Breastfeeding Problems Due to Infant's Oral Cavity or Neck

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What is the first thing that comes to your mind when someone asks, "How is your baby doing with breastfeeding?" If you're like most women, your response is centered on how much milk you're making and how often the baby is actually at the breast. No one is going to talk about the baby's oral, head, and neck anatomy, but that is where the whole process of feeding begins. The function of this region of the baby's body can make or break the whole feeding experience. The major players are the:

  • Nasal cavity: This is the main passageway for air, which aids in purifying and moisturizing it before entering the lungs. In the front, this area is surrounded by the cartilaginous (a tough, elastic tissue) part of the nose. Underneath the nose, the hard palate provides a firm border between the nasal and oral cavities.
  • Oral cavity: This has a significant role in ingestion of food. It is bordered by the roof and floor of the mouth, the lips, and the cheeks.
  • Pharynx: The most important job is swallowing and keeping itself open, which is critical for respiration.
  • Larynx
  • Trachea
  • Esophagus

Oral Abnormalities That May Interfere With Breastfeeding

  • Cleft palate or lip: There are three different types of clefts -- lip, palate, or palate and lip. The feeding issue stems from the baby not being able to form a sealed oral cavity to generate suction.
  • Short frenulum: Also referred to as "tongue-tie" or a "short tongue."
  • Retracted jaw or tongue: The tell-tale sign is when the baby's cheeks are dimpled or she makes a clicking sound when breastfeeding. Some methods to improve the situation include making sure that the baby's head and neck are properly aligned; doing exercises where you stroke and apply pressure to the tongue from the tip to the back; short-term use of a nipple shield, a flexible silicone nipple that is worn over the mother's nipple to feed.
  • Micrognathia: This is a small or "pushed back" lower jaw. On the outside of the body, the chin looks recessed. In the mouth, the tongue is positioned further back in relation to the oral cavity. It is often related to a wide U-shaped cleft palate and Pierre-Robin malformation sequence. With a small or recessed jaw, the tongue may not be able to come forward sufficiently to be properly positioned below the nipple. In addition, the lower jaw may not be well-positioned to compress the areola for productive milk ejection. One technique that may help is gently pulling forward under the jaw.

    Sucking Problems

    • Sleepy baby: A few possible reasons that this may occur are medical issues; the baby may be overstimulated, or your milk may be "coming in." Although it is essential to determine why your baby is sleepy, it is equally as important to work on waking methods.
    • Weak suck: Typically, the breast continually comes out of the baby's mouth, particularly when the mother shifts even slightly. Also, milk leaks out of the baby's mouth while he is nursing. Overall weakness can be a contributing factor, or the baby may have respiratory or endurance problems. Both assisting the baby to have a stronger suck and increasing the flow of milk are the keys to changing a weak suck. Aside from ensuring that the baby's latch-on and positioning are correct, cheek and jaw support are essential.
    • Poor initiation of sucking: There can be many obvious reasons for this -- premature, jaundiced, or neurologically-impaired babies may have difficulty. Quite often, a baby will display an excessive rooting reflex. Regardless of what the issue is, it is critical that underlying problems receive treatment. Managing excessive rooting is achieved by giving the baby's body firm support and controlling the head through proper positioning. It is also important to assist the baby with mouth closure by firm jaw support.
    • Biting, clamping or clenching response: Make sure that the baby is very well-supported as this often stems from overactive muscle tone. Some treatment methods include "mouth play," or giving the baby a lot of oral experiences (feeding, touching) to increase awareness of what the mouth can do. Stimulation on the face will also help to achieve this goal.
    • Excessive tongue-tip elevation: The tip of the tongue is raised up against the hard palate, just behind the area of the mouth where the sockets of teeth should be. In this case, putting the breast in the mouth is problematic.
    • Tongue protrusion or thrusting: One treatment includes applying firm, downward pressure to the tongue to push it down and out. Another technique is to walk your fingers back on the tongue to achieve the same goal.
    • Lack of central grooving of the tongue: The best method of treatment is "proprioceptive input," or teaching the sensory receptors in the tongue to respond to a stimulus. This involves placing a downward pressure at the midline of the tongue and slightly stroking forward. A firm, straight nipple may also help, so a nipple shield may be recommended.
    • Excessive jaw excursion: Babies will display disorganized sucking at the breast with a loss of suction and a repeated need to "relatch." To help the situation, it is necessary that positioning is correct and that the mother gives the baby jaw and cheek support.
    • Inadequate mouth opening: There can be many reasons for this, but typically relates to the baby's state of alertness or a clenching jaw. Some methods to help the situation may be: adjusting the baby's state; beginning the rooting reflex; helping to open the mouth; preventing jaw clenching.
    • Gags: The best method of treatment is desensitization.
    • Low or high muscle tone: Babies are described as "hard to hold" or they "arch away from the mother."

    Premature Babies and Associated Sucking Problems

    If your baby is premature, you may notice that he has a combination of sucking issues. The most common are:

    • Disorganized or inefficient sucking patterns
    • Weakened lip seal
    • Impaired tongue shaping or movement
    • Weakened stability of the inner cheek
    • Trouble synchronizing the suck and swallow with breathing
    • Poor ability to awaken and to stay alert at the breast
    • Low control of posture
    • Irritability

    One commonly seen complication in premature babies is Infant Respiratory Distress Syndrome (RDS). This can have a negative impact on feeding as well. Babies with RDS have difficulty synchronizing their sucking, swallowing, and breathing. They cannot withstand long feeds and tire easily. As a result, the baby does not have an adequate intake of nutrition.

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    Article Sources

    • Arvedson JC and Brodsky L. Pediatric swallowing and feeding: Assessment and management. San Diego: Singular. 2002.
    • Cherney LR. Clinical management of dysphagia in adults and children. 2nd edition. Gaithersburg, MD: Aspen. 1994.
    • Wolf L and Glass R. Feeding and swallowing disorders in infancy: Assessment and management. Tucson, AZ: Therapy Skill Builders. 1992.