Chiropractic Care for the Breastfeeding Dyad
Sharon A. Vallone, DC, DICCP
Hartford CT USA
From: LEAVEN, Vol. 39 No. 6, December 2003-January 2004, pp. 126-27.
The art and joy of breastfeeding
may not come naturally for a mother and child when tools used in an
assisted birth (forceps or vacuum extraction) may have disrupted the
smooth action of the child's jaw, therefore interfering with the infant's
ability to suckle.
Generally speaking, neither
hospital personnel nor lactation consultants are well educated about
the incidence of musculoskeletal trauma. During delivery, there may
be trauma to the joints and muscles of the head and neck. This results
in unnecessary delays in establishing a successful breastfeeding relationship
between mother and child. The mother's enthusiasm for breastfeeding
may be worn down by repeated difficulty when attempting to breastfeed
her baby.
Time and ingenuity might
allow an infant to overcome some difficulties. For example, an infant
who cannot open his mouth widely enough to encompass the nipple and
the areola due to a tight jaw, may compensate by moving his lower jaw,
side to side, in a sawing action. Although he is now able to stimulate
an ejection reflex and elicit an adequate milk flow, this action will
ultimately cause damage to the nipple. His mother may continue to experience
pain or injury until he is older and has a larger mouth. Time alone
is not always a healer in these cases. Unfortunately, the neurologic
programming that occurs day after day with an improper latch-on will
be strong and it will take patience to teach a baby how to suckle efficiently,
even after correcting the mechanical dysfunction.
Chiropractors (DC) who are
trained in treating infants, along with other practitioners who use
gentle, noninvasive manual techniques called adjustments, can be vital
team members in the care of the nursing dyad in the early establishment
of a healthy latch-on. Osteopaths (DO), physical therapists (RPT), occupational
therapists (OTR), massage therapists (LMT), and craniosacral therapists
(CST) are some of the other professionals who also practice manual therapies.
Practitioners can be found through US state and national associations,
but breastfeeding mothers also find supportive practitioners through
word of mouth from Leaders and parents who have had successful experiences.
The health care practitioner
will first interview the mother and her support team to determine if
the pregnancy, labor, or delivery were complicated by constraint or
position, medication, or interventions. Any or all of those factors
pose inherent dangers to the musculoskeletal system since they require
force on or near these vulnerable joints and muscles, and usually have
to be performed rapidly. Along with the potential for trauma, a practitioner
needs to evaluate all body systems to assure that the musculoskeletal
component is the predominant factor interfering with suckling.
The mother's milk production
and let down reflex, as well as the integrity of her nipples, will also
play an important role in the infant's ability to establish and maintain
an efficient latch-on, taking into consideration other possible factors
such as a yeast infection or an ineffective latch-on. The mother's milk
supply and let down are neurologically controlled. They may respond
to chiropractic adjustment, craniosacral technique, or acupressure,
as well as the more traditionally utilized herbs and medications. Ergonomics-how
the mother holds her own and her baby's body while breastfeeding-are
very important. Pain may influence her let down reflex and, consequently,
her milk production.
Once this information has
been gathered, an evaluation of the infant's oral function must be performed.
The baby's features are examined for symmetry and form. The practitioner
evaluates whether normal infant reflexes (rooting, suckling, extending
the tongue beyond the lower lip) are intact. The absence of normal reflexes
could indicate neurologic injury or the presence of subluxation of the
spine or cranial (skull) bones, interfering with normal neurologic function.
(Subluxation refers to a joint of the body whose movement is limited
in one or multiple directions.) This fixation has neurologic, vascular,
and lymphatic implications on its own and the surrounding tissues and
organs.
Spinal ranges of motion and
integrity of the joints, including the clavicle, are then evaluated.
The inability to turn the head, persistence of lateral flexion or rotation
to one side (wry neck), favoring one breast over another, and hyperextension
(movement beyond its normal range) of the spine in pain are all potential
signs of injury. Subluxation, strained ligaments, muscular sprain, and
fracture should all be ruled out.
This is followed by an assessment
of the integrity of oral function by evaluating the temporomandibular
joint (where the jaw bone meets the skull), including excursion of the
jaw (how wide the baby can open its mouth), and palpation of the muscles
involved in the action of the jaw and mouth. Palpation may reveal low
or high tone in these muscles governing improper action of the jaw or
the flanging of lips and closure of the mouth.
Cranial molding or subluxation
of the cranial bones may result in apparent changes such as flattening
or coning of the skull, but changes that are not so apparent might be
reflected in the hard palate (maxilla) and function of the Eustachian
tubes (temporal bones).
Treatment will have three
phases. The first will consist of soft tissue release of associated
high tone or "tight" muscles or stimulus of muscles of low
tone. Parents and caregivers are ideally taught how to work on these
muscles four to five times daily, using small circular massage of all
the external muscles to relax the action on the jaw or tongue. They
can even stretch the internal pterygoids muscles that control action
side to side, clenching, or bruxing. This is done by gently placing
their small finger between the gums and letting the child use their
finger as a pivot to stretch the muscles.
The second phase of treatment
is provided by the chiropractor or other practitioner. It consists of
the correcting of the dysfunctional motion of the associated joints
using specific gentle adjustments or manual techniques.
The third phase, often involving
the LLL Leader or lactation consultant, is to fine tune nursing techniques
once normalized function is restored. This integrated approach has demonstrated
positive results in many situations and has helped restore a healthy,
happy breastfeeding relationship.
Glossary of Terms
Acupressure: a form of alternative therapy similar to
acupuncture that uses manual pressure rather than needles.
Bruxing: grinding or clenching of the teeth, associated
with forceful jaw movements, resulting in rubbing, gritting,
or grinding together of the teeth, usually during sleep.
Biomechanics: motion study; the study of body movements.
Craniosacral technique:
a gentle, hands-on form of body therapy that evaluates and enhances a
physiological system called the craniosacral system, which is comprised
of the membranes and cerebrospinal fluid that surrounds and protects
the brain and spinal cord. Using a soft touch, usually no heavier
than the weight of a nickel, practitioners can release restrictions
in the craniosacral system to improve the functioning of the central
nervous system.
Chiropractic:
a system of natural health care based on the theory that disease
and disorders are caused by vertebral subluxation, a misalignment
of the bones, especially in the spine, that alters proper
nerve functions, circulation and lymphatic drainage.
Chiropractic Adjustment:
Chiropractic techniques that correct subluxation are drugless, non
invasive, gentle "adjustments" using the hands or a variety of
hand-held instruments.
Flexion:
bending the joint resulting in a decrease of angle; moving
the spine forward; the neck moves toward the chest.
Hyperextension:
straightening the joint resulting in an increase of angle;
moving the spine back; the neck moves away from the chest.
Lateral Flexion:
lateral movement away from the midline of the body; moving
the spine to the side (left or right); the neck moves toward
the shoulder.
Lymphatic: pertaining to the lymph system.
Neurologic: pertaining to the nervous system.
Palpation:
medical examination using fingers; a method of clinical examination
using gentle pressure of the fingers to detect growths, changes
in the size of underlying organs, and unusual tissue reactions
to pressure.
Rotation:
rotary movement around the longitudinal axis of the bone;
turning the spine to the side (right or left); the neck turns
toward the shoulder.
Subluxation: a joint of the body whose movement is
limited in one or multiple directions.
Upper Cervical Spine:
the two bones at the top of the neck make up the
Upper Cervical Spine, the Atlas (C1) and the Axis (C2). This
is the most moveable area of the spine, through which much
of the nervous system passes.
Vascular: pertaining to blood vessels.
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Dr. Sharon Vallone is
currently the Chair of the Board of Kentuckiana Children's Center, Louisville,
Kentucky, USA, a non profit organization that provides chiropractic
and integrated health care services to challenged children. She also
serves as an adjunct professor at the University of Bridgeport College
of Chiropractic and on the post graduate faculty at Palmer University,
teaching Maternal Health and Pediatrics. She has a family practice in
Hartford and Tolland, Connecticut, USA, with a primary focus on maternal
health and pediatrics; she provides support to women who choose home
birth, natural childbirth, breastfeeding, and natural health care for
themselves and their families. A graduate of New York Chiropractic College
in 1986, she was awarded her Diplomate in Clinical Chiropractic Pediatrics
in 1997. Dr. Vallone lectures internationally on the subject of chiropractic
as it supports the health and well being of pregnant women and children.
Last updated 12/29/06 by jlm.
Page last edited Sun Oct 14 09:31:22 UTC 2007.
