Although breastfeeding is natural, it is very complex. To breastfeed, your baby utilizes their whole body during the process of latching and feeding. Suck blisters on the baby’s lips are a common sign of latching compensation. The blisters can have various appearances and may develop for several reasons. Identifying underlying issues and understanding how your baby latches will help you determine what will make feeding easier for your baby and eliminate their suck blisters.

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) they manage the amniotic fluid surrounding them during this early stage.

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. We want to see 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 onto 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. The skin on the lips may appear two-toned or swollen. No matter where the suck blisters are, it is a red flag, and necessary to take a deeper look into why they are happening.

• Lip blisters
• Friction blisters
• Cobblestone lips
• Suck callouses

Oral restrictions - there is 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 the normal range of motion, babies often compensate by holding on with their lip muscles more. The added friction will cause the lips to become blistered. (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, meaning 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 (International Board Certified Lactation Consultant) 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 a functional latch and suck will promote 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 calm, which is helpful for successful breastfeeding. Premature babies have less developed fat pads in their cheeks. Fat pads in the cheeks help support the tongue during feeding. Instead, they may use other muscles to compensate 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 impact feeding.

Muscles are what direct the growth of the bones in the face and jaw. (1) Restrictions of movement from tension or oral ties decrease a muscle's range of motion. 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 and narrow palate, compromised airway development, and crowded teeth as some of the results.

• 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 you, and lets them do their work of latching. Try the straddle/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. Position your baby with their mouth and nose below the nipple so as they tilt their head back in a 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 an IBCLC (International Board Certified Lactation Consultant) who has taken continuing education specifically in oral function. They can help you assess and identify areas of tension in your baby’s body and oral function or tightness due to 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 must 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 during and after a release. The exercises will differ based on your baby’s tongue mobility 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.

1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4462418/
2. https://www.frontiersin.org/articles/10.3389/fped.2020.599633/full
3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3636930/
4. https://www.drghaheri.com/blog/2014/2/20/a-babys-weight-gain-is-not-the-only-marker-of-successful-breastfeeding
5. https://airwaymatters.blog/2018/10/08/tongue-to-toes-the-whole-body-connection/

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