The anatomy of the infant is designed to breastfeed, to suck. The structure of the mouth and throat are adapted to allow both swallowing and breathing at the same time. There is coordination between the muscles of the mouth, the functioning of the jaw and tongue, and the ability to breathe through the nose which allows for sucking, swallowing and breathing.  This should occur in a smooth rhythmic tempo.

Some infants have difficulty with breastfeeding and are unable to effectively feed without pulling off the breast, coughing, choking and preferring one breast. It is not uncommon for infants who have had a traumatic birth or assistance during delivery to have difficulty feeding. Premature infants have the highest risk for feeding difficulties as they may not have developed adequately to master the skills necessary to successfully feed. Some infant have an abnormal head position during delivery which creates excessive forces on protruding parts, like the nose and the jaw. This can be both painful and interfere breastfeeding. Trauma to the nose interferes with ease of breathing through the nose.  The infant is an obligate nose breather; the mouth is used for feeding not breathing, so when nose breathing is suboptimal, it can affect feeding. The jaw and the tongue together are used to express milk from the breast. If the jaw is injured, the mouth is usually not straight, it may be more diagonal. When the jaw does not function properly the result is usually inefficient, painful feeding for both the mother and the infant.

Infants that are not initially united with their mothers may have missed a critical window for optimal breastfeeding. With successful breastfeeding the mother produces a hormone, oxytocin. This is an important hormone which is involved with bonding between the mother and infant. Successful breastfeeding allows for optimal nutrition, successful bonding between the mother and baby and training of the structures in the mouth and throat. There are primitive reflexes in place, which help the neonate to find the breast and to suck. Unsuccessful sucking may be an early sign of neurological compromise.

It is important to understand what the problem is so treatment can be directed at the appropriate structures. There is no other specialist who focuses on the mechanical treatment of the infant with sucking dysfunction. If there has been trauma to the nose or the jaw during delivery, this can affect the infants’ ability to effectively suck. The muscles in the tongue and the mouth need to function properly to coordinate the action of sucking and swallowing while breathing. The nerves which supply the tongue, the face, the back of the throat and the neck can be affected with certain procedures during delivery which cause bruising and/or torquing of the cranium. Treatment is gentle with a goal of improving function of the structures involved. The earlier the infant is treated, the easier it is to establish effective feeding. Proper sucking is important not only for successful breastfeeding but for training the muscles of the mouth which later are used in speech and articulation.

During the exam the infant is evaluated to see if they have normal biomechanical functioning. Besides a thorough biomechanical examination, the neck, the cranium and the shoulders are assessed. Injuries to the neck, shoulder or clavicle are common reasons why the infant has pain or discomfort and prefers to feed from one side. These injuries should be evaluated for treatment. It is important that the neck functions properly to avoid plagiocephaly. Plagiocephaly is a flattening of one side of the head, which causes displacement of the ears. This has long term consequences and can be treated with good results. The neck can be gently treated so it regains normal functioning and no longer is a source of pain for the baby. The cranium is inspected for injury and symmetry. Injury to the cranium may be a reason why the infant has a preferred position of the head. It may affect nerves leaving the cranium which supply the face, the tongue, the mouth. This can be treated with gentle maneuvers directed towards restoring normal positioning. The mouth and its’ structures are evaluated next. Some infants have a frenulum or tongue band which attaches too far forward and does not allow them to stretch out the tongue far enough to get a good latch on the breast. Left untreated this can later affect their speech. This can be clipped by a pediatrician during a regular visit. This should be done promptly as it causes a painful latch and inefficient feeding. The tongue is further evaluated to determine if the infant can properly to suck. The infant, who is losing milk while feeding or makes a clicking noise while sucking, may have tongue bunching and can be treated so the tongue functions properly.  Next, the shape of the palate has an impact on how efficient they can express milk. Having had a nasogastric tube can affect the palate so that breastfeeding is more difficult. After removal, the infants may continue to make movements with the tongue to expel the tube. This movement is counterproductive to breastfeeding and can be addressed through treatment.  Many of the mechanical issues around feeding can be addressed with skilled treatment.  Parents can be taught how to work with their child so together with appropriate care there are minimal long term effects.


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