HELPING BABIES WITH BREASTFEEDING
The benefits of breastfeeding
Why wouldn’t you want to give your baby a tailor-made, natural, unprocessed, nutritionally balanced feed? The immediate benefits of breastfeeding are obvious: the bonding moments that successful breastfeeding creates, the convenience, and the cost effectiveness. Breast milk supports the baby’s immunity to disease too through transference of the mother’s antibodies. The process of suckling from the breast can also assist drainage the Eustachian tubes, thus protecting against ear infections. Feeding from a bottle doesn’t involve the same width of opening of the mouth, hence the same jaw movement, or the same tongue motion as breast feeding, so doesn’t have the same beneficial effect on the ear. In fact, in cranio-sacral therapy it is believed that the process of breast feeding, including the stimulation of the roof of the baby’s mouth (i.e. the palate) and the effect that the jaw motion and pressure changes have on the membrane and muscular connections in the skull, is a powerful “self-help” mechanism for allowing many cranial tensions created during the birth process to release.
The longer term health benefits of breastfeeding may not be so widely appreciated. A World Health Organisation paper published in 2013 reported that in the long term, failure to breastfeed is likely a factor in the development of inflammatory bowel disease, celiac disease, and diabetes. This is because breast feeding helps to establish the healthy “biome” in the gut by passing on from mother to baby the healthy bacteria required for optimum digestion, and providing the right nutritional balance to allow this to happen. Interestingly, a baby cannot digest approximately 50% of the sugars naturally occurring in breastmilk, so it is assumed that their purpose is to help establish the infant’s gut biome. Increasingly research is showing a link between many auto-immune diseases and the breakdown of the gut biome due to poor diet, lack of exposure to bacteria and over-use of antibiotics. Artificial-feeding was also associated with increased blood pressure and cholesterol levels in adulthood.
Why some babies struggle to breastfeed
Breast feeding should be the most natural thing in the world, and for many new mums it is. However, as someone who struggled to breastfeed my first child I know how problematic it can seem for some mums, and how distressing it can feel for both the mother and baby when breastfeeding isn’t going well. Whilst no-one should feel bad if they find themselves unable to breastfeed their baby, there are plenty of reasons for giving breast feeding your best shot. Understanding why some babies struggle with breast feeding can help to identify possible solutions to the problem.
Musculoskeletal disorders are a common factor. These are muscle and joint problems usually resulting from either the birth process or the position of the baby in the uterus during pregnancy (intra-uterine constraint). These very often involve neck and jaw issues, but if a baby is distracted by musculoskeletal pain anywhere in it’s body, or indeed by a headache, it seems reasonable to assume that this could make feeding more challenging. Typical signs that musculoskeletal issues are a factor in breastfeeding problems include:
• the baby pushing off the breast
• arching the back when feeding
• milk dribbling out of the mouth when at the breast
• difficulty in achieving an effective latch, often due to not opening the mouth wide enough
• ineffective suckling, often giving the mother sore nipples
• Distress or discomfort when being positioned for breast feeding.
A study published in the professional journal Clinical Lactation (2016) asked lactation consultants about their perceptions of musculoskeletal disorders affecting breastfeeding. The most common musculoskeletal issues were identified as congenital torticollis, sometimes known as “wry neck”, (25%) and neck tension (14%). The most common latch issues were identified in this study as painful latch (24%), neck problems (18%), non-latching (9%), and tongue-tie (27%).
Tongue tie is where the tongue is tethered too tightly to the base of the mouth, making normal sucking difficult for the baby due to restricted mobility of the tongue. There are different grades of severity of tongue tie, but it is not unusual to be offered a frenectomy (i.e.”cut” of the tongue tie). This can be very helpful if breastfeeding is proving problematic, and is generally a quick procedure which seems to cause minimal upset to the baby, with often an almost instant improvement in feeding. A Lactation Counsellor can check to see whether your baby has signs of a tongue tie. After a frenectomy it can be useful to use some simple soft tissue techniques, to help ensure that the tongue remains mobile as the surgical cut heals. For babies with a tongue tie that is considered too mild for a frenectomy, the same techniques can be helpful to improve oral motor function. See below under “Face Massage” for further details.
Looking for clues
So how would you know if your baby had a musculoskeletal problem? In addition to the feeding issues already described, babies with musculoskeletal and structural problems will often feel uncomfortable and may show this in a number of ways including excessive crying, sleep problems, and being generally unsettled. Sometimes there can also be very noticeable functional problems such as discomfort in certain positions and body positioning too.
Observations that parents might make which can indicate a musculoskeletal problem in a baby include:
• Erect head control (“military” posture when held upright)
• Preference to keep or turn head to one side
• Inability to turn head left or right
• Uncomfortable in certain positions, e.g. lying on the back or having the nappy changed
• Asymmetrical posture, e.g. lying in a curved “banana” shape
• Facial asymmetry: crooked smile, uneven eyes, an ear that “sticks out”
• Intolerant of the car seat
• Fusses or becomes frantic during tummy time
• Excessive back and neck arching
Need help? Here are some ways to get breast feeding on track…
There are a number of ways that you can get help.
Lactation Counsellors – These are specially trained professionals who can offer advice and support on all aspects of feeding your baby. They can also check your baby for tongue tie if you are concerned that this may be a factor. Your Health Visitor should be able to put you in touch with the lactation counsellors at your local hospital.
Support Groups – It can be very helpful to join a local group where support is available, and these will typically include access to a lactation counsellor.
NCT “Baby Talk” sessions – These are for Mums and babies under 6 months old. Haslemere and Midhurst NCT have Baby Talk sessions at The Royal School, Hindhead, on Monday mornings, 9-11am. There is always a lactation counsellor on hand, and it can be really helpful to share experiences with other new mums. Haslemere Chiropractic’s Michelle Carrington visits the group from time to time to offer free advice and baby check-ups.
La Leche League is an organisation set up to promote breastfeeding and support breastfeeding women. Their website has some fantastic resources and is well worth a look (www.laleche.org.uk). Our local group is based at Grayshott and their Café La Leche is a weekly gathering of breastfeeding mums who meet at The Timothy Room, St Lukes Church, Headley Road, Grayshott, GU26 on Monday mornings (10am-12noon). Support is available from a lactation counsellor. Toddlers and older nurslings are most welcome, and refreshments are available.
Chiropractic care – People are often surprised that babies may need chiropractic care. There are many reasons why a parent may decide to bring their baby to a chiropractor, and these are typically linked to muscle and joint problems (i.e. “musculoskeletal”), and the effect that these may have on the child’s nervous system. Chiropractors who offer care for babies will often be trained in cranial techniques too.
Muscle, joint and cranial problems can start as a consequence of the positioning of the foetus in the womb (intra-uterine constraint), and through the birth process. Lifestyle factors such as prolonged periods in car seats and lack of tummy time, can also have an impact on the musculoskeletal wellbeing of babies and infants.
At Haslemere Chiropractic Clinic, the practitioner who offers care for babies is Michelle Carrington (that’s me!). I have been in practice for more than 20 years, have attended numerous post graduate training courses on paediatric care, and am also a qualified cranio-sacral therapist. Techniques used to care for babies are always very gentle and designed to safely and effectively help little people. These include massage and soft tissue techniques, and gentle ways to improve function of the joints (often holding techniques or gentle vibration).
Every child visiting a chiropractor is individually assessed, and any issues addressed, rather than “treating” a specific problem. For a baby brought to the chiropractor in relation to feeding issues, a visit might typically involve: Checking the throat, jaw, upper neck and back of the skull (which can often be very tender due to the strains of the birth process); checking for tongue tie, and similar tethering that can occur with the lips and cheeks; releasing the muscles of the tongue; checking muscles that can compensate for other dysfunctions that affect feeding (these are quite diverse and include the muscles at the front of the neck, the diaphragm, and the shoulder girdle); and looking for any spinal and cranial problems which might be making the baby uncomfortable or unable to relax in the feeding position.
The techniques described above are broadly described as “manual therapy”. In the study published in Clinical Lactation (2016), most of the lactation consultants who responded (91%) noticed breastfeeding improvement following manual treatment.
Face massage – It can be helpful to carry out a simple routine of soft tissue techniques around the face and mouth to help the muscles of the jaw and tongue operate efficiently. As mentioned earlier, this same routine can be particularly helpful for babies with tongue tie including maintaining improved function after having a frenectomy. A demonstration of this routine will be posted soon in a separate blog on the Haslemere Chiropractic website, or call 01428 642778 and book a “Free Screening” with me (Michelle Carrington) and I would be delighted to teach you this technique in person.
It is recognised that early and consistent breastfeeding support can often make the difference in a mother and baby’s ability to establish a functional breastfeeding relationship. So, if you are struggling, don’t delay!
It’s well worth persevering to overcome breastfeeding difficulties, and there is plenty of evidence for success when mum’s seek help. Bournemouth University and Anglo-European College of Chiropractic (also based in Bournemouth) operate a combined Breastfeeding Clinic to assist new mothers and babies with feeding problems, and to provide chiropractic and midwifery students the opportunity to work and learn together. The aim is to provide more efficient and effective ways to help mother and baby establish happy and healthy feeding practices. The results are impressive. A study published last year showed that on follow-up after using the clinic 93% of mothers reported an improvement in feeding. Prior to treatment 26% of the infants were exclusively breastfed. At the follow-up survey, 86% of mothers reported exclusive breastfeeding. This is a clear demonstration that there is plenty that can be done to help overcome many breastfeeding difficulties.
If you are experiencing difficulty breastfeeding your baby, seek help from a lactation counsellor, join a local group who can offer you support and encouragement, and if you think that musculoskeletal problems may be a factor, consult a practitioner such as a chiropractor with a special interest in babies, who can offer hands-on care for your baby.
Horta BL and Victoria CG. Long-term effects of breastfeeding: a systematic review. World Health Organization 2013.
Lavigne, Valérie. “Lactation Consultants’ Perceptions of Musculoskeletal Disorders Affecting Breastfeeding: A Cross-Sectional Survey.” Clinical Lactation 7.1 (2016): 30-36.
Miller J, et al. Parent Reports of Exclusive Breastfeeding After Attending a Combined Midwifery and Chiropractic Feeding Clinic in the United Kingdom. A Cross-Sectional Service Evaluation J Evid Based Complementary Altern Med. 2016 Mar; 21(2): 85–91.