue and/or lip tie). Clicking on the breast (or feeding mechanism) often occurs when baby cannot maintain suction or a good seal (latch) and with each “click”, they are swallowing air. Aerophagia is excessive swallowing of air. When excessive amounts of air reach the baby’s stomach, abdominal distension (expansion), burping, vomiting/regurgitation, and excessive gas may result. This can be very uncomfortable, resulting in baby’s upset and crying that worsens when laid on their backs. This is why clicking may be found in conjunction with colic.
Note: Although there are other possible reasons for “clicking” and colic, if observed, a caring & comprehensive assessment of the baby is recommended.
Why: In order to achieve an optimal latch/seal when nursing, the upper lip needs to be able to evert outwards, similar to “fish lips” allowing for maximal extension of breast tissue into baby’s mouth. If the upper lip is tethered (tied) and curls inward, it may prevent the extension of breast tissue as well as push the tongue backwards. If this occurs, there would be notable pain for mom on latch and while nursing, as the baby’s gum pad (instead of tongue against breast areola) would be compressing the nipple.
Why: Callous or blisters on upper lips may be signs of a restricted lip (tie). As instead of the upper lip being able to evert (fish lips) while nursing, it is curling inward and receiving extensive friction (rubbing).
Dry or cracked lips are a common sign that the baby is having their mouth open and/or mouth breathing. A restricted upper lip (tie) could prevent the baby from being able to close their mouth (lips sealed at rest), resulting in compromised mouth breathing.
Why: If dried milk residue on tongue is regularly noticed, it may be a sign of a restricted tongue (tie) causing altered tongue function. To which the portion of the tongue with the milk residue is unable to contact the roof of the mouth (palate) to be cleansed and cleared in an optimized swallowing pattern.
Why: Reflux symptoms may be caused by possible restricted/tethered oral tissues (tongue and/or lip tie). Tongue and/or lip ties may present with frequent clicking on the breast, difficulty achieving a good latch (seal) and swallowing air (aerophagia) to which during the day is coming out as gas or as vomit/ regurgitation. At night, you may see silent reflux, with the baby waking up in the morning congested. Congestion while sleeping is not always an allergy. Therefore, prior to Mom going on special diets and/or removing dairy (common allergens), it is encouraged to have baby assessed – as if a tie is present and treated appropriately allowing for baby to attain a good latch, symptoms may resolve.
Why: Optimized breastfeeding should be comfortable for both Mom and baby. Baby’s tongue should extend above and beyond their lower gum pad, forming a tongue to upper lip seal with Mom’s areola (breast). A possible reason for maternal nursing discomfort or difficulties can be from baby having restricted/tethered oral tissues (tongue and/or lip tie). If present, there is likely to be notable pain for Mom on latch and while nursing, as the baby’s gum pad (which is hard bone covered by a thin layer of soft gum) would be compressing against Mom’s nipple to hold breast in place and get milk to flow.