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Chiropractic Journal of Australia : CJA September 2012
98 Chiropractic Journal of Australia Volume 42 Number 3 September 2012 INTRODUCTION Breastfeeding (BF) has numerous health and psychological benefts over infant formula feeding (FF) for the infant.1,2 Whilst controversies exist in some categories, the benefts may include: nutritional,3 immunological,4 cognitive,5-8 decreased morbidity,9,10 decreased mortality, decreased pain, decreased cost (products, healthcare), decreased risk of allergy, asthma/wheezing,11,12 and improved jaw development and dentition. Despite the numerous benefts of breastfeeding, continuation rates in Australia remain low. Breastfeeding initiation rates in Australia are approximately 92%. This declines to a rate of 71% exclusive breastfeeding at one month, 56% at 3 months, 46% at 4 months, and 14% at 6 months.13 Between one and six months the rate drops from 71% to 14%. This is similar to studies of breastfeeding rates in other countries.14,15 The rates of mixed breastfeeding and complementary feeding are 83% at one month, 73% at 3 months, 63% at 4 months, 56% at 6 months, and 30% at 12 months.13 Exclusive breastfeeding is recommended by numerous authorities as the best form of feeding in the frst six months.16 The introduction of solids is recommended at 6 months, with the continued use of breastfeeding until 12 months and beyond. Continued breastfeeding past 12 months may have several benefts.17,18 Paediatric Chiropractic and Infant Breastfeeding Diffculties: A Pilot Case Series Study involving 19 Cases. ADAM STEWART Abstract: Introduction: Paediatric Chiropractic may have a role in assisting infant breastfeeding diffculties. This pilot case series study sought to identify: 1. The percentage of infants with reported breast feeding diffculties which improved with chiropractic care: 2. The most common subluxations in infants with breastfeeding dif- fculties and: 3. Specifc subluxation patterns associated with specifc dysfunctional breastfeeding behaviours. Methods: A questionnaire was developed to address these questions and 19 infants/mothers were prospec- tively reviewed. Results and Conclusions: Improvements in breastfeeding behavior was found in every infant in this study. The most signifcant outcomes occurred with improved attachment to the breast (100%), reduced extension/arching (94%) and side shaking (88%) once attached, reduced overall stress of feeding (84%), reduced pain when feeding (77%), and side preference (64%). The most common subluxation patterns involved the upper cervical and shoulder joint complexes. A larger study and some minor design changes would allow better correlation between subluxation patterns and specifc dysfunctional breastfeeding behaviour. Given the possible benefts to community health, studies in this area should be given research priority. INDEX TERMS: (MeSH): CHIROPRACTIC; PEDIATRICS; BREAST FEEDING. Chiropr J Aust 2012; 42: 98-107. Adam Stewart, B.App.Sci (Chiro) B.App.Sci (Clinical Science) Private Practice of Chiropractic Belgrave, Victoria There is no confict of interest Received: 19 May 2012, Accepted with revisions: 15 June 2012 There are numerous reasons why mothers cease breastfeeding. These include maternal and infant factors, as well as societal and environmental factors.19 Self-reported reasons include inadequate milk supply (30%), felt it was time to stop (23%), problems with breastfeeding such as cracked nipples (10%) and resumed work (8%).13 Maternal factors include no desire to feed, lack of confdence, lack of technique training, concerns regarding supply, mastitis, inverted nipples, and sore nipples.20 Infant factors include tongue tie, facial nerve palsy, and diffculties such as poor attachment, fussiness, poor suck, and poor swallow. Paediatric Chiropractic has a role in addressing infant related breastfeeding diffculties, including poor attachment, fussiness, side preference, suck and swallow dysfunction. These diffculties can have a secondary effect on maternal issues such as maternal stress, maternal pain whilst feeding, milk supply, cracked nipples, and mastitis. For example, studies have indicated that milk stasis is the primary dysfunction in mastitis, and that attachment and side preference is the most signifcant contributor to milk stasis.21 There have been numerous case reports of chiropractic care for breastfeeding diffculties.22-28 A literature search revealed three case series studies. In one study involving a review of clinical records of 1,000 patients, there was a 99% improvement rate, with 80% having a primary TMJ dysfunction.29 In 2004, Vallone reported on the link between biomechanical dysfunction and inability to suckle successfully, and found improved nursing in over 80% of patients treated with soft tissue treatment and chiropractic adjustments.30 Finally, in 2009 Miller reported on a study involving 114 infants with suboptimal breastfeeding.31 All showed some improvement, with 78% of the group able to exclusively breastfeed, within 2-5 visits, over a treatment
CJA June 2012
CJA December 2012