The ability of a baby to properly latch and feed is a complex suck-swallow-breathe sequence. This requires the function of 6 cranial nerves, 6 cervical nerves and a few thoracic nerves in order to coordinate as many as 31 muscles in the lips, cheeks, tongue, jaw, chin, soft palate etc. All of this soft tissue means that there can be involvement of many structures in problems of latch or abnormal suck.
Let,s look at some of the muscles involved in moving the tongue. The three main muscles of the tongue are the genioglossus, the hyoglossus, and the styloglossus. The genioglossus attaches the tongue to the chin. The hyoglossus attaches the tongue down to a thin bone in the neck called the Hyoid. Finally, the styloglossus attaches high up on the jaw bone close to the ear.
The Hyoid, which is located right above the "adam's apple", is an attachment point for several muscles of the face and head, as well as muscles of the sternum and shoulder.
The hyoid also doesn't form a joint with any other bones and instead is held in position by the muscles above and below. Keep in mind that the hyoid is a major attachment point from which the tongue functions.
Now that we've covered the muscles of the tongue, let's look how the lower jaw is connected to the second bone in the neck called the axis. This bone acts as the pivot point around which the lower jaw can properly move. Also, the first and second bone in the neck have a close relation to the opening in the base of the skull where the cranial nerves responsible for eating and swallowing come from.
When there is an abnormal structural relationship between the head and the neck, many if not all of the structures that we have reviewed thus far can be compromised.
There are many things that can create an abnormal head and neck relationship. Some of these can happen while still in the womb. The womb can be a very confined space for a baby towards the end of pregnancy. This may cause some of the baby's anatomy to become misshapened. That might cause something like a head tilt or outward turning feet. A baby who spends their final few weeks with their head tilted can have a slight tightness and shortening of muscles on one side of the neck compared to the other.
The birth process can also be a contributing factor to head and neck misalignment. Doctor assisted births can place twisting and pulling forces on the neck that can result is head and neck misalignment, as well as forceps delivery and c-sections. When you think of how the hyoid is held in place by muscles, and how the lower jaw has attachments to the neck, it becomes apparent how head and neck misalignment can create latch and swallowing problems.
A 2008 study (Rubie, Griffet, Caci, Bérard, El Hayek, Boutté) of 1001 babies found that 10.7% of babies that they studied had Moulded Baby Syndrome. Moulded Baby Syndrome was classified as any of the following:
plagiocephaly (where the skull may be flattened in one area or asymmetrical )
torticollis, (head tilted to the side and baby often looking in the other direction)
congenital scoliosis (a curving of the spine - this can be mild and not very noticeable)
pelvic obliquity (misalignment of pelvis)
adduction contracture of a hip (misalignment of hips)
malpositions of the knees or feet
An assymetrical skull can change the tension of one side of the tongue compared to the other by having assymetrical attachment points for the muscles. A slight curving of the cervical spine could have an effect much like tilting your head to the side, where the muscle tension on the hyoid is assymetrical. Assymetry of the pelvis and hips results in assymetrical tension on the spine, shoulders, neck and head. All of which can affect the latch.
If a child is having latch and swallowing problems, the cause may very well be a tongue/lip tie, but those won't be the only the only structures involved. Structural chiropractic along with Craniosacral Therapy should be a part of pre and post revision care. In fact, some cases of tongue/lip tie can and have been corrected with structural chiropractic and CST alone. If you suspect that your child may have a tongue tie or an abnormal head/neck relationship, there are steps you can take to ensure proper evaluation and correction if necessary. an evaluation by a pediatric dentist or lactation consultant familiar with tongue/lip ties is a good first step. An IBCLC can also help you devise tactics to be able to breastfeed your child until and while any possible ties and all structural hard and soft tissues are corrected. Schedule an assessment with a structural chiropractor who also does craniosacral therapy.
