One of the many benefits of breastfeeding is that the baby is in control of the flow rate of milk. The majority of problems with breastfeeding are infant problems, even the mothers sore nipples is usually a problem from the baby. Therefore, I feel that understanding what a newborn can and should do at the breast is imperative to any practitioner working with breastfeeding concerns. One must understand normal suck, swallow and breathing (SSB) prior to understanding a dysfunctional pattern.
The baby must be able to coordinate his suck, swallow and breathing. This process can take up to 5 days to become fully mature and natural for the baby. 31 muscles, 6 cranial nerves, and some cervical nerves are all involved in this process. Proper SSB coordination requires motor planning, timing and sequencing by the baby.
The first thing to look at with breastfeeding is the latch. The way the baby places her mouth around the breast, or the seal, plays a key role in generating the intra-oral pressure changes necessary for milk flow and transfer. Periodic release of suction can lead to inadequate milk transfer and poor feeding efficiency. This can then lead to extended feed length, possible weight gain compromise, and reduced milk supply.
When assessing the babies latch, ask yourself the following questions;
- Before the latch:
- What is the infant state?
- Are feeding cues observed?
- Beginning the latch:
- Does the nursing start with the baby's nose at the level of the mother’s nipple?
- Does the baby open his mouth wide (in a gape)?
- Is the baby moved quickly onto the breast once the gape is seen?
- Does the baby's lower lip and tongue make contact with the breast before the upper lip?
- Assessing the quality of the latch:
- Is the baby’s mouth positioned asymmetrically at the breast?
- Does the mother feel pain?
- Is the baby’s mouth open wide (140°)?
- Are the baby’s lips sealed around the mother’s breast?
- Are the baby’s upper and lower lips flanged out?
- Are the baby’s cheeks rounded?
- Assessing adequate milk transfer:
- Is the babies jaw moving in a rocker motion?
- Can you hear the baby swallowing?
- What are the rhythms of the babies swallowing?
- Does the baby end the feeding with arms and hands relaxed?
- Does the baby appeared satiated at the end of the feeding?
Other factors that must be considered when breastfeeding include, but are not limited to:
- State regulation – Is the baby overly sleepy?
- Fussy babies – Is the baby calm enough to eat?
- Arching – Does the baby pull back and refuse to eat?
- Facial asymmetries – Is the baby’s jaw and smile symmetrical?
- Tongue-tie – Can the baby stick out their tongue?
Mom problems can also occur:
- Engorgement or mastitis
- Discomforts from pregnancy – backaches, carpel tunnel
- Discomforts from delivery – vaginal or c-section
Early weaning or bottle feeding can impact orofacial development, cause instability of orofacial function, and malocclusions. Straws and sippy cups bring the mouth in or narrow the palate. This may have an affect on the teeth and the teeth might not all fit into the mouth. Tight lingual frenulum’s and bottles alter the swallow by driving the tongue back and separating the epiglottis and the soft palate. The palate then starts to arch, narrowing the mouth.
(Palmer 2005) Bottle—feeding, pacifiers, excessive oral habits and tongue thrusting can have a negative impact on the shape of the oral cavity by placing abnormal forces on bone and teeth within the oral cavity. Orthodontics and retraining the tongue to swallow properly are usually needed. These abnormal forces create high palates, narrow dental arches and retruded chins that put individuals at risk for snoring and sleep apnea. Risk factors for OSA (obstructive sleep apnea) is that they infringe on tongue space and force the tongue back into the throat due to a lack of space.
Craniosacral Therapy and Breastfeeding
CST treatment might include reconnecting the parent bond. When mom gets anxious, the baby may become anxious. CST may also help to release any soft tissue restrictions at the base of the tongue, hyoid muscles, and surrounding structures to help facilitate a better SSB coordination. This fascial work can be done from inside or outside of the mouth.
We know the sacrum is connected to the tongue via a muscular network. The rectus series stretches from the coccyx to the pubic bone, (pubocococygeus) and from there as the rectus abdominis to the breastbone. It continues on from the breast bone to the hyoid bone. (sternohyoideus), and from the hyoid to the underside of the jaw (geniohyoideus). This muscular network may allow tension to travel from the pelvic floor to the jaw and vice versa. This is why a CS therapist will look at the whole body, not just the mouth, finding and releasing facial restrictions body wide improving mobility.
Mom’s who are experiencing problems with milk flow may beneift from CST. CST can help with releasing the fascia surrounding the breast, thereby, improving milk flow.Back to top of page
Tongue—tie (ankyloglossia) is a condition that restricts the tongue’s range of motion. The restriction is caused by a membrane (lingual frenulum) under the tongue being unusually short, thick or tight. There is also a membrane (labial frenulum) connecting the upper lip to the gums, which can cause a lip—tie depending on where it inserts into the gums.
The definition I prefer is that from Alison Hazelbaker . A tongue—tie is any condition that: limits tongue mobility thereby negatively impacting feeding, chewing, swallowing, breathing, speech articulation, facial development and oral toilet.
The tongue is responsible for shaping our palate, influences the way our teeth are seated in our mouth, regulates posture, drives speech, determines the openness of our airway, develops our facial structure, and since its base is located in the throat it plays a role in shaping our throat muscles. In the first years of life as a child grows the posterior third of the tongue descends following the larynx. Dysfunctions of the mandible, the temporal bones through the styloid process, and the hyoid bone may potentially interfere with the position of the tongue.
The tongue plays a major role in the swallowing process. When breastfeeding an infant should be able to bring the tongue under the nipple easily and shape his tongue by cupping the lateral borders of the tongue to form a central groove that will allow the liquid bolus to stay midline and move posterior. The tongue is responsible for propelling the bolus into the pharynx initiating the swallow. If there is not proper tongue mobility it can directly effect breastfeeding . Optimal tongue mobility includes: proper tongue placement in the mouth, tongue lateralization, tongue protrusion and retraction, and having progressive tongue contractility.
Tongue and lip—ties can cause problems with breastfeeding.
These include, but are not limited to:
- Nipple trauma and pain — from compression of breast from gum pad versus tongue
- Inefficient, inadequate sucking — poor wave motion of tongue
- Periodic release of suction — compromises milk transfer and feed efficiency, leading to extended feed length, possible weight gain compromise, and reduced milk supply
- Poor seal — tight labial frenulum does not allow flanging of lips — also causes nipple pain — hear clicking sound caused by the tongue’s recoil — baby constantly breaking seal or suction, If the baby has difficulty staying on the breast or the mother hears a clicking sound as the child nurses; these are signs that suction is being broken and the baby is not effectively milking the breast. They may gain weight slowly and be fussy. (1991 Mohrbacher and Stock)
- Increased duration of feeding — baby switched to bottle due to instant gratification
- Failure to thrive — can lead to malnutrition
- Colic — due to air being taken in during SSB – from poor lip seal
- Problems latching onto the nipple — Instead of sucking, baby may be chewing on nipple with gums.
- Poor transfer of milk. — The baby lacks the progressive tongue contractibility needed for propelling the bolus into the pharynx
- Digestive issues such as reflux. — a poor seal allows air into the belly with each suck and swallow
- Poor weight gain. — air in the belly cause the baby to feel full when it is not.
- Nipple and breast pain.
Other concerns with Tongue—tie include:
- Dental problems
- Speech impediments
- Sleep apnea
- Personal/social reasons — licking ice cream cone, kissing
A good lactation consultant should be able to help you determine if your baby has a tongue—tie and refer you to a specialist to have the tongue—tie released
Craniosacral Therapy and Tongue—Tie
Using the light, non-invasive touch a CS therapist may help before and after any revisions. As stated above in the breastfeeding section, CST helps release any soft tissue restrictions at the base of the tongue, hyoid muscles, and surrounding structures to help facilitate a better SSB coordination. This facial work can be done from inside or outside of the mouth.
We know the sacrum is connected to the tongue via a muscular network. The rectus series stretches from the coccyx to the pubic bone, (pubocococygeus) and from there as the rectus abdominis to the breastbone. It continues on from the breast bone to the hyoid bone. (sternohyoideus), and from the hyoid to the underside of the jaw (geniohyoideus). This muscular network may allow tension to travel from the pelvic floor to the jaw and vice versa.
A CS therapist will look at the whole body, not just the mouth, finding and releasing facial restrictions body wide improving mobility. In my practice I have noticed an increase in oral defensiveness and decrease in sucking 4-5 days post release. CST may help with this.Back to top of page
Also called GER (Gastroesophageal Reflux) or GERD (Gastroesophageal Reflux Disorder). It is the involuntary passage of gastric contents into the esophagus. It is primaily treated by one of two types of drugs, those that affect motility, and those that are acid suppressants. Premies are more suseptible to reflux due to their short lower esophageal spincter (LES) which is positioned slightly above the diaphragm, rather then below it as in a term infant. The presence of an OG or NG tube may also cause reflux as the spincter is unable to fully close with these in place.
Research has shown there are No Approved Pharmacological Agents that treat the cause of reflux
With reflux one should know if it is an acid problem or positioning problem — we should treat the cause not the symptom.
- Is the diaper to tight? The position of the diaphragm can change the motion of the lower esophageal sphincter (LES) The stomach must be able to curl up on itself to digest food.
- Is the ICG (inferior cervical ganglion) compressed?
- Is the jugular foramina narrowed and constricting the vagel nerve?
- Are the shoulders elevated compressing the vagel nerve?
- Is the head misshapen?
Positioning your baby on their left side may be of benefit.
Craniosacral Therapy and Reflux
CST can treat reflux naturally by releasing the fascial restrictions in the region, as well as the whole body, improving mobility in the area. The more relaxed the diaphragm is the more relaxed the lower esophageal sphincter (LES) is and the better it will work. A therapist can also work directly with the vagus nerve or with the cranial bones that form the jugular foramina to relieve compression in this area, thereby, allowing neurological information to flow freely.Back to top of page