Updated: Dec 25, 2020

Sucking and swallowing start to develop as early as the 17th week in utero. The coordination of sucking, swallowing and breathing is present at approximately 34 weeks of gestational age. Initially, the tongue moves up and down with the jaw and cups around the nipple. Lips surround the nipple without actively holding onto it. This is called true sucking as opposed to suckling.

Suckling develops when the infant learns to extend the head antigravity. The jaw begins to move up/down and forward and backward in large rhythmical movements to pump the milk. The tongue continues to move with the jaw, stroking the nipple and flattening it against the palate to extract milk towards the back of the oral cavity. Lips hold on to the areola like a ventouse, and remain contracted during swallowing.

Thus slight extension of the head and neck allows a variety of oral movements in line with suckling and facilitate the development of active and efficient oro-motor functions.

Tongue restriction can be caused by damage or strain to soft tissues either in utero or during birth, and can often be resolved by body work (Smyth A tongue restriction is not always a tongue tie). Dr A. Hazelbaker (lactation consultant and craniosacral therapist) assessment for lingual frenulum function include: -appearance of the tongue when lifted (when crying) -> shape (round, Vshape, heart shape), position (elevated, midline, down), lip positioning (closed, half-open, open) -elasticity of frenulum -length of lingual frenulum (>1cm, 1cm, <1cm) -attachment of frenulum to tongue (frenulum to tip distance) -movement of tongue (lateral, lift, cupping, peristalsis or backward movement in a wave-like motion)

Trained Osteopaths in paediatrics can proceed to an assessment of tongue mobility and detect the presence of true tongue-tie or restriction associated with cranio-facial tensions and soft tissue strain.

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