• Lauren Tandy

How Oral Habits Affect Facial Growth and Swallow Function

Not many parents understand completely how using a pacifier past 6 months to a year, thumb sucking, extended bottle use, or open-mouth breathing affect their child’s swallowing, dentition, facial structure, and overall wellbeing. Each of the topics listed above deserves its own article, but I will overview some key points here for you.

My graduate thesis was centered on artificial nipple usage and its effect on nursing. I was interested in this topic when I was in my master’s program with a newborn baby. Every time I asked a doctor, nurse, dentist, or lactation consultant if a pacifier was okay to use, I received a different answer. I didn’t feel comfortable going with someone else’s opinion. I wanted to find out the facts. I was especially interested in this topic because both my husband and I sucked our thumbs for an extremely extended period. I know personally how oral habits affect dentition, mouth breathing, and facial structure. I didn’t want this difficulty for my children. Here’s what I found:


  • Pacifier usage can actually be a benefit in the early months of life. Pacifier usage has been found by studies to reduce the instances of sudden infant death syndrome (SIDS).

  • If a baby uses the pacifier past 6-12 months, the pacifier becomes a security object that they develop an emotional attachment to based on their developmental progression.

  • The use of pacifiers was found to have a statistically significant negative relation to decreased nursing, according to my study.

  • It is recommended to reduce and discontinue pacifier use between 6 and 12 months to avoid long-term attachment. An alternative security object may help this process because a child of this age will need help to be comforted.


  • In my experience (11 years thumb sucking), my hard palate shaped around my right thumb. If ever I tried to suck my left thumb (which I often did when my mother used strategies such as painting my right fingernail with nail polish), it would not satisfy my oral need because the shape did not create a suction with my hard palate form.

  • Because I sucked my thumb through the development and growth of my oral and facial structure, my palate formed upward and into the area reserved for my nasal cavity. Because of this, I lost valuable airway space with decreased nasal airway passage. This also created open-mouthed breathing. I remember being told in P.E. at school that I am supposed to close my mouth to breathe. I didn’t understand why, but I tried. When I did, it only lasted for a minute, if that, because I didn’t feel like I was getting enough air. I would experience a “thirst” for oxygen and open my mouth to suck in the air.


  • Because I mouth breathed, I didn’t have air being filtered through the small cilia hairs in my nose. We are designed to breathe in through our nose for utilization of our natural filtration system. Essentially, there are tiny cilia hairs and mucosa that filters and warms the air as it passes through our nasal airway. This filters bacteria, tiny particles in the air, etc. When we breathe through our mouth and skip our filtration system, we get raw air. Whatever is in the air we receive in our lungs. Think about a water filtration system that you hook up to your sink, a respirator mask you wear when you’re painting, or the air filters we use in our central air systems for our homes. If we just don’t use those, we might get fumes, dust, smoke, etc. in our air. We might drink harmful metals or minerals that don’t benefit our bodies. Similarly, when we breathe through our mouth without our natural nasal filtration system, we may get sick more often, experience respiratory illnesses more often, or experience increased ear infections due to eustachian tube inflammation or airway inflammation. I know I had chronic bronchitis growing up that I could count on every winter.

  • In an open mouth position, the tongue sits forward. This is a forward resting posture. With typical resting posture, our tongue puts equal pressure around the alveolar ridge (the gum area that your teeth grow out of. This equal forward pressure helps our palate know where to grow. When our mouth is open and our tongue is not resting behind the alveolar ridge, we may have underdeveloped facial bones, narrow facial structure, and a small jaw with low muscle tone.


  • All of these things affect swallowing. The use of anything in the mouth for sucking promotes a tongue forward posture and tongue pumping to swallow. Tongue pumping is how a baby suckles and swallows from a bottle. This is supposed to change when they start drinking from a cup and eating from a spoon. The tongue starts cupping and retracting to receive liquid or food. Eventually, the tongue uses a backward wave or lateral (to the side) wave to move food to the back for swallowing (in typically developing swallows).

  • Disordered swallowing: This is called “DYSPHAGIA.” Children who don’t develop a retracted tongue posture for receiving and moving food and drink back for swallowing typically continue using an “immature swallow.” This would be the tongue-pumping motion we see infants use when they suckle from a breast or bottle. If you look at your child with this issue while they are swallowing, you will see the tongue coming past the teeth when they swallow. They might cough more often with swallowing due to decreased airway protection. They might purse their lips to keep their tongue from extending too far during the swallow. This is a disordered swallow that should be addressed and remediated for increased food and liquid control (to avoid food/liquid going into the lungs); for correct resting tongue posture to develop a wider hard palate and maxillary arch (facial bone); to promote increased nasal airway development for closed-mouth breathing, and for overall facial development (both functionally and cosmetically).

Lauren Tandy, M.S., CCC-SLP is the owner of Tandy Therapy LLC and treating speech-language pathologist who specializes in feeding and swallowing, oromyofunctional disorders, and early speech-language development. Please email hello@tandytherapy.com with questions or concerns

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