Oral Dysfunction in Breastfeeding Infants: An Overview

What Are the Conditions That Cause Oral Dysfunctionalities?

Oral dysfunctionalities in newborn infants may occur due to various pathologies or conditions; it can impact the normal suckling response through which the infant derives its food and nutrition from the mother's milk. These disorders may also hinder the newborn's approach to latch on correctly to the mother's breast or result in forceful infant feeding that can create distress. Several such clinical events or pathologies have been recognized that can traumatize the newborn's natural ability to suckle the mother's nipple. Some of them are enlisted below:

• Premature birth and low birth weight.

• Ankyloglossia or tongue tie.

• Laryngomalacia (noisy breathing in infants).

• Cleft lip and cleft palate.

• Submucosal fissures (a natural cleft or opening in the oral region).

• Oral lesions of the newborn.

• Syndromes associated with congenital abnormalities.

• Metabolic disorders of the newborn.

• Neurologic disorders of the newborn.

• Oral anatomic dysfunctions or changes (for example, a palate that is highly arched in the newborn that can interfere with its latch-on ability or impulse).

When Does Coordinated Motor Response Develop in a Healthy Infant?

Even from the fetal stage of life, the fetus performs the acts of both sucking as well as swallowing the amniotic fluid in utero in the mother's womb. This indicates that in-utero programming of motor activities is well developed in the fetal phase of life itself, even before birth. Research also suggests that the amniotic fluid swallowed by the fetus is similar to the act of suckling by the newborn.

What Is the Physiology of Suckling and Why Is it Important?

The process of suckling in newborns and infants is complex, as it involves the creation of negative pressure to draw the milk from the mother's nipple. The negative pressure creates an oral suction from the baby's oral cavity that combines a set of jaw movements to express or draw the milk from the nipple. The infant's lips are sealed tightly around the nipple to prevent the entry of air into the oral cavity. By simultaneous compression and elevation of the jaw and the tongue, the milk can be easily swallowed by the infant. Research indicates the sucking pressure of newborns and infants varies between 50 to 200 mm Hg (millimeters of mercury). Also, this swallowing process in the newborn is accompanied by the act of respiration too; though infants can swallow the milk without any interruption in their breathing patterns, there are brief periods where either there would be no suckling when there are sudden negative bursts of pressure and also short periods of interrupted airflow during the swallowing patterns. These patterns, from oral suction to pressure or motor coordination, may be impacted in infants with dysfunctions causing issues in breastfeeding.

What Are the Signs Indicating Oral Dysfunction in Breastfeeding Infants?

Signs that indicate oral dysfunction in breastfeeding infants include:

1. Difficulty With Latching: The baby may have trouble latching onto the breast correctly, leading to shallow or improper latching resulting in inadequate milk transfer.

2. Weak or Uncoordinated Sucking: The baby may have uncoordinated sucking, resulting in reduced milk intake and ineffective milk extraction.

3. Frequent or Lengthy Feedings: Babies with oral dysfunction might have the need to nurse often or for extended periods for obtaining adequate milk.

4. Insufficient Weight Gain: Babies with oral dysfunction might find it challenging to gain weight due to inadequate feed.

5. Fussiness and Agitation During Feeding: As infants face struggle in extracting milk, they may become fussy, agitated, or frustrated while nursing.

6. Clicking Sounds: Clicking sounds may be audible during feeding as there will be improper tongue movement or latch.

7. Prolonged Feeding Sessions: The duration of breastfeeding sessions may be prolonged compared to the usual duration when the baby faces challenges in maintaining an effective latch and sucking efficiently.

What Are Different Management Strategies to Overcome Oral Dysfunctionalities?

Healthcare professionals should teach breastfeeding mothers the proper technique for oral stimulation or guide them on why there is difficulty in latching in these infants suffering from oral dysfunctionalities.

• Finger Feeding Technique: It involves suckling training through a coupled tube that may be needed for babies born with neurologic disorders.

• Individualized Attention: Similarly, most superficial oral anatomic abnormalities or infants suffering from incorrect feeding patterns require the attention of the neonatologist or the pediatrician, the lactation specialist, and the oral physician for oral stimulation.

• Oral Exercises: Oral exercises to be stimulated in the infant if needed with a sequential order or maneuvers, varied orofacial practices, etc., may be used, but with professional care and by qualified practitioners.

• Active Participation of Parents: The participation of both parents or guardians may be needed to facilitate a correct environment for the newborn baby to adjust to breastfeeding as recommended by the oral physician and the lactation specialist.

How Is Multidisciplinary Approach Planned for Oral Dysfunction in Breastfeeding Infants?

According to UNICEF/ WHO (United Nations Children's Emergency Fund/ World Health Organization), it is essential for healthcare professionals and allied health workers to be educated in the interdisciplinary fields of pediatrics to enhance proper communication between the mother and child in cases of oral dysfunctionalities. These include

• Pediatrician: These oral dysfunctionalities can be studied and analyzed by the pediatrician or oral physician through careful examination of the patient's medical history (of the mother), oral evaluation of the newborn infant, and education on the breastfeeding technique.

• Lactation Specialist: A lactation consultant can help with the initial problems; for example, during the first few weeks, when the baby is still developing a good latch, the specialist will advise the mother on how to properly place the child for feeding.

• Speech therapists: They play a significant role in maternity wards of baby-friendly hospitals, as the WHO/ UNICEF recommended, so breastfeeding these infants can be analyzed and made more accessible for the mothers.

• Oral Physicians or Surgeons: Specific knowledge of the above elaborated neurophysiologic mechanisms and oral anatomy of the newborn is essential to plan further treatment.

Conclusion

The normal physiologic patterns are hampered in oral dysfunctionalities because of lack of proper oral suction, loss of motor coordination, ability to latch on, or unresponsiveness towards feeding that can cause severe distress to the infant and psychological stress to the breastfeeding mother. Interdisciplinary management for such infants is essential to stimulate correct breastfeeding response through a team of oral physicians, neonatologists, speech therapists, professional nurses, and lactation specialists.