Self-Assessment Checklist that may identify compromised growth, development, and function

Age group: Newborn – 6 Months

 

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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.

*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

 Mouth open/lips apart

 Snoring with mouth open (more than 3x/week)

 Gasp/stop breathing

 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 clicking sounds

 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

 Reflux symptoms
(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)

Baby awake mouth OPENWhy: At rest (when not eating, babbling, etc.), our mouths should be closed with lips sealed. If mouths are open routinely, it increases the tendency to mouth breathe. Learn more about the importance of nasal breathing for further information.
Colic symptomsWhy: Colic is an exhausting, unrelenting, all consuming condition that causes an otherwise healthy infant to cry inconsolably. Most commonly occurring from 2 to 16 weeks of age. A possible reason for these symptoms could be that the baby has restricted/tethered oral tissues (tongue and/or lip tie). As consequence, they may be clicking on the breast (or feeding mechanism), and/or unable to attain a good seal (latch). 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 gassiness may result. This can be very uncomfortable, resulting in baby’s upset and crying that worsens when laid on their backs. Although there are other possible reasons postulated for colic, if observed, a caring & comprehensive assessment of baby at Little Bird is recommended.

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).

Image 1: Optimized positioning for breastfeeding (can nose breathe and swallow at the same time)

Image 1: Optimized positioning for breastfeeding (can nose breathe and swallow at the same time)

Image 2: Compromised functioning (tongue restriction/tie) and/or tongue lacking muscular strength needed for optimized function

Image 2: Compromised functioning (tongue restriction/tie) and/or tongue lacking muscular strength needed for optimized function

© 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).

Why: When sleeping our mouths should be closed with lips sealed, guaranteeing that we are breathing through our noses. Learn more about the importance of nasal breathing.

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).
Restless sleepingWhy: Restless sleep and sweating can be possible indications that the baby’s sympathetic nervous system (fight or flight) is being activated causing arousals (that may not awake baby) in attempt to maintain their airway. If this is occurring, baby may not be achieving consistent deep sleep with full muscle relaxation (parasympathetic nervous system – rest and digest activation) that is necessary for optimized growth and development.

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.

Compromised functioning (tongue restriction/tie) and/or tongue lacking muscular strength that may cause clicking, swallowing air, etc.

© Natalie Cormier with Little Bird

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.

Upper lip everted (fish lips) allowing for an optimized latch

Upper lip everted (fish lips) allowing for an optimized latch

Optimized- Upper lip everted (fish lip, outwards)

Optimized- Upper lip everted (fish lip, outwards)

© Natalie Cormier with Little Bird

Upper lip inverted (folded/curled inward) impeding an optimized latch

Upper lip inverted (folded/curled inward) impeding an optimized latch

Compromised – Upper lip inverted (folded, curled inwards)

Compromised – Upper lip inverted (folded, curled inwards)

© Natalie Cormier with Little Bird

Lip tie callous

Baby sleeping with lips apart at rest, and with a central bubble on their upper lip. A potential sign of a
lip tie.

Lip Tie - Upper Lip Callous dry cracked

Baby sleeping with mouth wide open, notable dry/cracked lips and central upper lip with callous. A potential sign of a lip tie.

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.

The area of the tongue with continued dried milk residue, denotes the area of the posterior tongue that is not able to move/function optimally.

The area of the tongue with continued dried milk residue, denotes the area of the posterior tongue that is not able to move/function optimally.

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.

Baby reflux

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.

Optimized breastfeeding

Optimized breastfeeding

Compromised breastfeeding due to tongue restriction (tie).

Compromised breastfeeding due to tongue restriction (tie).

© Natalie Cormier with Little Bird
Plugged ducts, infected nipples or breasts and or mastitisWhy: A possible reason for plugged ducts and mastitis may be that the baby has restricted/tethered oral tissues (tongue and/or lip tie). Instead of a comfortable tongue to upper lip seal from baby for optimized breastfeeding, baby’s gum pad is compressing Mom’s breast and/or nipple. These excessive forces/pressure from the gum pad on the breast tissue can impede even drainage blocking flow and leading to possible various outcomes (i.e. plugged ducts, infected nipples and/or mastitis).
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