Optimized Growth, Development and Function

Age group: 6 Months – 2 Years Old

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Key Signs and Symptoms that You can Assess

If you have answered Yes to 1 or more items in the checklist below, this may indicate an opportunity to improve the growth, development and function of your loved one.

We would encourage you to schedule a caring & comprehensive assessment at Little Bird Pediatric Dentistry by calling 905-876-2473 (BIRD) or through the “Schedule an Appointment” button on our website (www.littlebirddental.ca).

*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 Child is Awake

 Mouth open (lips apart) most of the day or routinely throughout the day for over 30 seconds at a time

Why: At rest (when not eating, babbling or speaking, 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 symptoms

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.

 Chronic running/congested nose

 Difficulty breathing through nose

 Dry, cracked lips and/or habit of licking lips

 Frequent infections (Ear infections, Strep throat, Tonsillitis, etc.)

Frequent infectionsWhy: Following 6 months of age, anatomical changes take place (maturational descent of the epiglottis) alongside baby’s transition into developing a coordinated adult breathing/swallowing pattern.Possible causes for continued frequent infections may stem from mouth breathing, which lacks any filtration, thereby causing potential for inflammation and insult to the tonsils and adenoids. This may lead to an increase in size of the tonsils and adenoids (furthering airway compromise) and/or infection.Another possible cause is if the child has a restricted/tethered tongue (tie) with/without a compromised swallowing pattern known as a tongue thrust swallow. This swallowing pattern may not allow for necessary protection of the Eustachian tube when opening/draining with each swallow, and as such predisposes the child to developing ear infections.

 Regularly have bags (dark circles) under eyes

Why: Bags or dark circles under eyes are due to venous pooling, and is a sign that a child is not attaining a necessary length of quality (deep) sleep. This may be found in association with open mouth posture (mouth breathing while sleeping), snoring and/or heavy breathing (aka. breathing disordered sleep). Please see sleeping section below for further signs and symptoms that you can assess.

 Avoidance crunchy/fibrous foods (picky eater)

Picky eater 2 year oldWhy: There are many possible reasons for picky eating, however one that must not be overlooked is if the child has a mouth-breathing (open mouth) tendency, commonly seen in conjunction with a restricted/tethered tongue (tie) and/or compromised tongue thrust swallowing pattern.In this case, the child will tend to prefer a soft food diet that does not require much chewing as it is very challenging to breathe and eat with our mouths (humans are designed to breathe through our noses and eat with our mouths). Recall the last time you were sick with a congested nose, your diet too, likely consisted of soups, eggs, and soft foods.

Another possibility is if the child’s diet following 6 months was limited to soft foods that did not require the use of their muscles for chewing, they may develop a preference towards these foods.

 Smacking sounds when chewing/swallowing

 Crowding of teeth and/or anterior open bite (space between front teeth when back teeth are touching)

Primary teeth anterior open bite

Child with all their baby (primary) teeth, demonstrating an anterior open bite (space between upper and lower front teeth, when back teeth are together)

Why: If a child’s tongue rest posture and function are optimized along with lips sealed and nasal breathing, their palate (roof of mouth) will likely develop to be flat and wide, allowing for adequate space for teeth to erupt (without crowding). However, if one of these elements is not followed (i.e. tongue resting low in the mouth, compromised tongue thrust swallow, open mouth tendency and/or mouth breathing), the palate (roof of mouth) will likely develop to be narrow, high arched (can fit a thumb up) without adequate space for teeth to erupt, resulting in crowding.The same compromised elements may also lead to the presentation of an anterior open bite (as seen in the picture), where there is a space between the front upper and lower teeth.

 Hyperactivity throughout the day

Why: Although there are various possibilities for hyperactivity, one must understand that this is a common feature of children whom are over-tired, and may be showing signs of breathing disordered sleep (i.e. mouth breathing, snoring, obstructive sleep apnea, etc.). Young children are not able to comprehend being over-tired, and instead may demonstrate hyperactivity and an inability to focus or concentrate. Older children, teenagers and adults differ, as they are able to understand when they are tired and act accordingly. For example, think of when you drive late at night and are feeling tired. In order to stay awake, you might turn the volume up on the radio, roll down the windows and/or move around.

This is precisely what younger children are doing when they are overtired, but many times do not know how to stop.

 Limited attention span (difficulty concentrating/focusing, etc.)

While Child is Sleeping

 Mouth open (lips apart)

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 (aka. palate).

 Snoring or heavy noisy breathing (more than 3x/week)

 Gasp/stop breathing

 Drool on pillow (regularly)

 Audible teeth grinding

Why: Teeth grinding, restless sleep and/or sweating heavily can all be possible indications that the child’s sympathetic nervous system (fight or flight) is being activated causing micro (small) arousals (that typically do not awake the child) in attempt to maintain their airway (breathing). If this is occurring, your child may not be achieving consistent deep sleep with full muscle relaxation (parasympathetic nervous system – rest and digest activation) that is necessary for their optimized growth and development.

Primary teeth grinding

Upper baby teeth of child with generalized tooth grinding, showing even/flat wear across all upper teeth

 Restless sleep (always moving around and/or restless legs/arms)

 Sweating heavily while sleeping (pajamas and/or sheets damp)

 Regular nightmares and/or night terrors (more than 1/week)

Night terrorsNight terrors

Why: Amongst a list of possible causes that includes stress, etc. Regular nightmares or night terrors may also be an indication that the child’s sympathetic nervous system (fight or flight) is being activated causing a macro (large) arousal (that will awaken the child) in attempt to re-establish and maintain their airway (breathing). We must remember that the number one goal of our bodies is to keep us alive – keep us breathing; therefore if there is any airway compromise while asleep, our bodies will be triggered to awaken.

If this is occurring on a regular basis, your child may not be achieving consistent deep sleep with full muscle relaxation (parasympathetic nervous system – rest and digest activation) that is necessary for their optimized growth and development.

 Any History of Breastfeeding Difficulties
*If currently breastfeeding see below

Difficulties Breastfeeding (If Applicable)

a) Child’s Signs/Symptoms

 Difficulty achieving or maintaining a good latch (aka. poor latch)

 Gumming or chewing of nipple when nursing

 Clicking sound while nursing

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 the child 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 child’s stomach, abdominal distension (expansion), burping, vomiting/regurgitation, and excessive gas may result. This can be very uncomfortable, resulting in child’s upset and crying that worsens when laid on their backs. This is why clicking may be found in conjunction with a history of colic.

Note: Although there are other possible reasons for “clicking” and colic, if observed, a caring & comprehensive assessment of the baby is recommended.

Compromised breastfeeding due to tongue restriction (tie).

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

© Natalie Cormier with Little Bird

 Milk leak or spill out the side of the mouth while actively feeding

 Upper lip folded down (curled inward) when nursing

 Callous or blister on upper lip and/or dry, cracked lips

 Dried milk residue on tongue

 Reflux symptoms
(Vomiting, regurgitation, inability to sleep on back, crying after nursing, swallowing air during nursing, wakes up congested)

 Poor weight gain and/or failure to thrive

 

b) Mom’s Signs/Symptoms

 Creased, cracked, bruised, flattened or blanched nipples after nursing

 Bleeding or cut nipples

 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

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).

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.

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