Bottle-Fed Babies: how to promote optimal craniofacial development
- Alex Kelly
- Jan 26
- 7 min read
Updated: Apr 2
The Following Information was Collaborated with Laurel Arnold, RDH, Orofacial Myofunctional Therapist
This is not medical advice. It is always best to consult with your personal, trusted providers.
A few fun facts:
Swallowing begins in utero at 13 weeks with amniotic fluid
Suck, chewing, and oral/facial muscle movements begin around week 14
Brainstem mediated primitive sucking begins at 25 weeks
An Important Note on Oral Ties
Oral feeding development begins to take shape immediately after birth with early feedings at the breast. It should be standard of care that every baby is evaluated for oral ties within the first week of life. This would aid in eliminating feeding disturbances and complications as their "suck-swallow-breathe” pattern is taking shape. For this is what truly influences muscle and facial development. However, it is important to note that the qualifications of the provider giving the diagnosis is extremely important. If you have been given a tongue or lip tie diagnosis, and/or you may be suspicious of one PLEASE read this before moving forward (What to Look for in a Tongue Tie Provider).
Bodywork and craniosacral therapy may also be beneficial to babies born with birth trauma. I, personally, recommend it for every single baby regardless of how the birth went. The tension that craniosacral therapy alone can remove can make a huge difference in their latching ability, and overall oral and bodily development.
Breast-Fed vs Bottle-Fed: Craniofacial Development
The following is not at all a debate about formula vs breast milk, but rather a breakdown of the factual differences in feeding pattern that are developed with each.
Breastfed babies are more likely (but not always!) to have an optimal craniofacial development pattern compared to babies who are bottle-fed. Dr Brian Palmer says, “when baby is latched efficiently, the breast is drawn deeply in the baby’s mouth. This deep latch supports and maintains the normal wide and flatter shape of the palate (the roof of the mouth)." Bottle fed babies use their buccinator & lip muscles to feed, compared to breastfed babies who primarily use their tongue.
How to Promote Optimal Craniofacial Development in Bottle-Fed Babies
Bottle Choice
Choose a bottle with a nipple that promotes optimal feeding patterns and a proper latch. Slow flow nipples are typically recommended because it allows baby to control the milk flow and develop better sucking patterns.
❌Avoid: nipples with a wide neck and short nipple (i.e Tommee Tipee)
✅Look for: nipples with a gradual slope
Lansinoh Momma
Pigeon SS
EvenFlo Balance
See a visual video of ❌ and ✅ nipples here.
We use EvenFlo Balance+ WIDE NECK nipples and they work with the following bottles: Philips Avent, Nanobebe, Spectra, Nuk, Maymom, Avima, Parents Choice, Momi, Baby Buddah. There may be more, but these are the ones I know if.
Nipple Flow
Slow flow nipples are typically recommended because it allows baby to control the milk flow and develop better sucking patterns
Pacifiers
Ideally no pacifier use is recommended. From birth, infants should be resting/sleeping with their tongue up in the palate, pacifiers hinder this proper resting position. When it isn’t, we need to dig deeper to figure out why. Are ties present? Are they carrying tension that needs released by a CST or body worker?
If there is pacifier use it is best to eliminate the habit by the time the child is transitioning to a chew pattern (6 months), and choose one that is cylindrical shaped like the Ninni pacifier, or any of these.
If babies are open mouth sleeping/breathing, parents can encourage tongue up position by gently closing their lips & pushing up under the chin and holding for 3-5 seconds. A gentle pull down of the chin is beneficial to check on that resting tongue position.
Thumb/Finger Sucking
If the tongue isn’t naturally resting up, children often use a thumb or finger sucking habit to achieve the neurological stimulation of the trigeminus receptors on the palate. The sucking habit will provide a release in both physical and psychological tension. This can, of course, cause oral dysfunction and structural issues as the child grows. It is best to eliminate and encourage tongue up as early as possible.
Starting Solids
Soft purées are not recommended as the main source of food as they do not require the chewing action needed to help develop oral muscles and cranial growth. Food pouches are also not recommended because they encourage an extended sucking pattern when children should be transitioning to the chew pattern. This can lead to incorrect swallow patterns.
Baby led weaning allows for children to safely begin to work on their chew pattern while also working the muscles of the jaw to stimulate that optimal cranial and facial development. Safety should be taken into consideration to foods served, paying attention to which teeth have erupted. The app Solids Starts is a great resource. You can easily search any food, and they will visually show you how to properly prepare it for baby's age.
As children grow, crunchy foods such as carrot sticks, apple slices, and beef jerky are great examples of foods that encourage chewing.
Avoid Sippy & 360 Cups
While sippy cups aren’t inherently bad, a prolonged use can cause malocclusion (crooked teeth), dental decay, and muscle imbalances.
Highlights from Jill Savolt, RDH, Myo Therapist
A sippy cup is meant to be used SHORT-TERM as a child transitions from the breast/bottle to an open & straw cup. Children should begin transitioning away from a sippy cup and to an open cup at around 6 months, as this is the time they start to develop the proper muscle functions of the tongue, lips, and throat, and develop their mature swallow.
The reason why you do not want to prolong the use of sippy cups is because the spout teaches incorrect tongue placement.
When you swallow, your tongue should RISE to the roof of your mouth and behind your teeth. When you drink from a sippy cup your tongue is forced to DROP underneath the spout and into the floor of the mouth, encouraging all the wrong muscles.
They promote the suckle-like pattern that infants use for breast and bottle feeding, which limits the child’s ability to develop a more mature swallowing pattern, especially with continued use after the first year (Melanie Potock, MA, CCC-SLP). The spout of the sippy cup forces the child to continue to push their tongue forward and back, perpetuating suckling.
The Issue with 360 Cups
Not only do 360 cups also perpetuate biting and suckling, they force the neck and head of the child into extension which puts the airway at risk. They also require over-activation of the top lip and over-use of the jaw to support top lip pressure (Melanie Potock).
The Benefits of Straw Cups
Speech and Lip Development: when children drink through straws they develop strong lip muscles by sealing them around the straw. These muscles are needed for the early consonant sounds m, p, b. Straws improve lip rounding, which is necessary for drinking and swallowing (as well as speech and language development).
Proper Tongue Position and Development: drinking through a straw encourages children to keep their tongue in the correct position, which can help prevent the negative effects of mouth breathing. The retraction and elevation to the roof of the mouth that straws promote is considered a safe and mature swallow.
Teeth Development: drinking through a straw keeps the lips toward the front of the straw, protecting teeth alignment. Proper lip placement decreases suckling, which avoids pressure that could negatively impact teeth development.
What to Look for in Straw Cups
Non-Valved Straw Cups
Valved straws promote more of a suckling motion than sipping which is needed to help develop a mature swallow and facial development. Valves create an abnormal motor pattern. You want your child to have a rounded lip and suck with control, no force. You don’t want your child to have to bite and brace in order to drink. Many cups have their valves in the straw vs in the lid (example Zak). Cups like these you can easily trim off the valve - turning it into a regular straw.
Thin Straws
Thin straws are *more important when first learning to drink through a straw. They bring up a smaller portion of liquid which makes it easier/safer to swallow, thicker straws can be more difficult to drink out of when it comes to tiny baby/toddler mouths, it can also cause a child to drink too much liquid too quickly lowering their capacity for solids.
Short Straws
A short straw allows the tip of the straw to to just reach the tip of the child’s tongue. This allows the tongue tip to reach UP in order to develop a mature swallow pattern.
*the Talk Tools HoneyBear is a great cup when first teaching out to drink out of a straw
The Benefits of Open Cups
Open cups activate lip closure and tongue elevation.
Facial Development: drinking from an open cup allows the facial muscles and bone structure to grow normally, promoting proper speech, feeding, and swallowing skills
Swallowing Development: The mature swallow pattern is with the tongue elevated toward the roof of the mouth. Drinking from an open cup helps promote this mature swallow. *when babies/toddlers drink from a sippy cup they are forced into an immature swallow with their tongue being thrusted forward.
Speech Development: drinking from an open cup can promote speech development. It promotes strong lip closure which is needed for producing the m, p, and b sounds in English, Spanish, and other languages. It also promotes proper tongue elevation for the t and d sounds.
What to Look for in Open Cups
Size: if a cup is too big for baby then it’s like drinking out of a huge bucket, which can cause unsafe swallowing. You want a cup that fits easily in baby’s hands and a rim that fits comfortable in the corner of their lips.
Interior Slope: some cups like the ezpz have an interior slope for an even flow for a safer drinking position.
Other Ways to Promote Proper Jaw Development for Babies - Older Kids
TalkTools has great teething and chew devices to help guide the child from infancy sucking pattern to toddler chew pattern
The MyoMunchee Bebe can be used for oral stimulation instead of a pacifier. It helps train the tongue to be in proper position up on the palate. This allows the tongue to provide the nervous system stimulation rather than something like a pacifier.
Avoid pacifiers (at least wean by 4-6 months)
Use the REMplenish MyoNozzle
Give child chewy foods, not just pouches and puffs
Jerky and Tough Meats
Apples, Carrots, Celery, etc.
Make sure any tongue/lip tie is addressed
Skip the sippy & 360 cups, instead choose...
non-valved straw cups
open cups
thin, short straws
hard straws if child has a biting/chewing habit
use ARK’s Lip Blok to naturally exercise the mouth muscles, discourage tongue thrusting, promote tongue retraction, and correct overall tongue positioning
Incorporate oral activities into daily routine
blow through whistles
drink through straws
blow cotton balls across the table
blow bubbles (ARK’s Bubble Straw is a great tool)
Lastly, it is important to note that other factors can contribute to struggles in development and function: premature birth, genetic conditions, etc.
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