LLLI Center for Breastfeeding Information

Journal Abstract of the Month for December 2006

“Mandibular asymmetry and breastfeeding problems: experience from 11 cases.”

Authors: V. Wall and R. Glass

J Hum Lact. 2006 Aug 22(3):328-34.

Abstract:

In this case study of eleven mother-baby pairs the authors describe breastfeeding problems that may result from an asymmetry of the lower jaw line. This asymmetry—which may be subtle in appearance—can be a symptom of a well-known condition called torticollis, from the Latin for “twisted neck.” What is new about this article’s approach to this condition is the discussion of how this condition can adversely affect breastfeeding, especially in the early weeks, resulting in problems with latch, sore nipples, and poor milk transfer.

What is Torticollis?

According to the authors, 10% of infants demonstrate a preference for holding their heads to one side. This may be a result of positioning in the womb—being “stuck” in one position for a prolonged period. Risk factors for this condition include:

Sex of infant—Males are affected more often than females.
Parity of mother—First time mothers are more likely to have an infant with torticollis.
High birth weight
Prolonged labor
Unusual birth position
Multiple birth
Maternal uterine abnormalities

An infant with torticollis may have one or more characteristic features:

Shortening of the neck muscles on one side
Tilted lower jaw line
One eye may be smaller and higher
One ear may appear flattened, while the other appears “cup-like”
Occasional asymmetries of the back, chest, hips, and feet
Preference in positioning of head and body

How Does Torticollis Affect Breastfeeding?

The eleven mother-baby pairs discussed all had the lower jaw tilt and difficulty in latch-on. Eight mothers had nipple pain; five infants lost greater than 8% of birth weight, and an additional three were given supplements in the first 24 hours. One mother gave up by one month. Seven eventually, over the course of one to eight weeks, were breastfeeding effectively. Three were lost to follow-up. Clearly, misalignment of the baby’s lower jaw and possible discomfort in some positions can adversely affect normal, and comfortable, breastfeeding. The authors note that feeding difficulties in newborns are often mistaken for signs of sepsis, or infection, but have negative culture results. The signs of torticollis may be subtle and easily overlooked, but should be included in an assessment of these infants with feeding problems.

Solutions for the Problem

Solving the feeding problems torticollis may cause can be as simple as creative positioning. Typically, an infant with this condition is more comfortable in one position at the breast than another, and may have trouble when the mother switches breasts, forcing the infant to lie in a less preferred position. Mothers can be shown how to slide the infant from one breast to another so that he breastfeeds in the cradle position on the left breast, and the football position on the right, thus keeping the infant in his “comfort” zone for the entire feeding. Additional chin support may help; and in some infants, using a nipple shield may help in milk transfer.

Occupational or physical therapy may help these infants develop a more normal range of motion. Parents can learn ways to help their infants stretch tight muscles as well. Chiropractic treatment or craniosacral therapy helps some infants as well.

Looking for signs of torticollis, especially the jaw asymmetry, can be another “tool” for the La Leche League Leader or lactation consultant working with babies with feeding difficulties.

This paper is categorized by the following keywords:

Torticollis
Mandible/abnormalities
Breastfeeding

The full text of this article is available (for a fee) from Sage Publications:
http://jhl.sagepub.com/cgi/reprint/22/3/328

PubMed Citation:
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&list_uids=16885493&dopt=Abstract

Past Journal Abstracts of the Month