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Many articles in the literature proclaim how commonly breastfeeding and suckling difficulties occur in the newborn baby.1,2,3,4,5,6 As a chiropractor, I see this frequently in my office, although very often the parents do not complain of breastfeeding or suckling difficulties, but rather have complaints that are a result of this problem: excess crying, colic, excess spitting, restlessness during or between feeds, acting hungry all the time (suckling the fist or blanket), pulling off the nipple frequently, fussy right after feeding, excessively long or short feeds, falling asleep at the breast and taking a bottle directly after breast feeding.
The benefits of breast-feeding are well known; it is the perfect food for infants as all necessary nutrients are bio-available while also enhancing immunity and even destroying pathogens. Formula companies spend massive amounts of money attempting to mimic the healthful properties of breast milk. It is therefore very disappointing for mothers who find that their babies are unable to breast-feed properly. Usually this is simply a matter of education for the mother and chiropractic adjustments for the child. There are very few mothers who actually have a primary breast glandular insufficiency. When there is a problem, it is most commonly that the child's suckling reflex has been inhibited by mechanical forces, most of which are easily detected and corrected in the chiropractic office.
The suckling reflex is most intense in the first 20-30 minutes after birth.7 Unfortunately, in some birth cases, the child is not allowed to suck at the breast at this time, and this delayed gratification may make suckling more difficult later on. The suckling reflex, although a reflex and thus automatic, can be reinforced and aided with chiropractic adjustments (manual manipulation). First, it is necessary to test the reflex and to observe the child.
Because these complaints are so common in my practice, I have developed a grading system for the suck reflex, which can identify specific problems and can be tested over time to detect changes. This technique is also valuable in detecting early neurological problems as it has been documented that a poor suck reflex can be the first and only sign of a disorganized neurological system.7
The suck reflex is taken by the doctor placing a clean small finger into the baby's mouth at the front of the tongue; this is done after stroking around the lips to evoke and test the rooting reflex. Laying the finger on the front lip should cause the child to go into the full reflex and pull the finger up and into the mouth, wrap the lateral sides of the tongue around the finger creating a medial trough and starting the peristaltic motion from front to back toward the soft palate and pharynx.
The reflex is graded in the following manner:
- 0 - No tension is created, spits out finger
- 1 - Tongue doesn't wrap finger, weak, cannot move finger, may roll tongue side to side, may have early gag reflex.
- 2 - Accepts finger and closes mouth around it, tongue comes up, cheeks may not round outward from appropriate suckling pressure, early fatigue
- 3 - Tongue wraps finger, good strength, full response with little rest, cheeks round with full pressure and tight seal
- 4 - Hard clamp or biting (check masseter)
- 5 - Powerful suck, moves whole hand, full face wrinkling and dimpling