Physical Issues of the Infant:
Pre-mature babies Not all babies decide to show around their due dates and some like to make an earlier appearance than expected. Pre-mature infants, depending on their gestational age, may or may not have challenges after birth adjusting to the world and being able to nurse. Typically after the 38th week of development the infant will be able have a fully function suck-swallow-breathe mechanism in place. This allows the newborn to extract milk from the nipple, swallow the milk and then breathe air into the lungs in a precisely timed and rhythmic cycle. This cycle must occur in a precise order and requires a great deal of coordination and communication between higher brain functions and the rest of the body. Some pre-mature infants may need some extra time to more fully develop their suck-swallow-breathe technique before they become efficient.
Laryngomalacia is a congenital malformation of the larynx or portion of the airway. The term means a soft of floppy airway, which can complicate the ability to breathe and consequently the infant’s ability to produce a cyclic suck-swallow and breathe cycle. Your pediatrician or lactation consultant may help in diagnosing this malformation from a clinical history and how the infants sounds when they breathe. A referral to an otolaryngologist or more commonly known as an ENT (Ear-Nose-Throat) physician can help evaluate the malformation and better assess the severity and any need for treatment. A similar issue can occur in the trachea, which is another portion of the airway below the larynx, and is referred to as trachomalacia.
Torticollis or the twisting of the head and neck, is caused by the muscle tightening of the sternocleidomastoid muscle. This tighten will cause the head to turn in the same direction as the side with the muscle tension. As the head is restricted in its ability to freely move, nursing in certain positions can be extremely difficult for the infant and mother. The clavicle, which is attached to the sternocleidomastoid muscle, also serves to anchor the hyoid bone that connects to the tongue muscle. The one article below can be downloaded and will help you better understand how you can better feed an infant with torticollis. The other article outlines and explains in detail how torticollis effects head positioning, and can impact other structures that are connected to the clavicle.
Retrognathia or a set-back mandible or jaw may impact how well an infant is able to feed. Nearly all infants will have some degree of retrognathia and this is considered completely normal. As the head and neck develop in utero, the chin is in close proximity to the chest. The womb is very tight on space and the jaw will stay tucked into the chest until birth. As the infant matures, a properly developing jaw will grow forward and advance. Some infants will have an upper jaw (maxilla) that is set more forward and lower jaw (mandible) that appears to be set back. If the difference between these two arches is excessive, it may present a challenge for the child while latching and trying to nurse. As the jaw is position further back, the tongue will also be pushed further back. The posteriorly positioned structures can negatively impact the airway and may lead to a more open mouth posture and mouth breathing.
Infant Birth and Medical Complications
Figure 1 and 2: These images depict how a recessed mandible can cause the tongue to rest in the airway and create a mechanical disadvantage for nursing.
Lower muscle tone or hypotonia occurs when an infant does not either have the muscle strength or physical stamina to efficiently latch, nurse and extract milk from the mother. This should not necessarily be confused with an infant who tires at the breast or quivers the jaw while nursing. Those issue can occur in a child who inefficiently feeds and uses muscle of the face excessively while nursing and not the tongue. True hypotonia may be due to a host of reasons and with the help of your lactation consultant and pediatrician, they can help diagnose the underlying cause. More detailed information can be found here: Hypotonia in Infants and Feeding