What is a suck blister?
Babies begin to suck while they are still in utero. Sucking can be seen as early as 10 weeks gestation and swallowing as early as 12 weeks in utero.(1) During this early stage, they are managing the amniotic fluid surrounding them.
As early as 28 weeks gestation, the baby’s suck reflex is seen. A reflex is a reaction to a stimulus. In this case, when the baby’s top lip or just above the top lip is touched, the baby’s mouth puckers as if they are going to suck from a straw. Sucking at this age is not as strong and may be less coordinated until the baby is closer to full term.
A suck blister forms when there is friction on the baby’s lips. The baby’s lips create a seal when they latch at the breast. What we want to see are the lips relaxed and flanged with a large portion of areola tissue in their mouth after latching. Suck blisters result from compensations where the baby uses their lips to hold on to breast tissue for a variety of reasons.
Suck blisters can be on the top or bottom lip or both. On the top lip, it may be just in the middle of the lip or span the entire lip. Skin on the lips may appear two toned or swollen. No matter where the suck blisters are, it is a red flag that it is necessary to take a deeper look into why.
Other names for suck blisters
- Lip blisters
- Friction blisters
- Cobblestone lips
- Suck callouses
Reasons a baby might have suck blisters
Oral restrictions - there are 7 frenum in the mouth that connect the lips to the upper and lower jaw structure and the tongue to the floor of the mouth. They provide stability.(3) When the frenulum is short or tight, it restricts the movement of the lips and or tongue, depending on where the tie is located. If the lips are restricted, they will not be able to flange. The lips may curl in when latching and the baby can develop suck blisters. If the tongue is restricted and lacks normal range of motion, babies often compensate by holding on with their lips muscles more. The added friction will cause the lips to get blisters.(4)
Body tension - How your baby was positioned in utero, their birth and ties are all reasons your baby may have areas of tension in their body. Breastfeeding is a whole body activity. If there are areas of tension anywhere in their body, it can make it uncomfortable to latch deeply and nurse well. There is always body tension present with tethered oral tissue because of the pull it creates extending from the mouth to other areas of the body. The tongue is connected all the way to the toes so you may see areas of tension in the ribcage, hips or legs.(5)
Premature babies - Babies born early were still practicing their suck and swallow in utero. During feeding, they may have less coordination of their suck-swallow-breathe pattern, slower sucking and less sucking strength.(2) Working with a skilled IBCLC who can give oral exercises can help strengthen the muscles needed for feeding more effectively at the breast. More time spent at the breast practicing their latch and suck that is functional, will assist other areas of growth and development and faster weight gain. Being skin-to-skin with your baby helps regulate their breathing, temperature and ability to remain more calm which is helpful for successful breastfeeding. Premature babies do not have well developed fat pads in their cheeks which would help support the tongue during feeding. Instead, they may use other muscles to make up for the underdeveloped fat pads.
Cranial nerve dysfunction - The bones of the infant's skull are able to move in order for them to be able to get around the pelvic bone and be birthed from the vaginal canal. Sometimes a baby will get stuck in a position or need additional support to continue through the birth canal. Cranial nerves that communicate with the muscles in feeding may be pinched in the process and so feeding is impacted.
Why is correct sucking important?
Muscles are what direct the growth of the bones in the face and jaw.(1) Restrictions of movement from tension or oral ties decrease the range of motion a muscle will have. If the baby has a shallow latch and breast tissue is not pressing into the palate, the bones are instructed to grow up rather than wide. Over time, you see a more narrow jawline, high narrow palate, compromised airway development and crowded teeth as some of the results.
How to get rid of suck blisters
- Positioning - Position your baby on your body to give them stability. A position where they are more upright and gravity helps hold them to your body takes some of the pressure off of you and lets them do their work of latching. Try the Koala or laid back position. They are both more baby controlled rather than parent controlled.
- Latch - remember the importance of their neck being able to move both side to side and forward and back during the latching process. You may need to start with their mouth and nose well below the nipple so as they tilt their head back in gentle extension, they do not end up above the nipple. Their chin should be low enough on your breast that when their mouth is open wide, the nipple goes in their mouth just under their top lip rather than in the center of their mouth like a bullseye.
- Make an appointment with your IBCLC - a Board Certified Lactation Consultant who has taken continuing education in the areas of oral function can help you take a closer look at your baby to assess tension in their body and oral function or tightness as a result of oral restrictions. Not all IBCLCs have the same skill sets, so be sure to ask if this is a focus of their practice.
- Tongue tie release - before going for a tongue tie or other oral restriction release, you need to work with your IBCLC to prepare your baby. Exercises should be given by your IBCLC both before and after getting rid of the piece of tissue limiting the movement of your baby’s tongue or lips. Exercises that target the muscles that have not been being used and others that relax tight muscles from overuse will help for more success after a release. The exercises given will differ based on your baby’s function and limitations. Getting a release without the preparation work will not get the desired results and may make feeding more difficult for your baby.
- Bodywork - your IBCLC will be able to recommend a qualified bodyworker to address structural misalignments and other areas of tension. Being more comfortable in their body gives your baby more ease with movement and feeding.
How easy or hard it is for your baby to feed at the breast can be great information for improving their latch and feeding skills. Suck blisters on your baby’s lips from bottle feeding or breastfeeding, indicates an adjustment needs to be made. By addressing latching, tension and other challenges, you improve your baby’s foundation from which the rest of their growth and development build.
Footnotes:
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4462418/
- https://www.frontiersin.org/articles/10.3389/fped.2020.599633/full
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3636930/
- https://www.drghaheri.com/blog/2014/2/20/a-babys-weight-gain-is-not-the-only-marker-of-successful-breastfeeding
- https://airwaymatters.blog/2018/10/08/tongue-to-toes-the-whole-body-connection/
Resources:
https://www.legendairymilk.com/blogs/news/tongue-tie-and-breastfeeding?_pos=2&_sid=2adcbe5e8&_ss=r
