Breastfeeding may look easy but the truth is, it is really really hard.
Like, really hard. There are a number of issues you can have just trying to get the proper latch without having complications from things like a tongue tie or underlying myofunctional issues. Breastfeeding an infant with myofunctional issues (issues surrounding muscle function especially in the treatment of orthodontic problems) can be EVEN MORE challenging...but, don't throw in the towel just yet!
Like most moms (especially first time moms) you might have found this blog post scouring the internet late at night for resources to help you master breastfeeding. You are not alone, like I said before...it is REALLY hard. But, if it is especially hard for you keep reading, there might just be something that will help you...and your nipples..to survive this wild breastfeeding journey.
Did you know that myofunctional issues can begin as early as infancy, and it is NOT uncommon. In fact, 3 out of 4 children (that's 75% for you percent people) show signs of malocclusion (imperfect positioning of teeth when the jaw is closed) by the age of 5. This is a staggering rate considering that malocclusion has been shown to have effects on a child that go well beyond just crooked teeth or biting and chewing issues. Studies have shown that children with malocclusion issues can have challenges with airway, breathing, growth and development, learning and behavior.
So, what do malocclusion and myofunctional issues have to do with each other and breastfeeding?
Great question! Myofunctional issues cause malocclusion because the muscles in the face, head, neck, and jaw are not functioning properly or achieving proper resting positioning and it causes internal things to shift which in turn, causes the jaw to become misaligned. So, as parents, doctors, or dental professionals, we are seeing signs of malocclusion in early child development it means we may be able to detect it sooner and help prevent a lot of childhood issues very easily!!
Now, I know that you came here because you want to know what all of this has to do with breastfeeding and I am getting to that part...right now. Signs of a tongue tie or early myofunctional issues when breastfeeding are:
Creased, flattened or blanched nipples after feeding
Cracked, bruised, or blistered nipples; bleeding nipples
Severe pain when your infant attempts to latch
Poor or incomplete breast drainage
Infected nipples or breasts
Mastitis or nipple thrush
None of which sound fun, by the way! But, it doesn't stop there...for infants with myofunctional issues there can also be additional complications like:
Poor latch; sliding off the nipple when attempting to latch
Falls asleep when attempting to nurse
Gumming or chewing of your nipple when nursing
These issues are not limited to breastfed babies either. There are common issues we see in infants with myofunctional issues that are breast fed and bottle fed:
Poor weight gain
Poor transfer of milk
Unable to hold a pacifier in their mouth
Nasal obstruction or breathing issues; cyanosis
Lethargy and sleeping too much
In older babies who are starting to eat solid food they may gag easily, throw up often especially when eating or drinking, or refuse to eat foods with certain textures.
These early signs and symptoms are a key to diagnosing myfunctional issues at an early stage and preventing them from becoming issues with growth and development later on. But, not only that, figuring out if your baby has a tongue tie or some other myofunctional issue can solve a lot of problems you're having with latching, supply, and feeding in general.
For those of you who like to "geek out" on the science of it all, like me, I will spend a little time talking about tongue ties, swallowing, and why all of this is important for overall growth and development.
If you just want to know how to fix these issues feel free to skip ahead, no judgement.
Development of the swallowing system begins early – in fact, babies start to swallow in utero from around 16 to 20 weeks – and myofunctional issues can already begin at this stage. One anatomical condition which can lead to myofunctional issues is tongue-tie. This is thought to be a largely genetic condition in which the band of tissue connecting the tongue to the bottom of the mouth is too short, which restricts the movement of the tongue. The change in swallowing due to a tongue-tie can lead to conditions where the palate (or roof of the mouth) is not correctly shaped, such a “bubble palate” or “narrow palate”.
(Photo is of bubble palate or high palate from breastfeedingmaterials.com)
(Photo is of a narrow palate from thebreathingclinic.com)
This makes breastfeeding difficult, as it can be hard or even impossible for the baby to latch properly. Historically, the complications associated with tongue-tie (ankyloglossia) not only relate to breastfeeding, but also to speech impediments. The word “ankyloglossia” is derived from two Greek words: agkilos meaning curved, crooked, or looped, and glossa meaning tongue. As early as 200 AD, the Greek surgeon Galen recommended cauterization of the tissue. In the eighteenth century, many sources referenced the need for clipping the tongue to facilitate breastfeeding. In 1794, a medical text provided the following account (as cited in Griffiths, 2004): “A child’s being tongue-tie[d] will impede and hinder his sucking freely...He may be observed to hold his own very often...The mouth must be examined and the tongue set at liberty by cutting a ligament or string which will be found to confine the tongue down to the lower part of the mouth and which is done by the surgeon with little or no pain to the child who will commonly take to the breast immediately after the operation without any inconvenience to him and there is never any danger to be apprehended from the bleeding or any other consequence of the operation. It was common practice in the 18th century for midwives to keep a pinky nail long to quickly snip a tongue tie but, in the 1900s, when births moved into hospitals, this knowledge and practice was lost and became a point of disagreement.
More recently many providers are realizing the connection between a shortened lingual frenum (tongue tie) and a multitude of symptoms that may seem unrelated such as: high blood pressure, apnea, snoring, behavioral issues in young children, and more. Breastfeeding issues that point us to diagnosing a tongue tie early on allows us to act early to prevent a number of challenges later in life as well as aid in making breast feeding the painless, nourishing process it should be almost immediately.
So, what DO you do if you suspect that your infant has a tongue tie?
1. Consult your pediatrician, a lactation consultant, or a certified speech therapist.
2. Next, consider consulting a myofunctional therapist. An orofacial myofunctional therapist can work with your pediatrician, lactation consultant, and/or speech therapist to provide the proper re-training of the facial muscles and tongue to encourage proper positioning is achieved after the tongue tie release procedure to ensure proper function of swallowing, breathing, and chewing/eating.
A coordinated effort between a care provider and a myofunctional therapist can guarantee the best possible outcome for future development and ideal position for the tongue, neck, jaw, and airway. This means not only will breastfeeding become easier, but it will guarantee the best outcome for future development.
If you have questions, or comments, I would love to help. You can email me at firstname.lastname@example.org or, if you'd like to schedule a free myofunctional consultation you can call or schedule an appointment online today.
The Impact of Tongue-Tie and Frenotomy on Breastfeeding: A call for broadening the CPM's scope of practice - Anna Buhler, CPM
Myofunctional Issues Start in Infancy - Kidstowndentist.com