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New York, NY 10022

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The Most Common Problems

Believe it or not, the vast majority of difficulties experienced in breastfeeding trace back to a single cause: your baby’s gape. When babies are born, they open their mouths as wide as they can. It is not a simple mouth opening. Your newborn needs to be able to gape so widely she almost dislocates her jaw to get around your breast. It is a reflex, not something that is learned. If she cannot gape widely enough at birth, she will never develop the ability or stretch or grow into it. When your baby is unable to gape, it is called gape restriction.

Gape restriction is not due to your baby having a small mouth, which is often noted by healthcare staff. It is a structural anatomic problem. I posit that at least 25% of newborns have a restricted gape at birth. Understanding the cause for restricted gape is where it gets complicated. There are many different anatomic variations that result in this restriction. The most notable, obvious cause is an anterior tongue tie, but it is not the most common.

Anterior tongue tie is a specific diagnosis, whereby the tip of the tongue is tethered to the floor of the mouth because the tissue connecting the two did not dissolve in the womb. It occurs in 4-10% of the population and can result in a whole slew of issues, including speech problems, trouble moving food around, dental crowding, etc. All tongue tie should be corrected as early as possible, despite what your doctors tell you. It does not stretch, it actually gets thicker. And the tongue is a muscle that has to grow into a certain shape. But not all tongue tie causes gape restriction. In other words, there are plenty of babies with obvious tongue tie who nurse just fine.

The more common cause for gape restriction is not tongue tie at all. It is due to the shape and position of your baby’s structures involved in nursing, namely the roof of the mouth, the tongue and the jaw. It is their shape and relationship to each other that determines their mobility and freedom of movement. Put simply, the roof of the mouth, the tongue and the jaw have to be able to move independently away from one another and connect in a very specific way for your baby to gape widely enough to fit onto your breasts.

That’s not to say it is measure of absolutes. Sometimes babies can almost gape wide enough. But often they are very restricted. If you have an ample milk supply, you may only have a few issues, like pain, but your baby will still gain weight. Every situation is different, as are the manifestations, but here is the good news:

You can diagnose restricted gape yourself with these three simple questions:

  1. Is my baby able to open her mouth wide, and keep it open to latch onto my breast?
  2. Does it feel good when my baby nurses?
  3. Is my baby easily transferring milk out of my breasts?

If your answer to any of these questions is no, there is a very high likelihood your baby’s gape is restricted, and we highly encourage you to visit Dahlfull.

How to Fix the Problem

Once you (or your healthcare provider) realize your baby has a restricted gape, if you decide you really want to breastfeed, you should be seen as soon as possible. We recommend visiting our office within the first two weeks, but if you have a big supply or cannot be seen quickly, you can maintain your supply by pumping. There is still improvement with older babies. Keep in mind, however, that the longer you wait the more variables there are to overcome. The gape will not correct itself, and must be treated appropriately the first time.

The treatment for gape restriction is to release tissue in your baby’s mouth so that that roof of the mouth, the tongue and the jaw can move freely. Currently, there are very few doctors performing this procedure. Unfortunately, many of those who do the procedure are not trained appropriately and do not do it correctly. Without a thorough understanding of the mechanics of nursing and anatomic structures, doctors perform procedures that only partially correct the problem, wasting valuable time. Also, not every baby is a candidate. Every situation is different, so breastfeeding must be evaluated as a whole to avoid unnecessary procedures.

Dr. Dahl has been treating newborn nursing problems since 2003 and currently sees over 1500 babies a year. These mother/baby units are assessed before treatment is rendered. About 80% are candidates for the procedure at the time of their visit, and 75% of parents decide to proceed.

Successful nursing starts with the correct procedure. True success happens with lactation support, understanding breastfeeding as a whole, and craniosacral therapy, when needed. With this support, the success rate for appropriately done procedures is around 90% – and that means 90% of babies who receive treatment are able to nurse more efficiently.