Finally, I want to address why the compensations that the baby employs can cause problems in the long-term. Before that can be addressed, however, I want to explain how normal breastfeeding promotes optimal craniofacial growth. Completely normal breastfeeding is nature’s palate expander. The malleable breast is carried up by the tongue and molds the palate into a broad shelf by putting pressure on the inside of the gums. This, in turn, allows the teeth to eventually come in with adequate spacing. Many of the orthodontic problems that we see are a result of a high palate and crowded teeth (maxillary constriction). There is good evidence that breastfeeding promotes better dental occlusion (Peres, et al). The nasal septum sits on the palate (anatomically, the roof of the mouth is the floor of the nose). When the palate arches up instead of staying broad, the nasal cavity is narrowed. Furthermore, the septum has to buckle if the floor it sits on comes up - this results in a deviated septum. Both of these consequences predispose the baby to mouth breathing. While the deviated septum happens over years, the high palate can be noticed immediately after birth (some babies are very snorty while nursing). Because babies are obligate nasal breathers, the nasal obstruction can even further complicate the latch.
The palate is the hub of facial growth as a child gets older. If the palate is low and broad, the child can breathe out of the nose and there is less chance of sleep disordered breathing and sleep apnea. Breastfeeding for as long as possible (even when it’s not primarily for calories as a child enters toddlerhood) is critical for optimizing palate formation. We are starting to see more evidence for the benefits of breastfeeding for reasons previously undescribed. Guilleminault from Stanford shows the correlation between tongue tie and sleep apnea (2015), which has many downstream consequences (fatigue, difficulty concentrating, teeth grinding, bedwetting, behavioral issues and even symptoms mimicking ADHD).
Medical professionals who care for infants can learn to identify common tongue/lip tie compensations and instead see them as actual symptoms of tongue/lip tie. If we focus on keeping a child on the growth curve without examining *how* the baby gets to where they are on the growth curve when compensations are present, then we can set them up for early cessation of breastfeeding, issues with dental malocclusion, and sleep disordered breathing later in life. Our goal as medical professionals should be a thriving human. If we don’t change our practices, we are setting our patients up for consequences that are preventable.
Peres KG, Cascaes AM, Nascimento GG, Victora CG. Effect of breastfeeding on malocclusions: a systemic review and meta-analysis. Acta Paediatrica. 2015; 104: 54-61.
Huang YS, Quo S, Berkowski JA, Guilleminault C. Short Lingual Frenulum and Obstructive Sleep Apnea in Children. International Journal of Pediatric Research. 2015 1:1.