Research Overview - The Chiropractic Care of Infants with Breastfeeding Difficulties

The 24 included articles consist of eight case reports, two case series, and three cohort studies. A further five case reports and one case series describing breast feeding difficulties as a secondary complaint were included, as were five commentaries advocating for chiropractic.  The literature presented represents a low level of evidence but does provide support for the theoretical and clinical approach to these cases.  
Significant heterogeneity in the approach to care of the case reviewed was noted.  The cases described were both male and female infant from six days to six months of age.  Both manual and instrument adjustive techniques were used, and force modification relative to age was noted. The dysfunction presenting ranged from latching problems, to sucking difficulties, side preferences, TMJ dysfunction, altered primitive reflexes, failure to thrive, and cranial asymmetry.  The most commonly adjusted area was the upper cervical spine, along with soft tissue releases around the TMJ, and cranial work. Logan sacral contacts and full spine adjusting were also reported.  
The reviewers note a common theoretical perspective based on the detection and removal of spinal and extra-spinal subluxations, and comment that this theory-driven practice model of chiropractic aligns itself with a unique philosophical perspective that sets chiropractic as separate and distinct from all health care professions.
The authors provide an enlightening review of literature relative to birth trauma and forces on the foetus through birth. They report 'intrauterine pressure applied to the fetal head during expulsion of the fetus was 16 N at rest, 54 N during a uterine contraction, and 120 N during a volitional push. A vacuum device applied to the fetal head applies an additional traction force of up to 113 N, typically with up to four pulls, each coinciding (and additive to) a uterine contraction and push. In instances when obstetric forceps are used, the additional traction force can reach up to 200 N.  The adverse consequences of the use of forceps to the TMJ during birth are well-documented in the literature. The resultant TMJ dysfunction can lead tolatching difficulties, poor milk transfer and nipple pain’. 
When the authors note these adverse consequences are ‘well-documented’, caution should be applied, as their three references indicate the documentation to be a preliminary study from 1983, one case study from 1999, and the ‘dislocation of tempera-mandibular joint - an uncommon circumstance of occurrence: vaginal delivery’ from 2010.  This is a reasonable example of over quoting the level of research relative to a statement.
Single author articles from Grostic and Gutman are used to present theories on how and why neurological insult, particularly of the upper cervical area may adversely affect function.
The authors recommend an assessment of the infant while breast feeding, and provide an excellent review of what to look for from Cadwell’s 2007 article on an assessment of latching on and suckling of the healthy term neonate.
Overall, the article provides a good summary of the body of knowledge to date and will help practitioners, students, and researchers enhance their understanding of the chiropractic care of infants with breastfeeding difficulties, and a platform from which to drive related research.

Parent Reports of Exclusive Breastfeeding After Attending a Combined Midwifery and Chiropractic Feeding Clinic in the UK: A Cross-Sectional Service Evaluation

Journal of Evidence-Based Complementary & Alternative Medicine 2016, Vol. 21(2) 85-91 2015 Journal Impact Factor 1.931 (Nature = 2015 IF=38.138)

This excellent article reports on an integrative and novel (to the published literature) approach to addressing suboptimal breastfeeding.  It describes combined chiropractic and midwifery services for the mother child dyad, mother’s satisfaction, and breastfeeding outcome.  The result?  An almost 4x increase in the likelihood of exclusive breastfeeding after the intervention (a relative risk ration of 3.6)!     Startling figures related to breastfeeding are presented.  The WHO, UNICEF, and UK government policy recommend exclusive breastfeeding until 6 months. According to government statistics, 81% of UK mothers initiate breastfeeding, 46% exclusively breastfeed at 1 week declining to 23% at 6 weeks, and only 1% reach 6 months.  Estimates of the cost saving for the UKs National Health Service by supporting women to move from 1 week to 4 months of breast feeding reached £11 million annually!! And more figures of the same ilk are shared.
The study was a pilot cross sectional evaluation of service provided at a chiropractic teaching clinic incorporating both chiropractic and midwifery. As there were no previous studies in this area, a unique questionnaire was developed and administered.  There were 85 initial questionnaires completed, and 72 follow up (85%).  Prior to treatment, 26% of infants were exclusively breastfed. On follow-up 86% of mothers reported exclusive breastfeeding, representing a relative risk ratio of 3.6 (95% confidence interval = 2.4-5.4). A risk ration above 1 means the event is more likely to occur in the experimental group than control, and below 1 means the opposite.  This equates to an almost 4x increase in likelihood of breastfeeding with this integrative approach- within this small cohort.
The study describes some of its weaknesses.  There’s an amazing opportunity to take this message to our local midwives and see how we can better serve our community in this way.

Research Overviews Written by Matthew Doyle, Chiropractor.