Author Archives: Daniel Dodge

How Chiropractic Care Helps Improve Breastfeeding

You have probably heard that Chiropractic care can help with breastfeeding issues. However, you probably have not been told how specifically this can help. There are a wide variety of things that can impact how well a baby is able to breastfeed. Cranial alignment, spinal alignment, TMJ (temporomandibular joint) alignment, fascial restriction, dural restriction, tongue tie, lip tie, cranial nerve function, etc. There are clearly more things that can impact breastfeeding, but these are the major ones in which chiropractors can help. This article will go over each of these aspects and explain how and why they can affect nursing.

Spinal Alignment

Let’s start with spinal alignment. It was found in a study many years ago that up to 95 percent of babies born had some degree of upper cervical misalignment. The Upper cervical consists of the C1 or atlas and the C2 or axis vertebrae. The occiput sits right on the Atlas and closely affects upper cervical alignment as well. Babies go through a traumatic experience being born and most develop some type of misalignment. This upper cervical alignment is very important for several reasons. One is that this is the area of the brain stem. The brain stem is home to many of the vital centers of breathing heart rate blood pressure as well as the origin of many of the cranial nerves that innervate the head, neck, tongue and throat. If there is a misalignment in the upper cervical spine around these areas, then it can lead to inflammation that affects the brain stem function and the cranial nerve function. Altered cranial nerve function can cause an abnormal suck/swallow/breath pattern or affect how the tongue and jaw move to latch and suckle. Upper cervical misalignment can also lead to tight musculature and fascia in the upper neck. This can cause the baby not to be able to open their mouth as wide or hold a latch through the whole suck swallow breath rhythm.

Cranial Alignment

Cranial alignment and movement is very important as well. Proper occipital movement on the atlas allows for the baby to be able to tip and rotate his head optimally to find the nipple and latch. Proper temporal bone motion affects the range of motion of the jaw. The Jaw attaches into the temporal bone so if the temporal bone is not moving the way it is supposed to or it is stuck in an abnormal position it affects how the mandible is able to move in the TMJ and it may get stuck or tight while trying to open in order to latch. Altered temporal motion or positioning can lead to tight fascia or muscles that cross the TMJ. This again can pull the mandible to one side or pull the mandible into the joint too much so it can’t rotate and pivot the way it needs to in order to open fully. Altered maxillary shape and movement can affect how well the baby is able to latch or maintain a latch. The bottom of the maxilla forms the hard palate. If the palate is too high or too flat, it can make it harder for the baby to maintain a proper seal when trying to latch and suckle. The Maxilla should be a smooth semicircle from one side of the gum line to the other. Often times one side will be flat or there will be a ridge or a peak in the center of the palate which will all indicate that the maxilla is not shaped properly or moving properly.

Connective Tissue

One aspect that will affect all the cranial bones as well as whole body movement and flexibility is the dural tightness. The dura is the connective tissue that attaches from the surface of the nervous system to the surface of the skull, sacrum, and vertebrae. Most times tightness in this system is associated with the findings of a tongue and lip tie. This tightness will present as a very stiff baby. He won’t want to flex forward or droop his head toward his chest. He often is stiff and straight through the mid and upper back and down through the sacrum. He often times has shrugged shoulders and can have a tendency to arch his back often. If a child is stiff and inflexible, this is going to make it more difficult for them to relax their jaw and open wide enough for a proper deep latch. If a baby is tight and stiff and anxious trying to nurse, then typically it makes the experience quite a bit harder. Babies who are stiff like this also usually have fascial restrictions through their neck, upper back, shoulders, often down through their sacrum and hips. Again, a baby who is tight and ridged is not going to move comfortably to get in an optimal position to open their mouth wide and achieve a proper latch and suck swallow pattern.

Lip and Tongue Tie

One of the biggest issues that is more and more prevalent today is newborns with a lip and tongue tie. I have done a whole blog post on just this topic if you want more information (here). But here is some basics. With a tongue tie there is extra tissue or tighter tissue underneath the tongue that is restricting the upward motion of the tongue. It affects other movements as well but mainly the upward motion of the back of the tongue. This means that they can’t bring the back of the tongue up to form a seal on the breast. This leads to the baby needing to alter his tongue movement to try to transfer milk. This altered movement is linked with altered throat movement during swallowing, so the suck swallow breath pattern is altered. This can lead to babies clicking while nursing, scraping the nipple with their tongue, swallowing air leading to reflux and colic. Tongue ties also cause restriction in the connective tissue throughout the jaw, throat and neck which affects how they open, latch, suck, swallow, etc.

Lip ties are additional tight tissue that connects the lip to the upper gum line. This will affect maxillary movement and shape as well as affecting how wide the baby can open his mouth to latch. Often you will notice you have to flip his upper lip up or there will be a blister that starts to form at the middle of his lip.

Chiropractic Care

All of these issues can be helped by a chiropractor. Chiropractors can help align the upper cervical spine and cranial bones. A chiropractor proficient in craniosacral therapy can help stretch the dural tissue and establish proper cranial movement. Chiropractors that utilize CST usually know how to do myofascial release or bodywork to help loosen the tissue restrictions throughout the head, neck, jaw, throat, shoulders, upper back, rib cage, sacrum, and hips. They can also release and loosen the tight tissue of a tongue and lip tie to help improve tongue movement. Chiropractors can also align the TMJ itself and make sure that the surrounding soft tissue and muscles are released and relaxed so that the baby can open his mouth wide and have a better latch. Chiropractic care is essential to help babies have optimal spinal, cranial, TMJ and whole-body motion. Chiropractic care allows the baby to be as relaxed and loose as possible to be able to move his head neck and tongue as freely as possible to achieve a proper latch and breastfeed affectively.

Anatomy of an Ear Infection

An ear infection is one of the most common childhood conditions. Many of those children who develop an ear infection typically end up developing many more subsequent infections. The mainstream medical treatment for an ear infection is a round of antibiotics. Unfortunately, when a child continues to develop ear infections, the treatment does not change. The only change comes in the strength of the antibiotic. It can be frustrating to put your child through one round of antibiotics after another in hopes that they will somehow stop developing ear infections. The good news is that there is another approach that can have amazing results without the use of medications. This article will explore the anatomy of an ear infection and how chiropractic can help end the cycle of infections and antibiotics.

Anatomy

Here is a picture that shows the outer ear, middle ear, and inner ear. The external auditory meatus, or ear canal is part of your outer ear. This is the canal where you develop ear wax. Ear wax is part of the immune system. It is a good thing. You will find more when your immune system is active and trying to protect the body. When the immune system fights off the threat and is less active then the wax is resorbed without any problems.  Next, there is the tympanic membrane, or the eardrum. This is a thin membrane that vibrates when sound enters the ear. The vibration then causes three little bones in your middle ear to vibrate and transmit this vibration to the cochlear nerve so you hear sound. The middle ear also has the semicircular canals that are part of your vestibular system. These canals are filled with fluid and the shifting of this fluid helps you to sense where you are in space. Proper stimulation of these canals allows you to have good balance. While abnormal stimulation of the canals can lead to vertigo. The middle ear then drops into the eustachian tube. This cartilaginous tube opens to your pharynx, right behind your soft palate. The eustachian tubes help you equalize pressure within your ear so you can hear properly and the fluid in your semicircular canals can move and function properly. The outer ear and middle ear are mostly surrounded by bone and fascia. As you move further inward towards the inner ear and the eustachian tube there is more soft tissue and fascia as well as several muscles that attach to and surround the eustachian tube. There are four muscles that attach to the eustachian tube, but two are mostly responsible for opening the eustachian tube during swallowing. These muscles of the soft palate are the tensor veli palatini and the levator veli palatini. The former is innervated by cranial nerve 5 and the later cranial nerve 10, the vagus nerve.

Infection

Most ear infections that you are going to have are in the middle ear, behind the eardrum. You can see in the first picture that there is a little pocket behind the eardrum where fluid can build up and provide an environment for bacteria, virus or fungus to grow. (It is important to note that most ear infections have a viral and bacterial component.) Typically the middle ear does not have fluid in it. Any fluid would drain down the eustachian tube into the throat so there would not be any environment for an infection to occur. However sometimes the eustachian tube can not equalize pressure effectively and fluid builds up. This occurs more often in the early years of childhood because the eustachian tubes start out more horizontal as infants and become more vertical as you grow.

There are several things that can lead to this build up of fluid. One is a misalignment in the upper cervical spine. Misalignment causes inflammation in the joints of the spine as well as in the muscles and soft tissue that attach to the bones that are misaligned and not moving properly. This inflammation can press in on the eustachian tubes making it harder for them to drain fluid from the middle ear. Another cause can be a lack of proper motion in the cranial bones. Cranial bones surround the ear canal and eustachian tube. The cranial bones move in a rhythmic motion along with the soft tissue that attaches to them. If the cranial bones are not moving, the soft tissue and fascia attached to them lack motion. Therefore fluid is allowed to build up and not drain with the movement of the soft tissue. A more and more prevalent cause for the eustachian tube not being able to drain properly is a tongue tie. Tongue ties affect the soft tissue within the mouth and throat. Tongue ties affect the natural resting position of the tongue as well as the fascial tension within the mouth and throat. This altered tongue position and the increased tension in the soft tissue of the throat make it harder for the eustachian tubes to equalize pressure in the middle ear and drain any fluid that may develop there. Cranial nerve dysfunction that typically accompanies a tongue tie also causes soft palate dysfunction as well as dysfunction within the muscular function of the muscles of the pharynx and larynx which includes the muscles that attach to the eustachian tube.

Chiropractic Care

Chiropractic adjustments can help with all of these things. A spinal adjustment helps align the upper cervical spine and balance the musculature. Cranial work and myofascial release helps improve cranial motion and reduces soft tissue tension allowing for better drainage of the middle ear. Upper cervical adjustments and cranial adjustments also help to stimulate the vagus nerve and improve cranial nerve function so that the musculature of the pharynx, including those that attach to the eustachian tubes, as well as the soft palate can function properly and therefore help the eustachian tube to open, equalize pressure, and drain any fluid from the middle ear. Regular chiropractic adjustments allow the body to function optimally and prevent the development of fluid in the middle ear. Therefore preventing the environment for bacterial, viral, or fungal growth and infection.

Ruptured Eardrum and Tubes

Sometimes when the pressure produced by an infection in the middle ear is too much, the eardrum ruptures. This is ok. There is no cause for alarm. Typically your child will be crying and screaming about how much pain they are in, then all of a sudden they feel fine. This is usually an indication that the eardrum has ruptured. You can look and see if there is fluid or pus coming out of the ear. This is normal. Don’t put anything into the ear, you want to avoid anything that may lead to further infection. Usually I recommend essential oils around the ear or a cotton ball with essential oils placed or taped right on the outside of the ear canal. Usually if the eardrum has ruptured the fluid is not draining down the eustachian tube properly so avoid liquids or oils in the ear. It usually takes a few weeks to fully heal, but when it does you will not even notice that it happened. There is usually not even a scar on the eardrum.

Ear tubes are typically the last resort of typical medical treatment for recurrent ear infections. A small slit is put in the eardrum where a plastic tube is placed. The eardrum then heals around the tube. This allows for air to flow from the outer ear to the middle ear. This allows for better equalization of pressure as well as a possible route for fluid to flow out if it begins to build up. However, unlike the eustachian tube which slants downward to allow gravity to pull fluid down from the middle ear, the outer ear is higher than the middle ear and fluid would have to flow upward to drain out of the middle ear. Therefore, if the eustachian tubes are still blocked or not draining, fluid can still pool in the middle ear and provide the environment for infection. Tubes are also foreign plastic to the body. This means that eventually the body will reject the tubes and they will fall out. Typically tubes last only a few years at best before the body pushes them back out. Therefore, even with tubes, chiropractic care is still necessary to allow for proper function of the eustachian tube, pharynx and all the surrounding soft tissue, connective tissue and bone.

Torticollis

Torticollis is a fairly common condition that babies, toddlers, even adults can get. This condition is characterized by tightening of the musculature of the neck to cause the head to rotate one direction and tilt slightly to the opposite direction. All children that present with this condition do not all present identical.  In some children the head is very restricted in rotation and will only look one direction. In other children the head prefers one rotation but can more easily be rotated the other way. These variations have to do with the degree of spinal misalignment, cranial misalignment and muscular and fascial tension.

Standard medical treatment usually consists of simply stretching the muscles and forcing the head the opposite direction. While this can help to loosen some of the muscles in the neck, it is not an optimal treatment and can lead to a lot of distress for you and your child. Torticollis is not just tight muscles on one side of the neck.  There are always spinal misalignments in the upper cervical spine along with altered cranial bone movement and fascial tightness. These things cannot be stretched away. A chiropractor needs to perform an adjustment to mobilize the upper cervical spine and do cranial adjusting and myofascial release to loosen the connective tissue and muscles while establishing proper cranial movement and position. Bodywork and fascial release is an important part of therapy that is not the same as stretching. The connective tissue in the body is not released by stretching. It is released by a light touch that helps to unwind the connective tissue to loosen it. Adults need the same care as well, if they develop torticollis. Stretching may help it feel better or a little looser for a little while, but the root of the problem is not being addressed.

Some children have this issue resolve in one or two visits to the chiropractor, some need more regular treatment to resolve all of the underlying issues. Often times there are complicating issues such as a tongue and lip tie or plagiocephaly that will require a longer duration of care. Torticollis can lead to altered head shape or plagiocephaly, difficulty nursing, digestive issues, reflux, irritability, colic, etc. It is important to correct torticollis as soon as you realize that your baby is looking toward one side more often. The longer it goes on, the longer it may take to correct all of the additional issues that arise.

Torticollis is a serious condition that needs to be addressed. However, it is a condition that can easily be corrected if you visit a good pediatric chiropractor. Certified pediatric chirorpactors look at the whole picture and address all the issues associated with the torticollis; the spinal misalignments, cranial misalignments, and muscular and fascial restrictions.

The Webster Technique

The Webster technique was developed by Dr. Larry Webster, founder of the International Chiropractic Pediatric Association (ICPA). Many people think this is a technique used to flip breech babies to a head down presentation. However, this technique does not focus itself on flipping babies. The Webster technique was developed to help women have an easier time during labor and delivery. The technique is centered around balancing the pelvis and uterus by aligning the sacrum and releasing any tightness in the round ligaments of the uterus. The basic biomechanics is that as the sacrum rotates back on one side, the uterus is pulled slightly to that side. So in order to center and stabilize the uterus, the opposite side round ligament tightens in response. This causes pulling and slight twisting of the uterus. From this the baby can then experience in-utero constraint because there is less space for the baby to move and feel comfortable. This may even lead to a baby choosing to turn breech in order to get more comfortable.

The Webster technique focuses on balancing the sacrum and round ligament to optimize the space in the uterus so the baby will choose an optimal head down position. This technique becomes more necessary after 30-34 weeks in order to make sure that the pelvis is balanced, and the baby is in the best position for labor and delivery. However, it is a useful technique throughout pregnancy to alleviate discomfort and optimize fetal development by eliminating any in-utero constraint.

A good prenatal chiropractor will also check more than just the sacrum and round ligaments. When I adjust pregnant clients I make sure to release any tightness in the hip flexors as well as the muscles in the glutes, hips and low back. I also make sure to align the whole spine including the low back and pubic bones. Evidence based research shows that Chiropractic adjustments help reduce pain during pregnancy as well as pain during labor and delivery and shortens time of labor.

Tongue Tied

Knowledge of tongue and lip ties has become more and more mainstream these days. We are seeing the impact these have on breastfeeding, oral development, and speech. More practitioners are learning how to diagnose and treat these conditions. This article will be a very brief explanation of what tongue ties and lip ties are, how they can impact you or your child’s health, and how to treat these conditions.

What Is a Tongue or Lip Tie?

First, lets look at what tongue and lip ties are. A tongue tie is when the frenulum, or band of connective tissue that connects the tongue to the bottom of the mouth, causes restriction in the motion of the tongue. A lip tie is when the frenulum that connects the upper lip to the gums causes a restriction in the motion of the lip or causes structural change to the gums. There are also buccal ties that can occur too. These are less common but they form along the upper gum more towards the back teeth on either side. These connect the upper gum to the inner cheek. These tend to not cause the same amount of issues as the tongue and lip ties.

There are different grades to identify the type of lip and tongue tie. So lets start with the tongue tie classifications. There are four types of tongue ties and they are distinguished by where the tongue tie attaches to the tongue. They are not indicative of severity of the tie (type 4 is not worse than type 1). These numbers are based on Dr. Kotlow’s classification system for tongue ties. Pictures of these can be found at here.

– A Type 4 tongue tie is when the frenulum under the tongue attaches all the way to the tip of the tongue.

– A Type 3 tongue tie is when the frenulum attaches at the midline of the tongue.

– A Type 2 tongue tie is when the frenulum attaches to the tongue at a point posterior (behind) to the midline of the tongue.

– A Type 1 tongue tie is when only the posterior tissue is restrictive. This may not be observable without palpation of the tissue and may be hidden under the mucosal tissue beneath the tongue.

Now for the lip tie classification. Again, there are four classes of lip ties and they are distinct for the anatomical variations not based on severity.

– A Class 1 lip tie has no significant attachment to the gum line.

– A Class 2 lip tie attaches exclusively to the gingival (gum) tissue.

– A Class 3 lip tie attaches just in front of the anterior papilla (the edge of the gum tissue).

– A Class 4 lip tie attaches posterior to the papilla onto the hard palate.

Why Do People Have Lip or Tongue Ties?

So now that we know what we are looking at, lets look at why this occurs. During development the body grows as cells multiply and create different tissues. As these tissues grow and shape themselves, cells are produced and some cells are degraded, a process called apoptosis. This process requires different enzymes to have methyl groups (a carbon atom with three hydrogen atoms attached) attached to them so that the enzyme can be functional and do its job of degrading unnecessary tissue. This process runs smoothly for those with no methylation problems. However, more and more people today are expressing genetic anomalies such as MTHFR that disrupt the methylation process and make it harder for a person to add methyl groups to molecules to make them functional. So as a result more babies are being born with midline defects such as a lip and tongue tie. If you have an issue with methylating the best thing to do is start taking a Vitamin B complex that has methylated B vitamins (It should say folate as 5-methylfolate and Vitamin B12 as 5-methylcobalamine). You also want to eliminate any other supplement that has unmethylated B vitamins (these would say folate or folic acid and Vitamin B12). You also want to cut out any processed foods that are fortified with Folic Acid. Many breads and grain products will be fortified with an unmethylated form of Folic Acid.

 

What are Common Symptoms of a Lip or Tongue Tie?

Lip and tongue ties can be difficult to diagnose, but there are some common symptoms that occur when a lip or tongue tie is present. Babies can have difficulty nursing. This can manifest as a painful latch or pain while suckling, clicking, choking or gaging while nursing especially upon milk letdown, inability to transfer milk affectively (this leads to more frequent nursing), shallow latch, or all together an inability to latch. Babies may also have digestive symptoms such as reflux, gassiness, spitting up, or colic. As the mother you may experience pain while nursing, creased or flat nipples after nursing, dryness or cracks on the nipple due to too much friction while nursing, clogged milk ducts, mastitis, or low milk supply. While these are not symptoms exclusive to lip and tongue ties, they are very common symptoms that should influence you toward getting evaluated by a professional.

 

What Can be Done?

Once it is determined that your baby has a lip or tongue tie there are a few options to help resolve the issue. Non invasive solutions include bodywork, myofascial therapy, chiropractic care, and craniosacral therapy. These focus on releasing the tight connective tissue, improving structural alignment, and increasing cranial and dural motion. This can be helpful in cases where the ties are not as severe and there are more mild symptoms. However, a more invasive treatment may be necessary. There are two different frenectomy procedures that are available that involve cutting the frenulum. One involves using scissors to cut the tissue. This procedure is typically done when there is an obvious anterior component to the tongue tie. Typically this procedure does not cut far enough back to eliminate any posterior components of the tongue tie. However, you may find a good pediatric dentist who will do a thourough procedure to release both anterior and posterior components. The other frenectomy procedure involves a cutting laser. A pediatric dentist trained in lip and tongue tie revision will use the laser to remove the excess tissue allowing for immediate increase in motion of the tongue and/or lip. After care requires stretches every few hours to prevent reattachment. Once the laser revision is performed it is ideal to have bodywork, craniosacral therapy or chiropractic care to help release and unwind any underlying restrictions that still remain. The ties are like the tip of the iceberg, there can be a lot of underlying restriction and tightness that is not obvious, but can continue to affect function. Results after the laser revision can vary quite a bit. Some mothers notice an immediate improvement and can feel like the revision completely corrected all the problems. However, there are times when there seems to be little to no immediate improvement. This is when bodywork and chiropractic care is especially necessary. The underlying tightness needs to be released in order to notice improvement and is necessary when attempting suck retraining exercises. If there are still restrictions within the cranium, jaw, neck, upper back and throat, then nursing and suck retraining exercises are going to be hindered. Suck retraining exercises can be given to you by your lactation consultant (the lactation consultants we used are referenced at the bottom of the article).

What Can Happen if Nothing is Done?

So what can happen if you decide to leave the tongue or lip tie alone and not pursue any revision or fascial therapy? There are many possibilities. One being that there may not be any obvious issues, adaptations, or symptoms later in life. However, with the abnormal structure present of a lip and/or tongue tie there will be adaptations necessary, obvious or not, and there is a likelihood that other symptoms would arise. Some common symptoms are speech difficulties, gapping in the teeth, early or worsened tooth decay, narrow maxillary and mandible (jaw) development causing sinus problems or TMJ issues, headaches, neck/upper back/shoulder pain and tightness, reflux, digestive issues, torticollis, plagiocephaly and possibly others. Speech issues can be an obvious sign if the child was not diagnosed with a tie earlier. Most children will have trouble with R, S, L, Z, D, N, T, Y, K, -NG, CH, TH, SH, and –dge although other sounds may be difficult as well. Having a tongue tie can lead to mouth breathing which can contribute to asthma, allergies, sleep apnea, snoring, and enlarged tonsils/adenoids. Ear infections may be more prominent in someone with a tongue tie because the back of the tongue can not elevate enough to equalize the pressure in the Eustachian tubes. This can lead to fluid build up that can not drain properly, allowing for an environment for the growth of a bacteria or virus. When children get older the swallow mechanics are altered due to the tongue tie and can affect drinking from a straw or how the child is able to swallow foods.

 

What Needs to Be Done After a Revision?

If you choose to have the lip and tongue ties revised with the cutting laser or scissors, there are several things to be aware of and to include in the care of your child. As mentioned earlier, there are varied degrees of improvement in symptoms with the frenectomy. Stretches for the tongue and lip should be shown to you at the time of the frenectomy and are typically done every few hours for the first 1-2 weeks and continued at a less frequent rate until the tissue is fully healed (about 1 month). Suck retraining exercises may be necessary to help strengthen the muscles necessary for a good latch and proper suckle. Bodywork, Craniosacral Therapy, and/or chiropractic care is very important regardless of the degree of tie and regardless of the type of symptoms you see. Very commonly, those with lip and tongue ties also have a tight dural tube. The dural tube is the connective tissue that surrounds the nervous system, the brain and spinal cord down to the sacrum. Unwinding the tightness in the dura and throughout the body will help your child feel more at ease and comfortable. Tummy time is another important addition to care after a frenectomy. Tongue and lip ties affect cranial nerve function, restrict normal range of motion and can diminish the baby’s ability to develop proper head control. Along with removing restrictions by utilizing chiropractic care and bodywork, having your baby build the muscles responsible for head control and movement helps to strengthen cranial nerve function and encourage a proper development. Children and adults over the age of 2 may benefit from orofacial myofunctional therapy. An orofacial myofunctional therapist works to help strengthen the tongue and other facial muscles to help correct breathing, chewing and swallowing issues that may still be present after a lip or tongue tie revision.

It is improtant to remember that not every child is the same and there are so many variables that can impact the decision of how to care for your child’s lip and/or tongue tie. Not every tongue tie will need a frenectomy. Some children can reestablish proper function just through chiropractic care and bodywork. Other children may need a frenectomy to be able to reestablish proper function. Tongue ties and lip ties can be a complex and sometimes overwhelming issue to navigate. However, with the right team of care providers on your side it can become a lot more manageable; and you can rest assured you are doing everything you can to help you and your baby thrive together. Below are a few trusted providers that we have used and referred others to.

Holistic Dentist (Lip & Tongue Tie Preferred Provider)

Dr. Preetha Thomas, DMD, Enclave Dental – www.enclavedental.com

Lactation Consultant

Mellanie Sheppard, IBCLC, RLC (and associates) – For Babies’ Sake – www.forbabiessake.com