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Breast Feeding Difficulties and Temporomandibular Joint (TMJ) Dysfunction
by Dr. Moshe Laub B.P.T, D.C.

Breastfeeding is one of the best things a mother can do for her new baby.  In fact, the American Academy of Pediatrics calls breastfeeding "uniquely superior" to all other forms of infant nutrition  and the American Academy of Family Physicians recommends that all babies, with rare exceptions, be exclusively breastfed for about six months .  Milk produced by all mammals is specifically adapted for feeding their own young, meaning that cow milk cannot provide all the nutrients needed by a human child in the correct amounts.  Furthermore, breast milk reduces the incidence and severity of a wide range of infectious diseases, reduces the risk of Sudden Infant Death Syndrome (SIDS), and reduces the risk of a great many other diseases such as diabetes, leukemia, asthma, and more.  Breastfeeding not only greatly helps the child's health, but it also helps mothers by decreasing bleeding after the birth, speeding return to her pre-birth weight, decreasing the risk of later developing breast or ovarian cancer, and reducing the effects of osteoporosis.

The act of breastfeeding is also a vital part of the infant-child bonding process and in the learning development of the infant.  Beyond these emotional, psychological, and developmental benefits, there is also a physiological communication between mother and child during breastfeeding .  By breastfeeding, the mother's body is able to respond to the changing needs of the infant in ways that are impossible to replicate through formulas.
 
Despite the vital importance of breastfeeding, many mothers find it difficult or impossible to nurse their infants.  Only rarely, however, is this difficulty due to a problem with milk production or other conditions with the mother.  The most common causes are the child's inability to either latch or suckle effectively.  Midwives, lactation consultants, and other health professionals that deal with infant nutrition can suggest ways a mother can help her child overcome these difficulties, but a chiropractor can also be an important member of the team addressing these issues.  Unknown to many, problems in the child's temporomandibular (TMJ) joint can affect their sucking and latching abilities.

The TMJ joint is the joint where the lower jaw (called the mandible) meets the skull.  When the mouth opens, the jaw rotates around the head of the mandible and slides forwards slightly.  TMJ dysfunction is any condition where these motions are impeded or compromised by problems such as misalignment or obstructions.
 
It should not be surprising, therefore, that difficulties in this motion can interfere with breastfeeding.  Of 1,000 infants treated in one recent study for breastfeeding problems, 800 had TMJ dysfunction .  Another study of 25 infants with breastfeeding problems and 10 children without problems revealed a pattern of TMJ issues in the children that couldn't breastfeed.

Why would an infant have TMJ dysfunction in the first place?  One leading cause is birth trauma.  Birth requires the baby's head to be squeezed through along the small diameter, muscular birth canal.  The human skull is adapted to actually have the skull plates shift position in order to make this journey.  Displacement of skull bones is inevitable during a vaginal birth.  Even a Cesarean birth  can cause displacement and shifting during birth.

In most children, these bones shift into their normal alignment but some bones and joints can remain misaligned.  These misaligned skeletal structures are called subluxated.  Subluxated structures around the TMJ can cause a number of issues, such as pain, poor muscle development, and joint dysfunction.  Remember that infants before the age of two experience the world largely through their mouths.  Oral pain or muscle issues can interfere with vital developmental milestones.
 
Parents that have children who can't or won't breastfeed also know the emotional burden it can cause.  The first, most obvious worry is about supplying sufficient nutrition to the infant.  Beyond that, infants that are having nursing difficulties are frequently colicky.  One case study describes a 3-week-old infant that showed "flatulence and outbursts of crying from 9 PM to 1 AM" for each of the prior 19 days .  Another mother reported her 15 day-old child had an inability to breastfeed and colic since birth, was crying constantly, and had shaking, screaming, rash, and vomiting when she attempted feeding .  Another 2-day-old diagnosed with persistent failure to latch actually had jaundice from presumed malnourishment and faced hospitalization prior to chiropractic treatment .  Other symptoms encountered in children that are not able to nurse are excess spitting, restlessness during or between feeds, suckling objects like a fist or blanket, pulling off the breast frequently, excessively long or short feeds, falling asleep at the breast and taking a bottle directly after breast feeding.  While not all these symptoms are definite indications of potentially malnourishing breastfeeding problems, they definitely deserve follow-up.

Just as the mother's health is improved by breastfeeding, her health can be negatively affected by breastfeeding problems.  If an infant is nursing poorly, cysts can develop in the milk ducts, infections can occur in the nipples, there can be insufficient or uneven production of milk, and more.  This can result in a vicious circle where breastfeeding problems lead to problems with nursing, which results in less breastfeeding, which leads to more issues affecting the mother.

Chiropractic can help infants with nursing problems due to TMJ dysfunction by realigning bones and joints.  By doing this, the TMJ is brought into correct functioning, assisting the child with establishing and maintaining nursing.
  
Chiropractic care can retraining muscles involved in feeding as well balance the joints and muscles involved.  A chiropractic adjustment in the TMJ area may decrease the irritation and allow for improved tongue coordination. Simple non-force procedures can be very effective in solving the suckling and feeding problems in the newborn.
Babies that are able to breastfeed normally are much more likely to be healthy babies.  The non-invasive techniques of a skilled chiropractic physician can help alleviate or eliminate musculoskeletal problems preventing proper breastfeeding.  These changes provide the foundation for good health of both mother and child now and in the future.

References:

  American Academy Of Pediatrics. Policy Statement: Breastfeeding and the use of human milk. Pediatrics, 2005 Feb;115(2):496-506.
  American Academy of Family Physicians. Breastfeeding (Policy Statement) [Internet]. 2007 [cited July 17, 2009]. Available from: http://www.aafp.org/online/en/home/policy/policies/b/ breastfeedingpolicy.html
  Australian Breastfeeding Association. Every mother knows {Internet]. 2009 [cited July 17, 2009]. Available from: http://www.kindredmedia.com.au/library_page1/every_mother_knows/66/1
  Arcadi, VC. Birth induced TMJ dysfunction: the most common cause of breastfeeding difficulties. In: Proceedings of the National Conference on Chiropractic and Pediatrics. Oct, 1993 Palm Springs, CA. Arlington, VA.: International Chiropractors Association; 1993.
  Arcadi, V. Birth-induced TMJ syndrome is most common cause of breastfeeding difficulties. Dynamic Chiropractic, 1993 Aug;11(17)
  Krauss, L. Case study: infant's inability to breast-feed. Chiropractic Pediatrics, 1994 Dec; 1( 3)
  Sheader, WE. Chiropractic management of an infant experiencing breastfeeding difficulties and colic: a case study. Journal of Clinical Chiropractic Pediatrics, 1999; 4(1)
  Esch, S. Newborn with atlas subluxation/absent rooting reflex from Case reports in chiropractic pediatrics (case #4). ACA J of Chiropractic, 1988 Dec.

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