Small chin
The lower jaw is small and shifted back, the chin seems to be "hidden".
CONDITION / FACE
Sequence by Pierre Robin.
Pierre Robin sequence is a congenital condition in which a newborn has a small lower jaw, the tongue falls back and makes it difficult to breathe. Most of these children also have a cleft palate. Some children are helped by the position of the body and the plate, and in case of severe breathing disorders, the jaw is lengthened by surgery.
CONCEPTUAL VISUALIZATION- What it is
- A small lower jaw, sunken tongue and breathing disorders in a newborn.
- How common
- 9.5 per 100,000 live births.
- Cleft palate
- More than 3/4 of children have this condition.
- How we treat
- Most children — without surgery; with severe breathing disorders, the jaw is lengthened by distraction.
01 / WHAT IS ITWhat is
What is
sequence by Pierre Robin.
Pierre Robin sequence (also called Pierre Robin syndrome or anomaly) is a congenital condition in which three features are combined: a small lower jaw, a backward tongue, and difficulty breathing due to the tongue blocking the airway.
The condition is called "sequence" because one change entails the following ones. It is believed that at first the jaw grows too small, because of this the tongue lies higher and farther than it should and can interfere with the fusion of the palate. Therefore, most children have a wide U-shaped cleft palate.
The condition can be isolated or part of a genetic syndrome or a combination of other defects. The examination and prognosis depend on this, so not only the surgeon examines the child.
The expression is very different: in some children there are almost no signs, in others - severe breathing disorders with pauses and blueness. The main thing in the first weeks is to provide the child with free breathing and sufficient nutrition.
This is general information. What will suit your child, the doctor will tell after the examination.
02 / SIGNSHow it
How it
presents.
The condition is usually noticed immediately after birth. Symptoms of breathing disorders can come and go and are more common during sleep.
The tongue goes down
The root of the tongue moves back to the throat and blocks the airway.
It's hard to breathe
Noisy breathing, snoring, pulling in the chest, pauses in breathing, blue lips - especially in sleep. Pauses in breathing, blue lips or chest tightness are reasons to call 103.
It's hard to eat
The child gets tired quickly, stops to breathe, does not gain weight well. Cleft palate makes feeding even more difficult. If the child cannot eat without stopping to breathe, see the doctor the same day.
Cleft palate
A wide cleft in the palate through which the mouth communicates with the nose.
Cleft palate03 / REASONSWhy it
Why it
develops.
Pierre Robin sequence is a congenital malformation of the jaw. It can be separate or part of a wider state.
Jaw development
The lower jaw does not grow enough. This is considered to be the first link, which leads to the sinking of the tongue and problems with breathing.
A separate state
It happens that the child has no other defects or syndromes - then they say about the isolated sequence of Pierre Robin.
Syndromes
In other children, the condition is part of a genetic syndrome or a combination of several birth defects. Therefore, the doctor may recommend a consultation with a geneticist.
Prevalence
In a review of 34 studies, Pierre Robin sequence occurred in 9.5 per 100,000 live births.
04 / SEEK MEDICAL ADVICE
When to seek urgent medical care?
In a child with Pierre Robin sequence, breathing may suddenly become worse, especially during sleep. Do not wait until it passes: the signs below are a reason to call for help immediately.
103 immediately if:
- the child stops breathing, there are pauses in breathing;
- lips, tongue or skin turned blue, gray, pale or marbled;
- the child suffocates, wheezes or cannot breathe;
- it is difficult for the child to breathe: he croaks, pulls in his stomach or chest during inhalation;
- the child is difficult to wake up or does not wake up;
- the child did not urinate for 12 hours;
- convulsions;
- weak, shrill or continuous crying;
- a rash that does not fade if you press on it;
- a temperature of 38 °C and above in a child up to 3 months or 39 °C and above — in 3–6 months.
Do not delay a visit to the doctor:
On the same day: the child cannot eat without stopping to breathe, refuses to eat, snores and breathes noisily in his sleep more and more. If your child has recently had surgery, call the doctors who are treating it first. In the coming days: feeding lasts a very long time, the child does not gain weight well. Planned: a surgeon's consultation regarding the jaw and palate, hearing and development testing. It is possible to put a child to sleep on his stomach or on his side only according to the doctor's prescription and as he showed: all other babies are advised to sleep only on their backs.
05 / DIAGNOSTICSHow we assess
How we assess
a child
- Examination after birth
The doctor evaluates the jaw, tongue, palate and how difficult it is for the child to breathe. Sometimes the condition is noticeable even before childbirth on ultrasound or MRI.
- Sleep research
Breathing disorders are more common during sleep, so the international consensus recommends a sleep study to assess their severity.
- Examination of the respiratory tract
The ENT doctor checks for narrowing in places other than the tongue.
- Evaluation of feeding
How the child sucks and swallows, or gains weight.
- Geneticist
To find out if it is a separate condition or part of a syndrome.
06 / TREATMENTHow we treat
How we treat
sequence by Pierre Robin.
Treatment depends on how difficult it is for the child to breathe and eat. Most children are helped without surgery; the operation is performed when other methods do not allow free breathing.
01
Without surgery
The first step for most children.
- Body position
- On the stomach or on the side, the tongue moves forward and covers the throat less. But sleeping on the stomach in babies increases the risk of sudden death in sleep, so such a position is only prescribed by a doctor and under supervision. In a review of 875 children treated with positioning, 715 did not require other respiratory treatment, although this decision was often made without objective measurements. How safe this treatment is and how to properly monitor these children is still being investigated.
- Orthodontic plate
- The plate in the mouth pushes the root of the tongue forward. In a review of studies, some of the results were similar to jaw lengthening surgery, but the plate cannot completely replace it.
- A tube in the nose
- A soft tube through the nose to the throat keeps the air path open.
- Feeding
- Special bottles and, if necessary, a tube until the child learns to eat by himself.
02
Surgery
If the child still has difficulty breathing.
- Distraction of the lower jaw
- The jaw bone is dissected and an apparatus is installed, which is untwisted little by little every day. The jaw lengthens, the tongue moves forward. According to the review, if other methods have not helped, this is the preferred method for stable breathing.
- Fixation of the tongue to the lip
- The tongue is temporarily sewn to the lower lip so that it does not sink. This method is considered for milder violations or if distraction is not suitable.
- Tracheostomy
- A tube in the trachea through a hole in the neck — for the most severe cases. In a meta-analysis of 13 studies, distraction produced a better respiratory outcome than tracheostomy and was less likely to require an intragastric feeding tube; the authors note that larger studies are needed for definite conclusions.
03
Outcome and risks
- Facial nerve
- After distraction in a review of 729 patients, facial nerve branch weakness occurred in 6.4%; it can be temporary, but it can also be permanent.
- Jaw growth
- It is often said that the jaw will "catch up" with age. But only a minority of studies show faster jaw growth, and even fewer that the lag disappears completely.
- Child development
- In the review of studies, 10% of children with an isolated condition had developmental disorders, and more - with syndromes. Therefore, the development is monitored for a long time.
- Palate
- The cleft palate is closed in a separate operation, usually at 6–12 months.
07 / AT THE VALIKHNOVSKYI INSTITUTE
How
How
we treat it.
The sequence of Pierre Robin at the Institute of Surgery of Dr. Valikhnovskyi is treated in the field of "Surgery of birth defects". The clinic is responsible for the surgical part — jaw and palate. The child's breathing in the first weeks is managed by a neonatologist, and feeding, hearing and development are handled by specialized specialists.
CLINIC SERVICE
Surgery of birth defects
Congenital defects of the face and body in children and adults — from the first operation to the correction of the consequences.
View service
What we do for this condition
- Distraction osteogenesis of the lower jaw — the jaw is gradually lengthened by the device by approximately 1 mm per day, if the position of the body and the plate do not help.
- 3D planning — a digital model of the jaw based on CT data to calculate the operation in advance.
- Plastic palate — closure of the cleft, usually up to a year.
Rostislav Valikhnovskyi
Plastic surgeon, candidate of medical sciences, founder of Dr. Valikhnovskyi Institute of Surgery.
How treatment works with us
- Photos and extracts onlineSend a photo of the child from the side and statements - the doctor will first assess the situation.
- ConsultationExamination of the jaw, palate, breathing and feeding; which examinations are already available.
- PlanIs jaw surgery necessary now, or are other methods sufficient; when to close the palate.
- SurgeryDistraction of the jaw or palate plasticity; parents are next to the child in the hospital.
- RecoveryThe distractor is unrolled according to the schedule; the doctor will teach the parents if it needs to be done at home. Followed by control examinations as growth progresses.
08 / QUESTIONS AND ANSWERSCommon
Common
questions
Short answers. What is right for you, the doctor will tell you during the consultation.
How to put a child to sleep?
Just as the doctor advised your child. On the stomach or on the side - only according to his appointment and with the supervision he advised. Without such a designation, babies are put to sleep on their backs.
Is surgery always necessary?
No. Most children are helped by the position of the body, a plate or a tube in the nose. The operation is performed when these methods do not allow free breathing.
Is the distraction painful for the child?
Unwinding the device does not require anesthesia, discomfort is relieved with painkillers. As after any operation, there are risks - the doctor will tell you about them during the consultation.
Will the jaw grow by itself?
Partly. Studies differ: in only a minority of them did the jaw grow faster than usual, and the complete retardation rarely disappeared.
When is a cleft palate operated on?
Usually at 6-12 months. The surgeon determines the timing for your child.
Will the child develop normally?
In a review of studies, 10% of children with an isolated condition had a developmental disorder. With syndromes, this risk is higher, so the child's development is monitored for a long time.
What to feed if the child gets tired quickly?
The doctor will select the bottle and regimen. If the child does not gain weight, they are temporarily fed through a tube. Difficulty breathing often interferes with eating - when breathing is adjusted, feeding also becomes easier.
Sources
17 sources · guidelines, consensuses, reviews and studiesshowCollapse
- Best Practices for the Diagnosis and Evaluation of Infants With Robin Sequence: A Clinical Consensus ReportJAMA Pediatrics, 2016doi:10.1001/jamapediatrics.2016.0796 ↗
- European Guideline Robin Sequence An Initiative From the European Reference Network for Rare Craniofacial Anomalies and Ear, Nose and Throat Disorders (ERN-CRANIO)The Journal of Craniofacial Surgery, 2024doi:10.1097/SCS.0000000000009701 ↗
- Global birth prevalence of Robin sequence in live-born infants: a systematic review and meta-analysisEuropean Respiratory Review, 2023doi:10.1183/16000617.0133-2023 ↗
- Robin Sequence: Neonatal ManagementNeoReviews, 2024doi:10.1542/neo.25-12-e780 ↗
- The management of upper airway obstruction in Pierre Robin SequencePaediatric Respiratory Reviews, 2023doi:10.1016/j.prrv.2022.07.001 ↗
- Management of cleft palate among patients with Pierre Robin sequenceThe British Journal of Oral & Maxillofacial Surgery, 2023doi:10.1016/j.bjoms.2023.06.003 ↗
- Non-operative interventions for Pierre-Robin sequence: A systematic review and meta-analysisJournal of Cranio-Maxillo-Facial Surgery, 2024doi:10.1016/j.jcms.2024.08.008 ↗
- Systematic Review of Safety and Efficacy of Positional Therapy as First-line Management for Robin SequenceThe Journal of Craniofacial Surgery, 2025doi:10.1097/SCS.0000000000011325 ↗
- A Systematic Review of Mandibular Distraction Osteogenesis Versus Orthodontic Airway Plate for Airway Obstruction Treatment in Pierre Robin SequenceThe Cleft Palate-Craniofacial Journal, 2022doi:10.1177/10556656211011886 ↗
- Systematic review and meta-analysis of surgical approaches for improving airway stability in infants with Robin sequence: evaluating complications and outcomesThe British Journal of Oral & Maxillofacial Surgery, 2024doi:10.1016/j.bjoms.2024.04.003 ↗
- Mandibular Distraction Osteogenesis vs. Tracheostomy in the Management of Pierre Robin Sequence: A Systematic Review and Meta-AnalysisThe Cleft Palate-Craniofacial Journal, 2026doi:10.1177/10556656241311549 ↗
- Facial Nerve Dysfunction After Mandibular Distraction Osteogenesis in Patients with Robin Sequence: A Systematic Review and Meta-AnalysisThe Cleft Palate-Craniofacial Journal, 2023doi:10.1177/10556656211070728 ↗
- Mandibular Catch-Up Growth in Pierre Robin Sequence: A Systematic ReviewThe Cleft Palate-Craniofacial Journal, 2019doi:10.1177/1055665618774025 ↗
- Neurodevelopmental impairment in children with Robin sequence: A systematic review and meta-analysisEarly Human Development, 2025doi:10.1016/j.earlhumdev.2024.106185 ↗
- When to get urgent medical help for babies and children under 5NHS, 2026nhs.uk/baby/health/when-to-get-urgent-medical-help-for-babies-and-children-under-5 ↗
- Sudden infant death syndrome (SIDS)NHS, 2025nhs.uk/baby/caring-for-a-newborn/sudden-infant-death-syndrome-sids ↗
- Cleft lip and palateNHS, 2023nhs.uk/conditions/cleft-lip-and-palate ↗
The figures on the page are from these sources.
Small jaw
in a newborn?
Send a photo of the child from the side and statements. The doctor will tell if jaw surgery is needed and when to close the palate.