Oral Play is the New Tummy Time, Not Just for Tongue Tie

What oral play is and why it is important for all babies, along with suggestions to start doing this and integrating it with your own babies and clients. If you feel it valuable, please copy the link and share this article with anyone and in places where you see families requiring more support on this.

What is oral play?

Oral play is exercises that involve the face, mouth and tongue. It is the intentional movement of the muscles and bones that ensures the proper development of the face, mouth and teeth, and also supports the baby in the development of a proper and safe swallow. It is focused on developmental play.

What is tummy time, and why did it become a must-do thing?

When I was a baby, I was lucky to have a simple metal bouncer. And since the early 80's, the use of props and toys to entertain and hold our babies has grown massively.

Anything that is designed to hold a baby instead of another human or the floor is called a "container", and it is called this because it is designed to CONTAIN baby, to hold baby safely so that they can be left unattended. 

Don't get me wrong, I am all for the use of containers appropriately so that parents can get a break, however, they should not be used without the understanding of what they remove from the development of baby.

When a baby is in a container, they usually have their head supported at the back and have little ability to exercise the appropriate range of movement in their necks. The most popular containers are car seats and buggies, in which baby cannot look up without pushing their chins forward; they cannot simply extend their neck because the back of the chair offers support. And this is okay.

Most of us are now aware that we should be doing "tummy time" for our babies because when a baby is on the floor on their tummy, they develop the strength in their own necks and backs to lift their heads and look around.

Tummy time for babies with reflux or silent reflux is frequently something parents come to me worrying about because it's a position that causes their baby to vomit immediately (through the direct pressure in their bellies). I equally find the opposite and that many babies with digestive discomfort prefer to be on their tummies, and this is because it offers gentle pressure on their stomachs.

I'll write a blog on Tummy Time for Babies with Reflux in a few weeks, so check back!

The point is that tummy time has become something that parents need to "do" because of this increased use of containers because there is less "just put baby on the floor" approach to parenting. we removed the freedom of babies to explore their surroundings, and so we must consciously create opportunities for babies to get this development opportunity.

How is oral play similar to tummy time, and why is it important?

In our modern world, we appreciate the importance of exercise to keep our muscles strong and toned, and indeed their importance to our health long term. However, we have also completely forgotten to exercise the muscles of the face. It is almost like we have forgotten that we have muscles in our faces!

And our babies are having less and less opportunity to exercise their facial, mouth and tongue muscles properly.

For babies who are bottle-fed, most bottles have a natural flow to the teat, in that if you hold the bottle upside down, the milk will flow naturally from it. This means that the baby gets the milk without having to actively engage their facial, mouth and tongue muscles. We can do stuff to help them; keep reading!

For babies who are breastfeeding and have a proper latch, they must use their tongue, cheeks and jaw muscles actively to remove and control the removal of milk from the breast. (note that if your baby cannot control the removal of milk from the breast or gets overwhelmed with a fast letdown, then they do not have proper control over the function of their face, mouth and tongue muscles. Keep reading).

When we start introducing solids, we are taking a slow approach, and for babies with reflux, especially those who have had trouble feeding, have a history of choking episodes, or struggle to get on with foods. This slow approach generally means we use purees more than foods that actually encourage chewing and the movement of the mouth. And I understand the worry that parents have around choking. Hence, a reason to go and do an infant first aid course if you haven't done one already.

Chewing foods is an excellent exercise for the jaw and tongue muscles. 

Are you the sort of person who gets rid of chewing gum early because it gets too chewy and makes your jaw tired? Perhaps what you need is MORE chewing at this stage... this is the point of exercise: to strengthen muscles and build up stamina.

In recent decades, we have started to believe that food that requires chewing is not of the highest quality. If our lamb doesn’t literally "fall off the bone" or "melt in your mouth", then we think it’s not good. We have become accustomed to being able to squish food with our tongue without chewing stuff quickly… we deem it “not good”. We avoid raw foods because they make us chew.

And so, our approach to feeding infants has reduced their need to use their mouths properly.

What is the impact of not doing oral play?

The reason to start doing oral play with your baby is not just to help them chew; it is to develop the muscles of the face and, importantly, to make sure they learn how to swallow safely.

There are lots of products, potions and expensive beauty treatments being sold all over the world for maintaining a young face.

What if you didn't need Botox?

What if you could simply keep and improve the tone of your face by exercising the muscles?

What if you knew you were not going to develop a saggy jowl or pendulous double chin by exercising the muscles of your face? What would you do?

Regardless of the actual appearance of the face, facial, mouth and tongue exercises have a vital role to play in the overall health of your child:

If the tongue is functioning properly and in co-ordination with the jaw and cheek muscles, they all hold the mouth closed at rest. This mouth-closed position means that your child is a nose-breather rather than a mouth-breather. And this comes with several direct benefits for life:

• Safe Swallow: There are a lot of people who do not know how the tongue should move or how to swallow safely, and I am one of them, being a person who regularly struggles with water going down the wrong way for no apparent reason. (1)
• Reduces illnesses: Mouth-breathing does not filter the air breathed in, and so the body has a higher exposure to dust, pollen and airborne viruses and bacteria. (2)
• Nose-breathing also promotes the production of nitric oxide, which improves the oxygen circulation in your body (3)
• Fresh-smelling breath and reduced risk of tooth decay: mouth breathing promotes the growth of pathogenic bacteria in the mouth (4,5)
• Reduced risk of sleep apnoea and breathing problems (6,7)
• Reduced risk of allergies and asthma (8, 9)
• Better sleep quality: the brain gets a better supply of oxygen, and so can reach the 4th stage of deep sleep (10)
• Proper formation of the dental arch: at rest, the tongue should be gently suctioned to the roof of the mouth, tucked in behind the upper gumline; over time, this position gently pushes the upper teeth outwards to make space for all the child's adult teeth to grow, or to "fit". (11)

Proper and frequent exercise for the face, mouth and tongue can play a vital role in your baby's development.

How do you know if your baby needs more oral play?

All children should be doing oral play, just like all children should be doing tummy time, however, it is more important for babies with oral function difficulties, and these include tongue tie (ankyloglossia), lip tie, buccal ties (cheek ties), muscular tension or muscular misalignments.

There are over 50 pairs of muscles involved in the process of swallowing alone, so it is not surprising that some babies struggle to learn this skill. (XX) If you observe your baby experiencing any of the following, it could be that they will benefit from more oral play as well as perhaps an oral assessment with a suitably qualified and experienced practitioner: (this list is not comprehensive)

• Frequent coughing, choking, gagging or spluttering while feeding (regardless of breast or bottle fed). This frequency could be every few days or every feed.
• Unable to hold onto a pacifier/dummy on their own. For example, if they are sleeping and their dummy naturally falls out of their mouth
• Open mouth position at rest (observe this when they are sleeping)
• Diagnosis of laryngomalacia / floppy larynx (blog post planned on this coming soon)
• Audible breathing or stridor (noisy, screeching or squeaking inhalation, sounding like the baby is struggling to breathe)
• Difficulty feeding comfortably
• Difficulty staying latched to bottle or breast
• Slips off the bottle or breast frequently
• Clicking sound when feeding
• Dribbling milk while feeding (breastfeeding or bottle feeding)
• You observe them getting overwhelmed with milk feeds
• Dislike lumpy foods
• Feeding aversions
• Baby cannot open their mouth very wide or for very long, or you observe that their chin opens off-centre.
• Thumb-sucking

How do you start with oral play?

Oral play starts off really simply: anything that has a baby moving their mouth. Babies and children mimic what they observe, so you can start to use your own mouth and tongue to create shapes and sounds for them to copy

• Exaggerate your tongue and facial movements when speaking to them; let them see that you move your face.
• Make weird and wonderful sounds and noises that encourage them to do the same.
• Smile, laugh, giggle, tickle and enjoy singing.
• Chew - show them how you chew food and move food around your mouth with your tongue.
• Use appropriate teethers that allow baby get their tongue out and teethers that go into and around their mouths. Personally, I recommend handling teethers and O-Balls for the way they encourage baby to use their tongue and mouths.

To supercharge your baby's ability to develop their tongue and facial muscles properly, I have a short mini-course called "It's All About The Tongue", in which we explore the importance of the tongue. It functions in greater depth, helping you assess if your baby has a tongue tie or muscular tension and what targeted and specific exercises you can do with them to develop sucking reflexes, tongue elevation, protrusion, and more really helping you help them.

See here for more details.

Head to the links below for similar suggested blog titles:

• ADHD, Baby Reflux and Tongue Tie: Is there a link?
• How Can I Support a Client's Baby with Tongue Tie and Reflux?
• Centile Charts and Weight are Being Used Against Babies with Reflux

References

(1).  National Institute on Deadness and Other Communication Diseases, Dysphagia, NIH Publication No. 13-4307, October 2010

(2).  Jason Wachob, MindBodyGreen.com How To Strengthen Your Immune System By Breathing Through Your Nose, Jul7 2020

(3).  Lundberg JO, Settergren G, Gelinder S, Lundberg JM, Alving K, Weitzberg E. Inhalation of nasally derived nitric oxide modulates pulmonary function in humans. Acta Physiol Scand. 1996 Dec;158(4):343-7. doi: 10.1046/j.1365-201X.1996.557321000.x. PMID: 8971255.

(4).  Motta LJ, Bachiega JC, Guedes CC, Laranja LT, Bussadori SK. Association between halitosis and mouth breathing in children. Clinics (Sao Paulo). 2011;66(6):939-42. doi: 10.1590/s1807-59322011000600003. PMID: 21808855; PMCID: PMC3129960.

(5).  Tamkin J. Impact of airway dysfunction on dental health. Bioinformation. 2020 Jan 15;16(1):26-29. doi: 10.6026/97320630016026. PMID: 32025158; PMCID: PMC6986941.

(6).  Izu SC, Itamoto CH, Pradella-Hallinan M, Pizarro GU, Tufik S, Pignatari S, Fujita RR. Obstructive sleep apnea syndrome (OSAS) in mouth breathing children. Braz J Otorhinolaryngol. 2010 Sep-Oct;76(5):552-6. English, Portuguese. PMID: 20963335.

(7).  Pacheco MC, Casagrande CF, Teixeira LP, Finck NS, de Araújo MT. Guidelines proposal for clinical recognition of mouth breathing children. Dental Press J Orthod. 2015 Jul-Aug;20(4):39-44. doi: 10.1590/2176-9451.20.4.039-044.oar. PMID: 26352843; PMCID: PMC4593528.

(8).  Bresolin D, Shapiro PA, Shapiro GG, Chapko MK, Dassel S. Mouth breathing in allergic children: its relationship to dentofacial development. Am J Orthod. 1983 Apr;83(4):334-40. doi: 10.1016/0002-9416(83)90229-4. PMID: 6573147.

(9).  Izuhara, Y, Matsumoto, H, Nagasaki, T, Kanemitsu, Y, Murase, K, Ito, I, Oguma, T, Muro, S, Asai, K, Tabara, Y, Takahashi, K, Bessho, K, Sekine, A, Kosugi, S, Yamada, R, Nakayama, T, Matsuda, F, Niimi, A, Chin, K, Mishima, M. Mouth breathing, another risk factor for asthma: the Nagahama study. Allergy 2016; 71: 1031– 1036.

(10).  Sara Rigby. Mouth-breathing: Why it’s bad for you and how to stop. February 2022

(11).  Grippaudo C, Paolantonio EG, Antonini G, Saulle R, La Torre G, Deli R. Association between oral habits, mouth breathing and malocclusion. Acta Otorhinolaryngol Ital. 2016 Oct;36(5):386-394. doi: 10.14639/0392-100X-770. PMID: 27958599; PMCID: PMC5225794.