In my office, pediatric chiropractic often includes addressing issues with breastfeeding. I’m usually not a very formal person and prefer to write in a less “left brained” format; however, I’ve recently been organizing a plethora of case histories from the past year in my practice in preparation for a research paper. I thought it would be fun to travel over to my left brain today and share an especially inspiring case with you. Here we go...
Patient History
A 7-week-old male, born five weeks premature, was presented by his parent for feeding dysfunction and digestive distress. The parent’s pregnancy was reported to be normal with no complications. Active labor was two hours with minimal pushing. The baby had a slight cone head and bruising along his left back / side and forehead / nose at birth. His weight at birth was 6.9 lbs. He was in the neonatal intensive care unit for six weeks.
Breastfeeding was attempted immediately after birth, but he could not latch. Initial breastfeeding was unsuccessful due to prematurity. A bottle was offered due to the baby’s prematurity and need for weight gain, but the baby had little ability to take a bottle, either.
A nasogastric tube was placed and feeding was established primarily from the tube. He is not currently breastfeeding at all. He took 35%-50% of his feedings from a bottle and the rest from the NG tube. He was only offered the breast 3-4 times/day and could only feed 3-5 minutes until he tired and refused to continue.
His latch was shallow and he had a blister on his upper lip. His mother also reported that he was excessively gassy, strained to have bowel movements and his whole body appeared to curve to the left.
The primary concern was that he did not sustain a suck long enough to finish his bottle; current primary source of feeding was till the NG tube. The mother was hopeful to breastfeed, but the baby had limited ability to do so. He had been straining during digestion and appeared to be very uncomfortable in general.
Initial Exam Findings
Visual: Baby has head / neck rotation to the right and a whole-body curvature to the right. The orbit and cheek are lower on the right side of the face.
Oral exam: Tongue strength is observed to be weak and uncoordinated. Baby also has a moderately high palate. No obvious oral ties are noted.
Palpation: Spinal and cranial pattern imbalance to the right, including the upper cervical spine (C1 and C2) prominent on the right, internal rotation of the temporal bone on the right causing inferiority of the TMJ on the right. The entire cranium is in moderate extension, causing it to elongate A/P and become narrow laterally. Sacrum is posterior on the left.
Narration / Explanation of Cranial Presentation
This cranial pattern of global extension explains a lot about what this baby is experiencing! As the whole cranium elongates in the A/P plane, the sphenobasilar joint drops down in the interior of the infant cranium. This causes the sphenoid wings to tip upward.
Now here’s the amazing part: The vomer and palatine bones, which form the palate, are attached to those sphenoid wings and rise up at the same time, causing a very predictable high palate. This high palate often makes it very difficult for a baby to achieve a normal seal, leading to ineffective transfer and the ingestion of excess gas.
The other critical consequence to this extended pattern is that, as the cranium and sphenobasilar joint extend in the A/P plane, the rest of the cranium narrows in the lateral plane. This forces the temporal bones interiorly and compresses the occiput (because they are attached to each other).
The newborn occiput is an amazing piece of machinery! It is in four separate pieces and is connected by fibrous sutures. This design allows it to move in many ways quite differently than the adult (solid) occiput. The middle piece of the occiput forms the foramen magnum in the cranial floor. Remember that the famous jugular foramen resides in the fibrous union of the lateral foramen magnum and the temporal bone.
The jugular foramen contains several cranial nerves including the vagus (CN X) for overall parasympathetic function, and the glossopharyngeal (CN IX) for the muscles of swallowing.
Nearby, within the occipital condyles themselves, is the hypoglossal canal, which is the home for the hypoglossal nerve (CN XII) that controls the main muscles of the tongue.
Given the proximity of these critical nerves, it is easy to understand how upper cervical subluxation in combination with the global distortion of the cranium can lead to a weak / uncoordinated tongue, a hypersympathetic state, and challenges with digestion and swallowing, including reflux. In addition to all of that, this pattern often leads to stagnation of CSF fluid and an increase of overall dural tension.
How does all of this happen, you ask? Well, the forces involved in a normal spontaneous delivery have been measured to be approximately 29 pounds of pressure on the delicate newborn head and spine. In the event of a more complicated delivery involving the use of forceps or vacuum extraction, the measured forces are up to 69 pounds of pressure.1 Compare that to 56 pounds of pressure reported to cause a whiplash-type “sheering force in the cervical spine” of a fully formed adult head and spine.2 Birth trauma is not insignificant!
The Treatment Approach
Specific chiropractic adjustments were performed on all areas of subluxation – sacrum, upper cervical, temporal, occiput and sphenobasilar – using light-contact SOT technique.
Aftercare
A follow-up visit was scheduled within one week’s time. The parents were instructed to find ways to encourage the baby to turn his neck bilaterally, especially to the left to balance cervical asymmetry. A video was shared to demonstrate exercises to increase strength and coordination of the tongue.
The mother was encouraged to offer the breast regularly and to hold the baby skin to skin at all feedings, including bottle, to create a positive association with the breast and encourage the transition to breastfeeding. The dyad is working with an IBCLC for supportive care as well.
Response to Care
At the second visit, the mother reported that the baby was able to take almost 100% of his feedings from the bottle rather than the NG tube. She had even removed the NG tube for the past few days. He was also able to latch on the breast for approximately 10 minutes at a time. He could not sustain a full feeding from the breast yet, because he had been reliant on the NG tube for the majority of his feedings since birth. He had increased gas and digestive upset during the previous week, possibly due to the new method of feeding from the bottle.
The digestive upset was resolved after two more visits. The baby continued to transition to breastfeeding and the NG tube was permanently removed with the agreement of the primary care doctor. A total of six adjustments were performed within three weeks’ time; then care frequency was gradually reduced over a span of two months until a monthly wellness visit was initiated.
Clinical Pearls
This case history is a great example of how powerful the chiropractic adjustment is and how it impacts the lives of not only infants, but entire families. This is also a great example of why I am beyond proud and joyful to be able to deliver skilled care that has such lifelong impactful results. I implore any DC interested in working with this population to be diligent in study and training to be well-prepared for the privilege of changing lives.
References
- Dorough A, Vallone S. Differentiating the impact of biomechanical forces of labor and delivery vs. the effect of a posterior tongue tie on neonatal and infant feeding dysfunction: a clinical evaluation. J Clin Chiro Pediatrics, Nov. 2023;21(2):1893-1901.
- Cormier J, Gwin L, Reinhart L, et al. A comprehensive review of low-speed rear impact volunteer studies and a comparison to real-world outcomes. Spine, 2018 Sep 15;43(18):1250-1258.
