Specialist article: oral motor skills
Breastfeeding is more than nutrition.It is the first training for the mouth and breathing
At the breast, your baby works with the lips, tongue and lower jaw and coordinates sucking, swallowing and breathing. Here you can find out what happens in the mouth, what studies show about tooth alignment, bottles and dummies, and what you can compensate for if breastfeeding is difficult or not possible after a caesarean section.
Does this sound familiar?
Breastfeeding is not working out as you hoped, and you are wondering what your child is missing?
What applies to you and your child?
Tap whatever applies to you.
If some of these points apply, that is no reason to feel guilty. A child who could not be breastfed is not condemned to develop poorly. Much of what the mouth does during breastfeeding can be supported in everyday life and practised specifically later on.
What happens at the breastWhat you can compensate forThe key points at a glance
- Breastfeeding challenges the lips, tongue and lower jaw and trains the interplay of sucking, swallowing and nasal breathing. In our view, it is the first calibration stimulus for breathing, swallowing and head balance.
- Studies link breastfeeding with less frequent misalignment of the teeth and fewer middle ear infections. Long-standing dummy habits change the dental arches. These are observational studies, but the direction is fairly consistent.
- After a caesarean section, early skin contact helps with starting breastfeeding. If breastfeeding does not work, the pattern does not catch up by itself, but you can compensate for a lot: slow drinking, limited dummy use, a clear nose, later chewing and targeted training.
Video
Breastfeeding: training for life
Das Video lädt erst nach dem Klick. Dann werden Daten an YouTube (Google) übertragen.
The first few minutes
Breathing, sucking, swallowing: a programme that is already in place
A healthy newborn does not first have to learn how to drink. The sequences have been prepared in the womb for months and are ready from the very first minute.
When placed on the mother’s tummy, a newborn often pushes its way head first towards the breast. Breastfeeding research calls this the breast crawl. It is also guided by the smell of colostrum, the first milk of the first few days. The baby breathes through the nose as it does so, because in an infant the larynx sits so high that the air takes the route through the nose as if by itself.
It is often said that babies can swallow and breathe at the same time. Strictly speaking, they swallow between breaths, and breathing pauses briefly at the moment of swallowing. A study from Boston showed that during breastfeeding the swallows fall in an orderly way between breaths and do not disturb the breathing rhythm1. A programme in the brainstem switches between letting air through and closing off in a fraction of a second.
At the breast the baby does not learn to drink. It calibrates a programme that is already there.In our view, breastfeeding is the first calibration stimulus for breathing, swallowing and head balance, the three basic functions on which chewing, speaking and free nasal breathing later build.
Oral motor skills
What your baby trains at the breast
Drinking at the breast is hard work for a baby. In the video, Dr. Klaus Berndsen compares it to a small milking process in which the whole oral cavity is involved.
Lips
They enclose the breast without any gap and seal the oral cavity at the front.
Tongue
It moves in waves from front to back and then lowers. In the process, the tip of the tongue finds the small elevation on the front of the palate, the incisive papilla. This is where the tongue reference position later begins.
Lower jaw
It works rhythmically against the elastic resistance of the breast.
Breathing
The air goes through the nose; swallowing happens between breaths.
aged 3 to 24 weeks were observed by a research group in Perth using ultrasound during breastfeeding, while the pressure in the mouth was measured2
negative pressure in the mouth was reached on average when the tongue had lowered the furthest. That is exactly when the milk flowed2
What matters for development is that this work takes place many times a day, month after month. In our view, this is the most intensive early training of the mouth. Touch and pressure on the edge of the lips, the tip of the tongue and the front of the palate give the nervous system exactly the feedback from which it builds its reference for the tongue, lips and airway.
Breast and bottle
Same milk, different work
Breast milk and breastfeeding are not the same thing. Expressed milk from a bottle is still breast milk, but the work in the mouth changes.
At the bottle, the baby does not have to draw the nipple into the mouth and shape it, because the teat is already in there. The milk flows more easily, often helped by gravity. The tongue and lower jaw have to do less, and the larger the hole in the teat, the more sucking turns into mere swallowing.
But not all bottles are the same. In the Boston study, researchers compared breastfeeding with two bottle systems. With the soft-walled system, the swallows fell in an orderly way between breaths, as at the breast. With the hard-walled system, the babies swallowed in a less orderly way, breathing was more disturbed and oxygen saturation was lower1.
At the breast
- The baby draws in and shapes the nipple itself
- Milk only flows once the tongue builds up negative pressure
- Lips, tongue and lower jaw work in rhythm
- The baby sets the pace and the pauses
At the bottle
- The teat sits ready in the mouth
- Milk flows more easily, often with gravity
- Tongue and lower jaw have to do less
- The pace depends heavily on the teat and position
How much the baby works at the bottle can be influenced. What helps is described further down in the section on compensating.
Dummy and negative pressure
What a dummy changes in the oral cavity
A dummy soothes, and used briefly it is no big deal. From a functional point of view, what matters is the number of hours it spends in the mouth.
For the oral cavity to be sealed, three things are needed: closed lips, a tongue that settles against the palate, and breathing through the nose. Then a slight negative pressure develops in the mouth, and the tongue gives the upper jaw support and direction from the inside. Without lip closure there is no such negative pressure.
A dummy lies exactly in the space that the tongue needs for this. As long as it is in the mouth, the tongue cannot settle against the palate, the lower jaw drops slightly and the lips only close around the dummy.
Why duration is so important is explained by a principle from orthodontics. For the position of the teeth, the forces acting at rest are what matter most, that is, the pressure of the tongue and lips3. Animal experiments showed that a force acting for only a tenth of the time changed hardly anything. If it acted for half the time, the effect was as great as with constant loading4.
Something stays in the mouth permanently
A dummy, thumb or bottle teat stays between the tongue and palate for hours.
The nervous system adapts
It stores the lowered tongue and the open mouth as the preferred pattern.
Form follows
The dental arches and palate develop under altered forces, which in many children is visible in the bite and tooth alignment.
Problems show up later
Mouth breathing, snoring or speech difficulties often appear only years later.
The data fit this chain. In Iowa, 372 children were followed from birth. Long-standing dummy habits changed the dental arches, and some changes persisted long after the habit was given up5. A Brazilian cohort found that breastfeeding made an increased overjet at the age of twelve less common, and to a large extent because breastfed children used dummies less6.
In its recommendations for safe infant sleep, the American Academy of Pediatrics names the dummy, alongside breast milk, for preventing sudden infant death18. From a functional point of view, duration is what counts. Discuss the dummy during sleep with your paediatric practice and limit it during the day.
Research
Breastfeeding and tooth alignment: what studies show
Whether breastfeeding influences later tooth alignment cannot be tested experimentally. Nobody would deny babies breastfeeding by drawing lots. The evidence therefore comes from observational studies, and its direction is fairly consistent.
for misaligned teeth in breastfed compared with never-breastfed children, pooled from 41 studies with 27,023 participants7
less common were moderate to severe malocclusions in five-year-olds who were exclusively breastfed until the sixth month, compared with those never breastfed, analysed in 1,303 children8
aged three to five were examined while chewing. Those who had been breastfed for twelve months or longer chewed better on average, regardless of bottle and dummy9
Not every study finds an effect. In Iowa, the duration of breastfeeding in the first year of life was not related to the measured dental arches, whereas the duration of dummy use was5. Such findings are part of an honest assessment. They also show how closely breastfeeding and sucking habits are linked.
Breastfeeding is an important early influence. Not the only one.Genetic disposition, nasal breathing, habits and illnesses also shape how the jaws and teeth develop. An early risk constellation does not determine the later dentition.
A survey of our own by Dr. Klaus and Sabine Berndsen from 2005 fits the picture, but is only an indication. Of 315 adults treated for snoring, 20% stated that they had been breastfed for at least six months. There was no comparison group without snoring19. You can find all studies on the method under Studies and science.
Bonding and health
Oxytocin, infections, middle ear: what else breastfeeding does
Breastfeeding is about more than the mouth. Mother and child attune to each other physically, and the milk brings antibodies with it.
When the baby sucks at the breast, the mother releases the hormone oxytocin. It makes the milk flow and is often called the bonding hormone. A review summarised 29 studies with 601 women. Breastfeeding immediately triggered a release lasting about 20 minutes. Stress hormones fell, and the women were less anxious and more open to contact12.
fewer middle ear infections in the first two years of life were associated with six months of exclusive breastfeeding, pooled from 24 studies10
The major review on breastfeeding in the journal The Lancet concluded that breastfed children are better protected against infections and against misaligned teeth11. For the middle ear, we additionally look at function. Anyone who breathes through the nose and swallows correctly ventilates the ear via the Eustachian tube. More on this in the article on Ear pressure and pressure equalisation.
Caesarean section
After a caesarean section: starting breastfeeding often needs more help
Many children are born by caesarean section. Breastfeeding is just as possible afterwards, but the start is more often difficult.
After a caesarean section, the mother has wound pain, the milk may come in later, and the first latch is often delayed. The child misses the journey through the birth canal. A large analysis from 33 countries shows where the hurdle lies, namely at the beginning, especially after a planned procedure before labour begins.
for early breastfeeding after a caesarean section compared with vaginal birth, analysed in over 550,000 mothers13
at six months, once breastfeeding had started. The start is the hurdle13
That is good news. What matters are the first hours and days. According to a Cochrane review, if the baby is placed naked on the mother’s chest directly after birth, mothers breastfeed exclusively more often, until discharge and for weeks afterwards14. Oxytocin also plays a part. After an emergency caesarean section, its release during breastfeeding was lower12.
Dr. Berndsen more often observes in children after a caesarean section that sucking is initially weaker and less orderly. This has not been studied. But it fits with the fact that starting breastfeeding is demonstrably more often difficult after a caesarean section, and it is a reason to give sucking particular support in the first weeks.
Plan skin-to-skin contact
Talk to the hospital and midwife in advance about skin-to-skin contact directly after birth, including in the operating theatre or recovery room.
Use breastfeeding support
Midwives and breastfeeding counsellors help with latching and positioning when the scar hurts.
Express rather than give up
If latching does not work yet, expressing keeps milk production going until it does.
Breast surgery and feeding problems
Breast surgery, tongue tie, weak feeding: when breastfeeding is difficult
Not every breastfeeding hurdle is due to the birth. Some lie with the mother, some with the child.
In breast augmentation, an implant lies in the breast tissue. A review found three small studies on this. Women with implants attempted breastfeeding just as often. But when they did breastfeed, they breastfed exclusively less often15. The data are thin.
If you are planning breast surgery and would like to breastfeed later, it is best to raise this during the pre-operative consultation. If you have already had surgery, you can seek support from a breastfeeding counsellor early on.
In the child, the tongue tie is often suspected first. According to the report of the American Academy of Pediatrics, whether cutting a tight frenulum improves breastfeeding has not been established. Many signs overlap with other breastfeeding problems, which is why it recommends that a team take a close look at feeding16. What matters is how the child feeds, not what the frenulum looks like.
If your baby feeds weakly, often chokes, turns pale or bluish while feeding, or does not gain weight, have this checked promptly at your paediatric practice. This applies especially to premature babies, in whom sucking, swallowing and breathing are often not yet fully developed.
Compensating
When breastfeeding is not possible: what you can compensate for
Not every mother can breastfeed, and not every mother wants to. What matters is what you can do for the function from now on.
In the video, Dr. Klaus Berndsen says clearly that the work at the breast cannot be reproduced one to one. If this early schooling is missing and further disruptive factors such as a dummy, bottle or blocked nose are added, a deviating pattern of tongue, lips and breathing can become established. In our view, it often shows up later as mouth breathing, tongue dysfunction or misalignment of the teeth and jaw.
This is no reproach to parents who could not breastfeed. The pattern does not catch up by itself, but the basic programme remains in place and is at most overlaid. Other stimuli have to step in, in everyday life and later in targeted training, because the pattern can be trained.
Let the baby do the work
Hold your baby fairly upright during feeding and the bottle fairly horizontal. Then the milk does not flow by itself, and your child has to suck.
Slow-flow teat
Choose a teat with a small hole and never enlarge it yourself. The bottle should not be empty within a few minutes.
Allow pauses
Briefly take the bottle out of the mouth now and then. That way your baby sets the pace and breathing rhythm.
Limit the dummy
Give the dummy purposefully, not as a permanent solution, and take it out as soon as your child is asleep or calm.
Keeping the nose clear
Make sure your child breathes through the nose. If the nose is blocked for a long time, have it looked at by a doctor.
Chewing and cups
From the time solid food is introduced, offer small pieces to chew and practise drinking from an open cup early on.
Your baby drinks 120 ml from the bottle in five minutes and chokes while doing so. What is a sensible first step?
Everyday life
Handling the dummy well
Many parents do not want to do without the dummy entirely. Then what matters is how long and how often it is in the mouth.
A Cochrane review found in healthy breastfed babies that a dummy did not measurably reduce the breastfeeding rate up to the fourth month if breastfeeding was already established. It contained no data on the effects on teeth and mouth17. The question of oral function is answered by the studies on dental arches and bite further up.
From a speech therapy perspective, a simple rule applies: treat the dummy like a medicine. With a clear reason, a limited duration and a fixed end, at the latest when the first words need the mouth20.
A reason, not a habit
Give the dummy to help your child fall asleep or for comfort, not constantly during play or in the pram.
Out once asleep
Once your child has fallen asleep, carefully take the dummy out.
Check advertising claims
Labels such as “orthodontic” do not change the fact that something lies between the tongue and the palate. The same applies to the thumb.
Wean early
The shorter the habit, the easier the goodbye. A swap ritual helps many children.
Later
When a compensatory pattern has become ingrained
Whether the early period has left traces often only becomes apparent at toddler and nursery age. Then it is worth taking a close look at the basic functions.
Mouth open
During play, watching TV or sleep, the mouth is often open.
Snoring
Your child snores or sleeps restlessly.
Tongue forward
When swallowing or speaking, the tongue pushes between the teeth.
Dummy or thumb
They are still often in the mouth long after the second birthday.
Frequent infections
Colds or middle ear infections keep coming back.
Teeth and bite
The dental practice notices issues with tooth alignment or bite.
A pattern that runs by itself cannot be changed with reminders. It is learned anew through many identical repetitions. That is exactly what FaceFormer therapy relies on. It trains breathing, swallowing and head balance together instead of strengthening individual muscles, and in our view thereby creates the conditions for lip closure and nasal breathing to become established.
Children practise with the FaceFormer ZERO. It has the same shape and size as the ONE, only the material is softer. In the basic exercise and the pull exercise the tongue settles against the palate and the air goes through the nose. The youngest practise through play, accompanied by the app character Facy.
Children under four only train with expert supervision. How training with children is structured, which exercise plans are available and how you can motivate your child is described in detail on the page FaceFormer for children. Please do not stop treatments prescribed by a doctor, dentist or speech therapist on your own. The training can be combined with them.
How nasal breathing, the tongue and swallowing are connected in childhood is explored in more depth in the articles on the tongue reference position, the swallowing pattern, adenoids and mouth breathing in children and lip closure. If your child snores, the article on snoring and sleep apnoea is worth reading. Why a nose that is little used for breathing tends to swell shut is explained in the article on the nasal septum.
Questions
Frequently asked
Why is breastfeeding good for oral motor skills?
During breastfeeding, the lips, tongue and lower jaw work in rhythm, and sucking, swallowing and breathing are coordinated with one another. The milk only flows once the tongue builds up negative pressure. In our view, this is the most intensive early training of the mouth and the foundation for chewing, speaking and nasal breathing.
Does breastfeeding influence tooth alignment?
Observational studies suggest so. In a summary of 41 studies, breastfed children had misaligned teeth less often than children who were never breastfed. Not every study finds this association, and genetic disposition, nasal breathing and sucking habits such as long-term dummy use also play a role.
Is expressed breast milk from a bottle just as good as breastfeeding?
In terms of nutrition, it is still breast milk. For the mouth it makes a difference, because the baby has to work less at the bottle. A slow-flow teat, an upright position and pauses during feeding help your baby to suck by themselves and set their own pace.
Can I breastfeed after a caesarean section?
Yes. After a caesarean section the start is more often difficult, for example because of pain or milk coming in later. According to a large analysis, once breastfeeding has started, mothers who had a caesarean are breastfeeding at six months about as often as after a vaginal birth. Early skin-to-skin contact and support from a midwife or breastfeeding counsellor help.
How long can my baby have a dummy?
From a functional point of view, what matters most is how many hours a day it is in the mouth and for how many months. Give it purposefully rather than constantly, and wean your child off it early, at the latest when your child starts to speak. Your paediatric practice can advise you on dummies during sleep and on preventing sudden infant death.
My child was not breastfed and breathes through the mouth. What can I do?
First have someone check whether the nose is clear. The pattern of lip closure, tongue reference position and nasal breathing can be trained. For this, children practise the basic exercise and pull exercise with the FaceFormer ZERO; children under four with expert supervision. More on this under FaceFormer for children.
More articles from the knowledge section
Where to go next
Sources
- Goldfield EC, Richardson MJ, Lee KG, Margetts S (2006). Coordination of sucking, swallowing, and breathing and oxygen saturation during early infant breast-feeding and bottle-feeding. Pediatric Research 60(4):450-455. PMID 16940236. Source
- Geddes DT, Kent JC, Mitoulas LR, Hartmann PE (2008). Tongue movement and intra-oral vacuum in breastfeeding infants. Early Human Development 84(7):471-477. PMID 18262736. Source
- Proffit WR (1978). Equilibrium theory revisited: factors influencing position of the teeth. The Angle Orthodontist 48(3):175-186. PMID 280125. Source
- Proffit WR, Sellers KT (1986). The effect of intermittent forces on eruption of the rabbit incisor. Journal of Dental Research 65(2):118-122. PMID 3455965. Source
- Warren JJ, Bishara SE (2002). Duration of nutritive and nonnutritive sucking behaviors and their effects on the dental arches in the primary dentition. American Journal of Orthodontics and Dentofacial Orthopedics 121(4):347-356. PMID 11997758. Source
- Feldens CA, Petracco LB, Nascimento GG, Li H, Vítolo MR, Peres KG (2023). Breastfeeding Protects from Overjet in Adolescence by Reducing Pacifier Use: A Birth Cohort Study. Nutrients 15(15):3403. PMID 37571340. Source
- Peres KG, Cascaes AM, Nascimento GG, Victora CG (2015). Effect of breastfeeding on malocclusions: a systematic review and meta-analysis. Acta Paediatrica 104(467):54-61. PMID 26140303. Source
- Peres KG, Cascaes AM, Peres MA, Demarco FF, Santos IS, Matijasevich A, Barros AJ (2015). Exclusive Breastfeeding and Risk of Dental Malocclusion. Pediatrics 136(1):e60-e67. PMID 26077480. Source
- Pires SC, Giugliani ER, Caramez da Silva F (2012). Influence of the duration of breastfeeding on quality of muscle function during mastication in preschoolers: a cohort study. BMC Public Health 12:934. PMID 23114410. Source
- Bowatte G, Tham R, Allen KJ, Tan DJ, Lau M, Dai X, Lodge CJ (2015). Breastfeeding and childhood acute otitis media: a systematic review and meta-analysis. Acta Paediatrica 104(467):85-95. PMID 26265016. Source
- Victora CG, Bahl R, Barros AJ et al., Lancet Breastfeeding Series Group (2016). Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. The Lancet 387(10017):475-490. PMID 26869575. Source
- Uvnäs Moberg K, Ekström-Bergström A, Buckley S et al. (2020). Maternal plasma levels of oxytocin during breastfeeding: A systematic review. PLoS One 15(8):e0235806. PMID 32756565. Source
- Prior E, Santhakumaran S, Gale C, Philipps LH, Modi N, Hyde MJ (2012). Breastfeeding after cesarean delivery: a systematic review and meta-analysis of world literature. American Journal of Clinical Nutrition 95(5):1113-1135. PMID 22456657. Source
- Moore ER, Brimdyr K, Blair A et al. (2025). Immediate or early skin-to-skin contact for mothers and their healthy newborn infants. Cochrane Database of Systematic Reviews 10:CD003519. PMID 41120189. Source
- Schiff M, Algert CS, Ampt A, Sywak MS, Roberts CL (2014). The impact of cosmetic breast implants on breastfeeding: a systematic review and meta-analysis. International Breastfeeding Journal 9:17. PMID 25332722. Source
- Thomas J, Bunik M, Holmes A et al., American Academy of Pediatrics (2024). Identification and Management of Ankyloglossia and Its Effect on Breastfeeding in Infants: Clinical Report. Pediatrics 154(2):e2024067605. PMID 39069819. Source
- Jaafar SH, Ho JJ, Jahanfar S, Angolkar M (2016). Effect of restricted pacifier use in breastfeeding term infants for increasing duration of breastfeeding. Cochrane Database of Systematic Reviews 8:CD007202. PMID 27572944. Source
- Moon RY, Carlin RF, Hand I, Task Force on Sudden Infant Death Syndrome (2022). Sleep-Related Infant Deaths: Updated 2022 Recommendations for Reducing Infant Deaths in the Sleep Environment. Pediatrics 150(1):e2022057990. PMID 35726558. Source
- Berndsen K, Berndsen S (2005). Stillen und Schnulleranwendung als Ursache für Schnarchen und nächtliche Atemaussetzer. Laktation und Stillen 2/2005:58-59. Short article with survey, without a comparison group. Source
- Furtenbach M, Wallner B (2009). Myofunktionelle Therapie (MFT) im orofazialen Bereich: praktische und kritische Aspekte aus logopädischer Sicht. Kieferorthopädie 41(4):259-264. Source
Get started
Ready for the training?
The free FaceFormer app guides you through the basic exercises, counts along and reminds you of your sessions. If you wish, a practice from the practitioner directory can support you.
FaceFormer ZERO + ONE
Both material hardnesses for getting started, day and night. The set for adults.
FaceFormer ZERO
The softer FaceFormer for getting started, for children and for the night.
FaceFormer ZERO Children’s Set
ZERO with hygiene box, plush bag and success book with stamp.
FaceFormer training aims to restore the physiological setting of the basic functions of breathing, swallowing and head balance, with lip closure and the tongue reference position, thereby creating the conditions under which symptoms can improve. It does not replace a medical assessment. You can find practitioners near you in the practitioner directory.
