Dr. Adam Epskamp
Chiropractor BChiro(Hons), BSc(Chiro)
As a Chiropractor with a keen interest in the pediatric population it often surprises clients how much attention I focus on around infant feeding and particularly breastfeeding when consulting for infant children.
Obviously the infant can’t communicate directly with the practitioner so its necessary to hone in on behavior around certain activities to guide and help identify certain vertebral subluxation complexes or even other developmental changes that indicate appropriate progression towards the child’s milestones.
Breastfeeding and the behavior and experiences around breastfeeding give significant information and direction to an infants case. Feeding should be a rewarding experience and some mothers never have a problem while others are left wondering if they are doing it right and notice a preference to certain positions or slightly differing technique when comparing notes with other mothers, wellness nurses and lactation consultants. Some mothers even find breastfeeding painful.
If breastfeeding is painful or difficult this should raise concerns. The next step is to find help as most cases can be corrected. As a Chiropractor I’ve helped many infants improve their ability to breastfeed simply by finding the nerve interference and correcting the subluxation/misalignment. Even more commonly I’ll correct the vertebral subluxation/misalignment in a reportedly asymptomatic infant and receive feedback about how much easier breastfeeding has become, the feeding times are shorter and much more regularly spaced. The majority of cases I’ve managed have responded significantly well to Chiropractic care.
There have been a few cases where the Chiropractic adjustment only gave temporary relief to the infant and in particular the mother from painful feeding. These cases are where the practitioner must consider their differentials (other conditions that cause similar symptomatology). One such differential is ankyloglossia or otherwise commonly known as tongue-tie.
Tongue-tie occurs when there is a congenital tightness or shortening of the skin that anchors the tongue to the floor of the mouth. This skin is known as the lingual frenulum.
When the lingual frenulum is short this can restrict the mobility of the tongue and consequently the reduce function of the tongue. Restricted tongue movement can lead to poor sucking, poor feeding and painful breastfeeding for the mothers. If the infant cannot suck properly then breastfeeding becomes nipple-feeding and nipple-feeding is typically traumatic to the nipple and will lead to injury and painful feeding.
Here are some of the signs associated with tongue-tie in infants;
- nipple pain and injury,
- after breastfeeding the nipple becomes flattened,
- compression or “stripe” mark on the nipple following breastfeeding,
- the infant has poor suction while feeding,
- the infant in attempt to suck harder sucks in air and becomes gassy,
- the infant makes clicking sounds while feeding,
- cannot poke tongue out beyond lips or maybe even gums,
- unable to move tongue sideways,
- tip of the tongue mis-shaped be it notched, flat, heart-shaped,
- failure to thrive or appropriately gain weight.
A collection of these signs in combination with physical exam and history lead the practitioner to consider tongue-tie as a diagnosis, particularly if there is poor feeding and significant discomfort for the mother.
Once confirmed, the treatment is to snip the lingual frenulum (frenectomy, frenotomy, frenulectomy) to release the tongue and allow the infant to achieve good tongue mobility. It can be performed up to 16 weeks of age with out anesthetic (although in my experience through referral, practitioners don’t like to treat much beyond 12 weeks of age). The procedure is usually painless in this population, and once performed the mother is encouraged to immediately breastfeed to aid with healing, distract from discomfort and the breast milk will act as an analgesic. Beyond this age the procedure can still be performed but under anesthesia.
Once corrected immediate function is restored and all signs should significantly diminish if not resolve.