Infant Resting Tongue Posture: Why it matters and what it can tell us
Updated: 1 day ago
A baby who sleeps with their mouth open, makes a clicking sound while feeding, or seems unable to maintain a latch can prompt understandable questions about infant resting tongue posture. Families may be told that the tongue should sit in one particular place at all times, or that a low tongue automatically indicates a tongue-tie. Neither is quite that simple.
An infant's oral posture is variable and changes with feeding, breathing, sleep, alertness, positioning and development. A single observation rarely explains a feeding experience.
For clinicians, resting tongue posture can be one small piece of functional information. For families, noticing patterns can be useful, particularly when they occur alongside feeding concerns. It is not, however, a diagnostic test for tongue-tie, nor does it predict whether a baby will need treatment.
What do we mean by infant resting tongue posture?
Resting tongue posture describes where the tongue appears to sit when an infant is calm and not actively feeding or crying. Depending on the baby's state, the tongue may be visible at the lips, lie forward in the mouth, rest lower in the oral cavity, or have more contact with the palate.
Infants are not small adults. Their airway anatomy, suck-swallow-breathe coordination, arousal state and feeding patterns are developing rapidly, particularly during the early weeks and months. A photograph, a brief look during a consultation, or an observation while a baby is unsettled may therefore provide limited information.
Tongue posture may change after a feed, during light sleep, with nasal congestion, after crying, when the baby is tired, or simply as their head and body position changes.
There is no well-established evidence-based ‘ideal’ resting position that can be used alone to diagnose restricted tongue function. Statements that every infant should permanently hold the whole tongue against the palate go beyond the available evidence.
The more helpful question is not simply, ‘Where is the tongue at this moment?’ but, ‘How does this baby use their tongue, jaw, lips and breathing pattern during feeding and at rest?’
Why is resting tongue posture important?
Although the tongue is most noticeable when it is moving, it spends much of its time at rest. Its relationship with the palate, lips, cheeks and jaw therefore forms part of the wider oral environment.
The tongue is not an isolated structure. It works as part of a coordinated muscular system, and its position can influence how space is occupied within the mouth and how forces are distributed around the developing oral structures. At the same time, the tongue's resting position can itself be influenced by the shape of the palate, nasal breathing, muscle tone, oral habits, tongue mobility and other anatomical or functional factors.
This makes resting posture relevant, but not in the sense of there being one perfect position that every infant must maintain.
A baby who has a comfortable resting posture, effective nasal breathing and efficient feeding may have no reason for intervention simply because their tongue does not resemble an image seen online.
Conversely, a persistent low or forward tongue posture may be worth exploring when it occurs alongside other functional findings.
The important distinction is between observing a posture and understanding what has contributed to it.
The tongue and the developing palate
The relationship between the tongue and palate begins very early in development. During the early embryonic period, the tongue occupies the developing oral cavity and forms part of the mechanical and functional environment in which the palate develops. The timing described in clinical and embryological teaching varies, with the tongue-palate relationship developing during the early weeks of gestation, commonly described within approximately weeks 4–8.
As the baby develops, the tongue continues to provide an important muscular and mechanical influence on the developing palate and maxilla. Normal tongue elevation and contact with the palate are therefore relevant to the developing oral environment.
Where a restrictive lingual frenulum genuinely limits tongue elevation, the tongue may be unable to achieve the same contact with the developing palate. This can contribute to altered palatal development, including a higher or narrower palatal shape in some infants.
A tongue-tie can therefore be one contributing factor to a high or narrow palate. It is not, however, the only possible cause.
Palatal shape is influenced by multiple factors, including genetics, craniofacial development, airway and breathing patterns, muscle function, oral habits and individual anatomical variation.
The relationship is therefore not as simple as saying that every high palate is caused by tongue-tie.
How can restricted tongue function affect the developing mouth?
The tongue plays an important role in feeding and in the developing orofacial system. When tongue elevation is restricted, an infant may compensate by recruiting other structures to achieve the movements required for feeding.
Compensatory patterns can include increased jaw movement, altered mandibular positioning, increased activity of the mentalis and other perioral muscles, changes in lip behaviour and wider muscular tension patterns.
These adaptations do not occur in every infant with a tongue-tie, and their significance depends on the degree of restriction and how the individual infant compensates.
However, if the tongue is unable to elevate and contact the palate effectively, the normal tongue-to-palate stimulus involved in the developing oral environment may also be altered.
This is one reason why assessing tongue function is about more than looking at the frenulum.
The question is not simply whether a frenulum is visible, but whether it is restricting function and whether the infant is compensating for that restriction.
What are the potential consequences of a persistent low tongue posture?
A low tongue posture is not automatically a problem. An infant may temporarily adopt a lower tongue position depending on their state, breathing, positioning or developmental stage.
The concern is more about persistent patterns, particularly when a low tongue posture occurs alongside other findings.
Research has identified associations between altered or low resting tongue posture and dental, occlusal and speech-related outcomes, although much of this evidence comes from older children and adults rather than infants. A 2026 systematic review found associations between lingual resting posture and anterior open bite, crossbite and articulation errors, while also highlighting limitations in the available evidence and a lack of standardised assessment methods.
Research in older children has also identified relationships between mouth breathing, altered tongue posture and craniofacial development.
These findings should not be transferred directly to infants as though the same outcomes have been proven in babies. Infant craniofacial development is dynamic, and there is currently much less research specifically examining the long-term consequences of infant resting tongue posture.
Nevertheless, a persistently low tongue posture may be associated with:
reduced tongue-to-palate contact
an open-mouth resting posture
altered oral containment
changes in swallowing patterns
difficulty maintaining an effective oral seal
compensatory activity of the lips, jaw and perioral muscles
changes in the balance of muscular forces around the developing teeth and jaws
altered palatal or dental development over time
These associations do not mean that a low tongue posture causes all of these outcomes, nor that every infant with a low tongue posture will develop them.
For example, an infant who cannot breathe comfortably through their nose may naturally adopt an open-mouth posture and lower their tongue to facilitate airflow. In this situation, the low tongue posture may be an adaptation to an underlying airway problem.
This is why it is important to ask why the tongue is resting low rather than simply trying to force it upwards.
Resting tongue posture and breathing
Tongue posture and breathing are closely connected.
When nasal breathing is comfortable, the lips can remain gently closed and the tongue can occupy the oral cavity without needing to move forward to facilitate airflow. When nasal breathing is compromised, an infant may adopt an open-mouth posture and the tongue may sit lower within the mouth.
Nasal congestion, enlarged adenoids or tonsils, allergies and other upper-airway factors can affect breathing. Persistent mouth breathing therefore deserves assessment rather than being attributed automatically to tongue posture or tongue-tie.
If your baby is struggling to breathe, this is an emergency. Call 999 or seek emergency medical care immediately. Do not wait for a GP appointment, feeding assessment or tongue-tie assessment, and do not assume that breathing difficulty is caused by tongue posture or tongue-tie.
For persistent mouth breathing, noisy breathing or concerns about the upper airway when your baby is otherwise well, discuss this with your GP, health visitor or paediatric team.
Resting posture is not the same as tongue function
A tongue can appear to rest in an apparently favourable position and still have functional difficulties.
Equally, an infant may demonstrate a tongue posture that does not conform to an idealised picture but feed effectively and demonstrate appropriate oral function.
The two should therefore not be confused.
Tongue function includes the ability to move, elevate, lateralise and coordinate appropriately for the individual's developmental stage. During feeding, the tongue works with the jaw, lips, cheeks and palate to help create an effective feeding pattern.
Studies using ultrasound have demonstrated the dynamic nature of infant feeding, including tongue movement and intra-oral vacuum during breastfeeding (Geddes et al., 2008).
A resting observation therefore tells us something different from observing the tongue during feeding.
Both may be useful, but neither should be interpreted in isolation.
What else can influence resting tongue posture?
Resting tongue posture can be influenced by many factors, including:
nasal airway patency
nasal congestion
feeding method
prematurity and developmental stage
muscle tone
neurological development
head and body positioning
oral habits
tongue mobility
palatal shape
jaw position
lip competence
swallowing pattern
sensory factors
fatigue and arousal state
Feeding itself can also influence what is observed.
During breastfeeding, breast fullness, milk flow, positioning and the baby's ability to maintain an effective seal can all affect oral behaviour. During bottle feeding, teat flow, teat fit, bottle angle and pacing can influence the coordination of sucking, swallowing and breathing.
A clicking sound, milk leakage or difficulty maintaining a seal may therefore have several possible explanations.
What can a practitioner do to help?
If an assessment identifies a functional issue, your chosen practitioner may offer exercises or activities that are appropriate for your baby's age and individual presentation.
These may be designed to support tongue movement, tongue elevation, oral coordination, lip closure, tongue-to-palate contact or wider postural control.
Exercises should not be prescribed simply because a tongue appears low at rest. The reason for the posture needs to be considered first.
For some infants, appropriate support may involve feeding positioning, pacing, addressing bottle flow, supporting nasal breathing or working on wider oral and postural function rather than focusing specifically on tongue posture.
Where tongue restriction is contributing to functional difficulties, exercises may form part of a wider programme of support before or after specialist assessment.
Functional exercises should also be distinguished from postoperative wound-stretching. These are not the same thing, and families should follow the specific postoperative advice provided by the clinician undertaking any procedure.
There is currently limited high-quality evidence for many specific infant oral exercises, so they should be individualised and used as part of an overall functional assessment rather than presented as a guaranteed way to change the palate or facial structure.
What does this have to do with tongue-tie?
A lingual frenulum is normal anatomy. In some infants, its characteristics may be associated with restricted tongue movement and feeding difficulties. This is commonly described as symptomatic ankyloglossia or tongue-tie.
However, the appearance of a frenulum does not establish functional restriction, and not every visible frenulum causes problems (Messner et al., 2020; Academy of Breastfeeding Medicine, 2021).
The same applies to resting tongue posture.
A low tongue position is not proof of a tongue-tie, and a tongue that appears elevated does not rule one out.
If tongue-tie is suspected, assessment by a practitioner with specific experience in functional infant oral assessment is preferable. An IBCLC can assess feeding function whether a baby is breastfed, bottle-fed or combination-fed, and an IBCLC with specific experience in tongue-tie and infant oral function can bring feeding assessment together with consideration of oral anatomy.
When should you seek support?
An IBCLC can support families whether their baby feeds at the breast, from a bottle, or through a combination of feeding methods. They can assess feeding as a whole and help identify whether further assessment is appropriate.
If tongue-tie is suspected, choosing an IBCLC who also has specific experience in functional infant oral assessment and tongue-tie can be particularly helpful. Where a medical or surgical opinion is required, appropriate referral should form part of the care pathway.
For persistent mouth breathing, noisy breathing or other concerns about the airway in an otherwise well baby, speak with your GP, health visitor or paediatric team.
If your baby is struggling to breathe, however, this is not a routine GP or tongue-tie referral. Call 999 or seek emergency medical care immediately.
How does breastfeeding relate to facial and palatal development?
Breastfeeding is a dynamic oral activity requiring coordinated movement of the tongue, jaw, lips and facial muscles. Unlike a passive activity, effective breastfeeding provides repeated neuromuscular and mechanical stimulation to the developing orofacial structures.
Research has found associations between breastfeeding and aspects of dental and occlusal development, including lower rates of some malocclusions. This supports the concept that feeding method can form part of the wider functional environment influencing craniofacial development.
It is important, however, not to suggest that breastfeeding alone determines facial growth or guarantees a particular palatal shape. Genetics, airway, anatomy, muscle function and many other factors contribute to craniofacial development.
Where tongue restriction interferes with the normal mechanics of breastfeeding, the infant may be unable to use the tongue, jaw and perioral musculature in the same way as an infant without functional restriction.
This is another reason why feeding difficulties should be assessed functionally rather than assuming that the appearance of a frenulum tells us everything we need to know.
Can frenulotomy change a high palate?
A frenulotomy releases a restrictive lingual frenulum. It can improve tongue mobility where the frenulum is genuinely restricting movement, and evidence supports its use in appropriately selected infants with symptomatic ankyloglossia.
Research has demonstrated benefits particularly in reducing maternal nipple pain, and systematic-review evidence has also reported improvements in measures of breastfeeding effectiveness. However, the degree of improvement varies between individuals and between outcomes.
A frenulotomy is not guaranteed to alter the shape, width or height of an established palate.
This distinction is important.
If restricted tongue function has contributed to altered palatal development, releasing the restriction does not mechanically reshape the palate. The procedure removes the restriction and creates the potential for improved tongue movement and function. What happens developmentally afterwards will depend on the individual infant and the many factors influencing craniofacial growth.
The earlier a functional restriction is identified does not mean that a particular palatal outcome can be guaranteed. Nor does it mean that every infant with a high palate requires frenulotomy.
The decision to undertake a frenulotomy should be based on evidence of functional restriction and relevant symptoms, rather than on the appearance of a frenulum, a high palate or a low resting tongue posture alone.
How is a decision about frenulotomy made?
The Academy of Breastfeeding Medicine advises that no single assessment tool should be used as the sole basis for deciding whether a frenulotomy is indicated. A comprehensive assessment should consider the infant's history, the feeding experience, oral function, anatomy and direct observation of feeding where appropriate (Academy of Breastfeeding Medicine, 2021).
This approach recognises that feeding difficulties can have multiple causes.
For some families, skilled feeding support may resolve the difficulty without a procedure. For others, where there is clear functional restriction associated with persistent feeding difficulties, frenulotomy may be an appropriate option.
Families should receive clear information about why the procedure is being considered, what benefits may reasonably be expected, its limitations and potential risks, and what support is available afterwards.
A frenulotomy can release a restriction.
It cannot guarantee a particular feeding outcome, tongue posture, palatal shape or facial development.
What can families observe at home?
If you are concerned about your baby's mouth or tongue, try to notice patterns rather than repeatedly checking their tongue position.
You might make a brief note of when feeding feels easier or harder, whether there is pain or leakage, how long feeds usually take, whether your baby frequently loses their seal, and any concerns raised during routine weight checks.
A short video of a typical feed can sometimes help a clinician understand the concern, provided you feel comfortable sharing it securely.
Try not to compare your baby's mouth with images online. Still photographs rarely show feeding function and cannot account for your baby's age, developmental stage, feeding method, health or individual anatomy.
Your observations matter, but they are most useful when explored alongside a full assessment.
Looking at the whole picture
Resting tongue posture can provide useful information, but it is only one part of infant oral function.
A low tongue posture does not automatically mean something is wrong. A high palate does not automatically mean a tongue-tie is present. An open mouth does not prove that the tongue is restricted, and a clicking sound does not have a single cause.
At the same time, persistent low tongue posture, restricted tongue elevation or altered tongue-to-palate contact can be clinically relevant, particularly when they occur alongside feeding difficulties, compensatory muscular patterns, altered breathing or other functional findings.
The important question is therefore not simply where the tongue is resting.
It is why it is resting there, what the tongue can do, how the baby is feeding and breathing, and whether the pattern is affecting function or development.
A thoughtful assessment brings these observations together rather than focusing on one anatomical feature.
For families, the goal is not to achieve a picture-perfect tongue position.
The goal is safe, effective and comfortable function for that individual baby, while supporting healthy development.
Anatomy provides information. Function provides context.
References
Academy of Breastfeeding Medicine (2021) ‘Academy of Breastfeeding Medicine position statement on ankyloglossia in breastfeeding dyads’, Breastfeeding Medicine, 16(4), pp. 278–281.
Geddes, D.T., Kent, J.C., Mitoulas, L.R. and Hartmann, P.E. (2008) ‘Tongue movement and intra-oral vacuum in breastfeeding infants’, Early Human Development, 84(7), pp. 471–477.
McFarland, C.J., Hashemi Hosseinabad, H. and Schafer, E.C. (2026) ‘Still Tongue, Silent Cues: A Systematic Review of Lingual Resting Posture’, Communication Disorders Quarterly. First published online 3 March 2026. doi: 10.1177/15257401261425962.
Messner, A.H., Walsh, J., Rosenfeld, R.M. et al. (2020) ‘Clinical consensus statement: Ankyloglossia in children’, Otolaryngology–Head and Neck Surgery, 162(5), pp. 597–611.
O'Shea, J.E., Foster, J.P., O'Donnell, C.P.F. et al. (2017) ‘Frenotomy for tongue-tie in newborn infants’, Cochrane Database of Systematic Reviews, 3, CD011065.
Thomas, J., Bunik, M., Holmes, A. et al. (2024) ‘Identification and management of ankyloglossia and its effect on breastfeeding in infants: Clinical report’, Pediatrics, 154(2), e2024067605.
Peres, K.G., Cascaes, A.M., Leão, A.T. et al. (2015) ‘Exclusive breastfeeding and risk of dental malocclusion’, Acta Paediatrica, 104(8), pp. e393–e398.
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