The role of the palate, tongue and frenulum in effective breastfeeding
Breastfeeding may seem natural, but from a biomechanical perspective it is one of the most complex activities performed by a newborn. To remove milk effectively, the baby must precisely coordinate the tongue, jaw, palate, lips, cheeks and breathing.
When any of these elements does not function as expected, difficulties may include:
- nipple pain,
- biting the breast,
- a shallow latch,
- a clicking sound while sucking,
- frequently pulling away from the breast,
- poor milk transfer,
- insufficient weight gain.
The source notes that feeding difficulties are not always caused by the lingual frenulum alone. Assessment increasingly considers overall oral function and the quality and coordination of the sucking pattern.
1. Why does a baby bite the breast?
Mothers often describe feeding as 'biting'. In reality, most babies do not bite deliberately.
Most often, the baby compensates by clenching the jaw.
The source interprets this as the baby trying to hold the nipple between the gums because the tongue and oral seal are not maintaining suction effectively.
This may happen when:
- the tongue does not lift high enough,
- the tongue has limited mobility,
- the child is unable to maintain a sealed contact with the palate,
- the vacuum repeatedly ‘breaks’,
- the breast slips out of the mouth.
In this situation, the body activates an emergency mechanism: jaw clenching.
The mother may then experience:
- pinching,
- compression of the nipple,
- pain towards the end of a feed,
- a flattened or misshapen nipple after feeding.
This is not a sign that the baby is being deliberately difficult, but an attempt to stay latched onto the breast despite difficulty sucking effectively.
2. What does the palate have to do with feeding?
The palate acts as a kind of ‘working ceiling’ for the tongue.
During sucking, the tongue does more than simply move the milk.
First, the baby repeatedly presses the nipple and areola against the palate, creating a stable point of support.
If the palate is:
- very high,
- narrow,
- Gothic,
- asymmetrical,
the tongue has a much more difficult task.
The child may be unable to make full contact with its surface.
The effects are highly characteristic:
- loss of seal,
- drawing in air,
- clicking,
- frequent unlatching from the breast,
- fatigue during feeding.
Ultrasound studies show that effective feeding requires harmonious cooperation between the tongue, nipple and palate. Even minor disruption of this cooperation may impair milk transfer.
3. How does the tongue create a vacuum during sucking?
Only a dozen or so years ago, it was believed that a baby mainly 'squeezed' milk from the nipple.
Ultrasound studies and measurements of pressure within the oral cavity have now shown that a dynamically generated vacuum plays a key role.
The Process Is as Follows:
-
Opening the mouth wide
The baby takes not only the nipple but also a significant part of the areola into their mouth. -
Sealing
The lips and cheeks form a tight seal.
This prevents air from entering. -
Tongue elevation
The middle part of the tongue rests against the palate.
The tip of the tongue remains extended over the lower gum ridge. -
Lowering the middle of the tongue
At this key moment, the middle of the tongue lowers, increasing the volume of the oral cavity.
Negative pressure, or a vacuum, is created and draws milk from the milk ducts. -
The Tongue Returns to Position
The tongue rises to the palate again.
The cycle repeats as many as several dozen times per minute.
The main driving force is therefore not ‘biting’, but rhythmic changes in pressure within the oral cavity.
4. Why does cutting the frenulum alone sometimes fail to solve the problem?
This is one of the questions parents ask most frequently.
Just a few years ago, a restricted frenulum was considered the main cause of most feeding difficulties.
Today, we know that the situation is much more complex.
In 2024, it published a report emphasising that not every short lingual frenulum requires a procedure. Diagnosis should be based not only on the appearance of the frenulum but above all on an assessment of tongue function, effective milk transfer and the outcomes of professional breastfeeding support. In addition, a 2024 umbrella review found that the quality of evidence concerning the effect of frenotomy on breastfeeding remains limited and that the benefits are not clear for all infants.
Why?
Because over several weeks or months, the child may have developed an incorrect sucking pattern.
After the procedure:
- the tongue is more mobile,
- but still performs the old movements,
- continues to clench their jaw,
- still does not lift correctly,
- still does not maintain a stable seal and vacuum.
It is a little like removing a cast after a fracture: the bone has united, but strength, mobility and coordinated movement may still need rehabilitation.
For this reason, the source says that specialists increasingly discuss not only frenotomy but also assessment and support of oral function.
It may include:
- support from a midwife,
- myotherapy,
- functional tongue exercises,
- an assessment of muscle tone,
- an assessment of the palate,
- an analysis of the entire sucking process.
A growing number of experts emphasise that a decision about frenotomy should follow a comprehensive assessment of the baby rather than the appearance of the frenulum alone. Some studies report reduced nipple pain and perceived improvement in feeding after frenotomy in appropriately selected infants, but high-quality evidence on long-term outcomes remains limited. The procedure should therefore not be treated as a universal solution to every feeding problem.
Key takeaways for parents
Breastfeeding difficulties rarely have a single cause. Pain during feeding, clamping on the breast and poor milk transfer may involve difficulties in the coordination of the tongue, palate, jaw and the overall sucking mechanism. The lingual frenulum can be relevant, but dividing it does not always restore effective function on its own.
Modern clinical practice is therefore moving away from assessing anatomy alone and towards a comprehensive functional assessment of the child and interdisciplinary support. The combination of an accurate diagnosis, lactation support and - where it is genuinely indicated - appropriate treatment offers the best chance of comfortable and effective breastfeeding.