Date: Sat, 2 Sep 2006 22:52:12 EDT
From: Ann Conlon-Smith <[log in to unmask]>
Subject: Crooked mouth, crooked tongue
Help needed here. Just got home (oh these hours are killing me) from a
consult with 5 day old baby with an unusual (for me) situation. Mom called
me
because she was concerned with baby's low output and lots of clicking going
on
at breast. When I observed feed, oh yes, lots of clicking indeed and then
when I looked at baby -- very crooked mouth and tongue. I have never really
seen this as pronounced as this one before. Of course she is clicking!
When I
did weights, the intake was minimal though it had sounded like there was
swallowing -- there wasn't really. Was able to feed her some with
periodontal
syringe, finger feeding was fair, and nipple shield helped, but marginally.
Cup feed did not work as her tongue was never in the right spot and milk
went
everywhere. When I laid her on bed, she looked a little like she might
have
Torticollis since she turned to left repeatedly. It is holiday weekend here
so I have encouraged them to supplement with syringe or tube with finger or
by bottle until they can see a doc on Tuesday. Midwives d/c them after
birth
saying, "just keep an eye on her mouth but it probably from birth." Maybe
it is, but I cannot imagine how this will just miraculously correct itself.
Birth was fine. Also, baby spit up twice after feed and spit up was pinkish
and then brownish... Scared me some, but I am not sure. Mother's nipples
were
not bleeding. Baby has lost 8% of birthweight. I have left them with a
scale and told them that baby must start gaining as of now, with
supplementation
using EBM which mother has. Are we talking ENT? Cranial Sacral? Dysphasia
Clinic? Help me out here, please. Thanks, Ann
Ann Conlon-Smith, IBCLC
Dear Ann,
My recommendation would be for CranioSacral Therapy (CST). I have seen it
turn around cases of infants with too slack a closing of the lips, too tightly
pursed lips, inability to flange lips and asymmetries of face, skull, body.
Look at the pictures in the article, "Mandibular Asymmetry and Breastfeeding
Problems: Experience from 11 cases" that is on pp 328-335 in the most recent
issue of JHL, August 2006. The pictures show a number of asymmetries in the
babies and there is also an illustration of the various clues to look for.
CranioSacral Therapy would have shortened the time to easy, comfortable, effective
breastfeeding in all these babies.
If you check Dee Kassing's article at the BFAR website, "Breastfeeding and
Craniosacral Therapy: When it can help," she goes into even more detail as to
what to look for. I share this article, the one on CST and Bfing at the LLL
website, and the one about CST at the Kellymom.com website with all the clients to
whom I recommend CST for their babies.
Think about it: babies must have the necessary skills in order to breastfeed,
some of which include:
* ability to open mouth wide enough to encompass a mouthful of breast
* ability to sustain that wide open mouth for the duration of the feed w/o
slipping down on the nipple
* ability to flange top and bottom lips spontaneously. Lips should be not too
tight (pursed) nor too loose (slack)
* ability to use tongue in a cupped mode with an organized, rhythmic
peristaltic motion
* tongue should be forward over lower lip and gum (have had several non
tight/short frenulum babies who could not do this consistently until after CST
treatments.
My list is becoming more extensive:
If mother is having any ongoing nipple pain despite correcting position and
latch to a deep asymmetric latch and has any of the following indications, I
usually recommend CST. It does no harm and has turned around borderline nipple
soreness and milk transfer and even the most challenging breastfeeding
situations.
Presentation of the baby in positions other than face down
Very long (> 18 hours) or very rapid (<3 hours) labor
Epidural anesthetic
Forceps or vacuum extraction
Cord around the baby's neck one or more times
Severe slowing of baby's heart rate
Time during labor when contractions slowed or stopped
Cesarean delivery because of lack of progress
Other indications for CranioSacral Therapy include:
Asymmetry of face, head or body
Baby s lips not closing when sleeping; or tension (pursing) in
the lips
Baby ‘s inability to rotate head 180 degrees when laying down
Baby’s inability to lay flat with hips and shoulders resting on
firm surface
Baby is unable to open his mouth wide enough to latch or sustain
wide open mouth at breast
Variations in infant palate
Bruising on baby’s head
Nipple pain during or change in nipple shape at end of feed
despite deep asymmetric latch
I agree with Dr. Tina Smillie, MD, FAAP, FABM, IBCLC, that Babies are Born to
Breastfeed. If they are to actively breastfeed effectively and comfortably,
we must become even more aware of the subtle indications of asymmetry, flexion
and structural problems that require myriad artificial breastfeeding aids
(nipple shields, pumping/expressing milk, alternative feeding methods, drawing the
jaw down, pressing up on the jaw, flanging the lips, etc.).
Once these issues are addressed through CST (or any of the other elements of
body work, such as osteopathy or chiropractic) we will then return the correct
performance of breastfeeding to the baby, just as birth practitioners have
been doing back to ancient times. Midwives for centuries practiced the skillful
assessment that lead to gentle manipulation similar to what is embodied in
CST, which restores symmetry and flexion and baby's ability to suckle
effectively. Even today in locations all over the world, midwives search newborns for any
of the asymmetries described in the JHL article (thank you Virginia Wall and
Robin Glass) and in the article by Dee Kassing (Thank you, Dee!) and gently
work them out so that babies can successfully, effectively and comfortably
breastfeed.
Once you have developed the eye for these subtle problems, then you must
decide what steps to take to help resolve them. I know that in hospitals and
medical clinics and within the medical field, CST, chiropractic and osteopathy are
outside the comfort zone for referral. OTs and PTs are a good next step.
However they are limited to exercises and no hands on treatments. (Reference Case #
8 in the JHL article: the mother was able to successfully breastfeed the baby
until 13 months, but a photo {p. 332} of the baby, now 18 months old shows
that this little guy still has asymmetries of head, neck and ear.)
If your practice allows you the consideration of CST or chiropractic or
osteopathy, an additional problem is finding practitioners in your area who are
trained in these modalities and very experienced in work with newborns. Good
luck! If you do find someone, s/he will be worth their weight in gold in what they
can do to help your clients attain their goal of easy, effective, comfortable
breastfeeding and resolving structural issues that could persist into
childhood and adulthood.
I have been given the names of a number of practitioners in my local area by
former clients, midwives and Doulas. These names have all proven to be
wonderful professionals and effective in helping the babies (and parents and
siblings) who have come to my practice.
CST practitioners names are available at the Upledger Institute:
http://www.upledger.com/home.htm
I have developed a close professional relationship with an excellent infant
and adult CST practitioner. She is also DC. I asked her whether she though that
chiropractic or CST was more effective in resolving breastfeeding issues. Her
opinion is that CST can go more deeply into resolving these issues and that
the adjustments hold longer. Parents particularly appreciate these two
advantages because these treatments are frequently not covered by insurance.
All of this has been a development in my practice in the last two years, when
I was faced with a very challenging client. I searched the archives of
Lactnet and saw several postings about the efficacy of CST for resolving sucking
issues. Thank you for the words of wisdom of those of you who were well
acquainted with CST before me and spread the word to Lactnet. It has been invaluable
information for that initial client and subsequent clients.
Ann Russell, IBCLC, RLC
North County Lactation Services
Poway, CA 92064
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