WHY CAN’T MY BABY BREASTFEED?
Congratulations! You have just given birth to a gorgeous new baby. There are few more joyous
moments in life. You likely spent the last 9 months completely focused on your pregnancy and the new
life you were creating… you dreamed of meeting your baby and of the love it would bring to your life.
You were glowing! This is (supposed to be) the absolute most blissful time in your life.
Well… you may have had a rude awakening that new parenthood isn’t what you were expecting. After 3
months of morning sickness, (likely) 6 more months of sore joints and fatigue, not to mention the weight
gain AND then (in the very best of outcomes) a very challenging delivery; now you have the HUGE and
immediate job of feeding your child. Right at the time that your body needs to rest and recuperate from
the amazing physical triathlon that you just endured AND when your hormones are wrecking even more
havoc on your body… you now must buck up and run even faster with very little sleep. Your blissful
bubble just popped.
In the best-case scenario, all of the necessary details of biology work normally for you and your baby
and breastfeeding is established with little trouble. It will usually take a week or 2 to establish a good
milk supply, to “break in” your nipples so they can endure your baby’s strong suck without pain or
damage, and to find comfortable nursing positions for you both. But it is also common that feeding is
MUCH harder than you ever expected. Oftentimes, getting the help of a professional Lactation
consultant with issues of supply or positioning is all that it takes to iron out the kinks. Sometimes that’s
not the problem. When breastfeeding challenges occur, sometimes the problem is not with the
mother’s technique, but rather with the baby himself- barriers within the alignment and tone of his
body causing abnormal function and preventing normal breastfeeding.
Let’s break this down. What needs to happen in order for breastfeeding to be successful?
Your baby has to have a normal latch
Your baby must be able to open his/her mouth wide enough to get much of your areola into the mouth.
The milk ducts are deep within this breast tissue. If the baby has a shallow latch (and is not able to open
the mouth widely), he will be clamping down on your nipple. This not only hurts and can cause damage
to your nipple, it also doesn’t access the deep milk ducts; making milk transfer much harder. He must
work much harder than he should to feed and might tire easily, fall asleep at the breast, and/or feed too
often in order to feel full.
Why can’t your baby open his mouth normally? This is usually due to the misalignment of the jaw. The
TMJ or temporomandibular joint (the jaw) is the union of the Temporal bone, which sits just lateral to
the upper neck, and the Mandible. Your baby’s cranium and spine are not fused and are very pliable.
Issues of abnormal in-utero positioning and the birth process can cause these bones to shift out or
normal alignment.
Your baby has to have the normal use of his tongue
Your baby must be able to squeeze your breast tissue tightly to the roof of his mouth in order to create a
vacuum seal and suction pressure to transfer milk. If your baby does not have normal use of his tongue,
then he likely can’t drain the breast completely. You might become painfully engorged, leading to
mastitis. You might also have a low milk supply as he is not able to stimulate enough production. This
can be a complicated topic. There are some possible barriers that can prevent normal tongue function:
“Tethered Oral Tissues”- This is when the tongue is stuck to the floor of the mouth and cannot move
normally.
- This is caused by two different reasons (and sometimes both occur at the same time)-
Genetic tethered oral tissues- We often hear this called a tongue tie or Ankyloglossia.
True Ankyloglossia is defined as a condition in which an unusually short, thick or tight
band of tissue (lingual frenulum) tethers the bottom of the tongue’s tip to the floor of
the mouth. These ties can also occur under the upper lip or between the cheek and
gums. This is thought to be a “midline defect”, forming during embryonic development
due to a genetic mutation of the gene MTHFR (Methylenetetrahydrofolate Reductase)
that helps to process folate. In the case of true genetic tethering, your baby may need to
have a surgical release of these tissues; often performed by a pediatrician, and ENT
doctor, or a specialized Pediatric dentist with a scissors or a laser.
Structural tethered oral tissues- There are six main muscles that form the tongue and
allow it to move in all the needed ranges of motion for feeding and speaking. All of
these muscles originate and are attached to various cranial and spinal bones- mostly to
the Temporals, the Mandible, and the Hyoid bone in the upper neck.- If these bones are
imbalanced (again… due to in-utero positioning and the pressures of birth) then these
tongue muscles are tethered and tight. This scenario might be present combined with
Ankyloglossia. In either case, taking your baby to a specially trained Pediatric
Chiropractor to gently adjust the cranium and spine can be very helpful to restore
normal function. - Cranial nerve impairment- All of the functions of our bodies (including muscle action) require at
least 1 nerve to allow its action. In the case of the tongue, the main nerve supply is Cranial
Nerve XII, the Hypoglossal nerve. This nerve originates in the brainstem and then passes through
a small opening (called the Hypoglossal Canal) which is located deep within the upper skull/neck
junction. The HG Canal sits inside the Occiput (the bottom skull bone), just medial to the
condyles that articulate with the first neck vertebra (the atlas). It then travels through the upper
cervical spine to the angle of the mandible (lower jaw) and dives deep to the tongue.
Misalignment of any of these boney structures cause it to be impaired, resulting in weak
muscles of the tongue. - Abnormal palate alignment- As I mentioned earlier, your baby’s tongue must be able to press
your breast tissue tightly to the roof of his mouth (the palate). Sometimes the palate can be
abnormally high, making this job even harder. The palate is formed in two ways:
This alignment of the palate itself- The hard anterior portion of the palate is formed by
the Maxilla which sits just below the nose and is connected to the jaw and Temporal
bones on each side of the face (via the Zygomatic arch). The soft posterior portion of
the palate of made up of the Palatine bone, which is connected both to the Maxilla (in
the front) and the Sphenoid bone (in the back), which is then connected to the
Temporal bones and the Occiput…. Once again… alignment is the key to proper
function of this area.
The normal use of the tongue- Now this comes back full circle! The arch of the palate is
actually partially formed by the tongue pressing up against it during fetal development.
If the tongue does not have a normal range of motion (for all of the reason discussed
above), then there can be an abnormal development of the palate.
The take home message of this article is to have hope. If you and your baby are struggling to breastfeed,
there are usually very clear explanations when we look at the anatomy. There are also straight forward,
effective, and gentle ways to help. Seek out a certified and skilled Lactation consultant to address
aspects of feedings such as supply, breast health and positioning. Seek out a certified and skilled
Pediatric Chiropractor to address aspects of feeding such as the baby’s latch and tongue control. You
might need to seek out a professional for an evaluation and release of genetic tethered oral tissues if
they are present. There is an abundance of good help available to you. There is a plethora of research to
support the benefits of breastfeeding- physically, neurologically, and emotionally.
“Breastfeeding is not just a method of delivering nutrition; it’s also a way of establishing a relationship,
requiring a sensitive dialogue between mother and infant… they learn to trust each other and to feel
confident of each other’s love… This is baby’s first relationship in life and one that sets the tone for
how baby learns to view the world”.
The Breastfeeding Book”, Martha Sears RN and William Sears, MD. Little Brown and Co., 2000.
It is so worth it. There is help available.