Mouthing in Babies
Why does my baby always have their hands in their mouth?
By Nicole Pates, Paediatric Physiotherapist – Western Kids Health and Jamie Williams, Paediatric Speech Pathologist – Nourished Babes
There seems to be a huge misconception around mouthing and its importance. I’ve noticed that a lot of grandmas and nannas seem to believe that a baby’s hands don’t belong in their mouth. It seems to coincide with the misconception that dirty play is risky because of germs and messy mealtimes are an exercise of bad parenting and bad manners. Parents are finding themselves stopping their little ones mouthing but none of us are really sure why.
Mouthing is an incredibly normal part of development and has so many benefits. In fact, little ones who haven’t mouthed, haven’t been given the opportunity to mouth or are delayed in showing this developmental stage are at risk of not transitioning to solids and moving through the textures as easily as babies who have had these opportunities.
A baby’s mouth is their window to the world and mouthing allows babies to experience their world like no other activity. This is because the sensations in a baby’s mouth are more highly developed than any other part of their little body. Even in utero babies may begin exploring their womb world by sucking their thumb or fingers (anyone have a scan of their baby sucking their thumb?). They then begin to suck the breast for comfort (not to transfer/drink milk), play with their bottle teat, mouth their hands, suck dummies, suck an adult’s fingers/hands, mouth blankets, clothing and so on. Mouthing gives our little ones the opportunity to feel and familiarise themselves with different sensations in the mouth.
It’s enjoyable, it’s calming, it’s regulating, it’s helping them learn and it’s getting them ready for their transition to solids.
Mouthing helps our little ones learn to process and organise information about their own body and their world.
There’s also another reason those hands are so keen to move towards the mouth, there is a hand-mouth connection, even as adults we exercise this! When we speak, we use our hands, we eat by bringing our hands to our mouth and some of us bite our nails when we are nervous.
Mouthing sets the stage for feeding and speech development. To start, it helps prepare our little ones for solids by working on the gag reflex. In infants, the gag reflex starts in the back 3/4 of the tongue, mouthing toys and fingers helps desensitise and move the gag reflex to the back 1/4 of the tongue. If the gag reflex remains in the front of the mouth baby will gag regularly on a spoon or a finger food when it enters the mouth.
Mouthing also helps teething, the increased sensation of the gums caused by teething not only encourages baby to mouth to calm but the rubbing of the gums on fingers and safe mouthing toys help the eruption of teeth.
Mouthing also facilitates oral feeding skills and offers experiences that prepare the mouth for oral feeding development and further can be helpful when baby’s move through different textures (e.g. from puree to lumpy foods). Pressure and input to the lips, cheeks and tongue helps our little ones feel, organise and coordinate the movement of food in their mouth. It’s helpful for leaning to chew, suck and bite.
When do babies start mouthing?Babies will begin the generalised mouthing stage from birth up until about 4-5 months of age. During this time, they are becoming familiar with different sensations. Mostly firmness, hardness and softness. This opportunity among the benefits listed above also help them to familiarise themselves with these sensations that are similar to cups, spoons and finger food.
Around 6 months, if a baby is provided with mouthing opportunities and is comfortable with mouthing, they enter the discriminative mouthing phase. This phase gives them the opportunity to learn more about their world by experiencing sensory information of size, taste, weight, texture and shape. This information is helpful for the introduction of lumpier foods.
So what play ideas use mouthing to encourage development?
Incorporating mouthing into gross motor play
- Sidelying
The magical forgotten position. It can be quite difficult to get your head around at first. It can be started very early on in bubs life, as soon as you are ready. It allows bub to bring their hands together and easily to their mouth. Brilliant for self soothing and a mouthing opportunity. As bub gets older they can mouth teethers in this position also. Some find it hard to get bub to stay in this position, and there is a neat little trick. They are semi-rolled forward so their shoulder is tipped a little more toward being on their tummy rather than straight up to the ceiling.
2. Nested
Nesting bub also assists bub in bringing their hands together in midline and developing early postural control through chin tuck (basically the beginnings of head control). There are many different ways to nest but between 0-3 months when bub is on their back, they have a special reflex called the ATNR, which makes it difficult for bub to keep their head in the middle. Using a rolled up towel or similar, bub has the opportunity to keep head centred and mouth away as much as they would like.
3. Reverse Pull to Sit
Before bubs can learn to sit they have to have strong neck, core and back muscles and be able to counteract gravity and things that might throw them off balance (like their own movements!)
Lots of people talk about pull to sit and chin tuck, that being if you pull your baby into sitting, they tuck their chin in so their head doesn’t lag behind their body. They should achieve chin tuck before 6 months, usually around 3-4 months.
Miss C is maybe 14 weeks in this video and does NOT have chin tuck with pull to sit – totally normal and ok.
But I am using that mouthing phase to work on reverse pull to sit and help her strengthen her head and neck. All she wants to do is chew on her hands so I am using them to motivate her to keep that chin tucked!
4. Supported Sitting
You can start supporting your baby in sitting once they are showing signs of good head and trunk control. This is not earlier than 3 months and usually around 5 months. Babies need to be able to hold their head and begin to push up in tummy time. You may also notice that they are doing mini sit ups or abdominal crunches when reclined on you. Here Miss C is sitting between my legs, with a pillow table, and mouthing her skwish toy
How can we encourage mouthing?
The gentlest most responsive way to provide mouthing opportunities to our little ones is the make a game of it, songs are very regulating and help with the playfulness of the interaction. Get face to face with your little one, guide their hands towards their mouth, sing, “I like to eat, eat, eat fingers and thumbs” and model a sucking motion on your own hands. Please keep an eye out for any subtle cues that they aren’t enjoying it and take a step back. You can also try allowing them to hold the mouth toy and you gently move their hand/s towards their mouth. Again, keep an eye out for any subtle cues they show in their body or face that they are not ok with this and be responsive by moving their arms back to a level they were comfortable. Each day you can play and see if your baby is ready to get their hands/mouth toy closer to their mouth.
If they are mouthing, let them be, but if mouthing is interfering with them practising important skills like tummy time, pulling up, sitting etc we can try to provide them with some more intense input just before this activity to reduce that need to have their hands in their mouth constantly.
Allowing them to explore a range of different mouthing toys as well as their fingers and hands is beneficial. Think different textures, shapes, temperatures. Always make sure you include a mouth toy that is longer, so they experience sensations all over the mouth, not just at the front of the mouth (this is extremely helpful for moving the gag reflex back).
You can start with something like a Beckman Tri-chew or an Ark Baby Grabber. You can pop in freezer to see if they enjoy the cold temp too. If your baby takes a dummy, you could also offer a nice amount of sucking time before an activity. When they show you they are enjoying biting down you can encourage biting/chewing on a safe mouth toy to get some nice input through the jaw, you may see them do this at around 3-4 months. See below for a range of mouthing toys.
When your little one is sitting well in a supportive highchair, you can offer them spoons and something like the Num Num Gootensil to mouth while you/the family eats. This may be before you introduce solids or when they are not up to eating at each meal.
When your little one is around 6 months and showing signs of readiness for food, you can use food as well as mouthing toys to help them with their love of oral exploration. This is another way to offer that intense input before trying to do an activity you can’t quite get them to do because their hands are in their mouths. Have them seated in a supportive high-chair and if they are ok with it put some puree on their tray and let them bring the puree to their mouth. Offer them different spoons to mouth. While we should offer all little ones a range of different sensations, our little ones who love their hands probably will love experimenting with bitter, sour, sweet, spicy, cold (or even frozen ice-blocks) and textured food. If you feel confident and baby isn’t yet biting, you can offer hard munchables (cold raw celery sticks, raw carrot sticks, a bone from a chop etc) these are exclusively for the purpose of mouthing. For babies 7-9 months you can offer crunchy soft dissolvables like Baby Num Nums and Potato Stix (the purpose of these is to give them some nice input through the jaw, practise biting skills and practise chewing skills). Older kids can crunch on carrots, suck lemons, seaweed, apples etc (but please be informed about choking and choking risks).
Even as adults we all have sensory preferences, we seek out or avoid certain touch, taste, smell, movement, visual input and auditory input. However, be mindful that if your little one is finding some sensory input overwhelming or uncomfortable or is constantly seeking it AND it’s interfering with everyday things please seek out an occupational therapist.
Below are some ideas for safe mouth toys, please always supervise your little one when they are mouthing a toy. These products are made of safe materials, choose a few that will offer a range of different shapes, sizes, textures and temperatures. Always include a few that will reach different parts of the mouth (not just the front):
TEETHERS!
Check out our favourite teethers & mouthers below
We hope all this info has been reassuring and helpful in understanding and shifting some old-wives’ tales. Do not fear if you feel your little one hasn’t had much experience mouthing. Missed experiences do not always impact other skills, such as success with mealtimes. We are all doing the best we can with the information we have available to us at the time. If your little one didn’t have many experiences with mouthing, it’s never too late to start! You haven’t missed the boat.
– Jamie & Nicole –
Thank you so very much for this article. It certainly helped me understand why my little one (13 weeks) keeps putting his hands in his mouth, but also why he is choking himself (gagging) too.
I loved this article! As a speech pathologist for 20 years it’s an issue where we are definitely on the same page. Side-lying position was new information for me (I will research this, so many thanks). You are spot on about developing gag reflex but I think it may be useful for parents to know that 40% of the population do not have a gag reflex, and this is absolutely fine. In the past it was standard practice in hospital emergency departments to immediately make anyone without a gag reflex ‘Nil by Mouth’ so unable to drink or eat until they were assessed and given the all clear by a speech pathologist. This has now changed based on that finding that for 40% of people an absent gag reflex is normal – in fact I’m one of the 40% and was often a voluntary Guinea pig used to illustrate this fact to ED staff.
The last thing that may be useful to add is that there are great baby tools that allow you to place a soft food like cool watermelon in a net like material pouch that screws onto a handle. This allows babies to safely experience mashing soft foods like watermelon using an up down jaw driven mashing movement with gums and tongue. Babies can then practice these beginning chewing movements, experience the taste and texture of the watermelon but the remaining pulp stays safely in the net pouch so it isn’t a choking hazard.
This tool is also excellent for allowing children with assisted feeding through a naso-gastric tube or PEG (a port in the stomach) to experience taste for pleasure in a safe way (the ability to experience taste for pleasure is so important for these children!). The tool also allows practicing prescribed swallowing rehabilitation exercises, using real food, but always under the strict supervision of a specialist in transitional feeding and swallowing rehabilitation. Just some extra thoughts, but many thanks again for an excellent post Nicole. Clare Catmore Speech Pathologist.