Ask the expert – If breastfeeding is tricky, how can a speech pathologist help?

Sometimes, breastfeeding doesn’t go smoothly. But, professionals are waiting to help. Along with midwives and lactation consultants, did you know that speech pathologists are also experts in breastfeeding?

Here, Dr Kelly Weir, spokesperson for Speech Pathology Australia, answers our questions about what speech pathologists have to do with breastfeeding. Plus – what we should do about tongue and lip ties.

Many new parents would be surprised to learn that speech pathologists are experts in feeding difficulties. So, when would a parent take their new baby to see one?

You might see a speech pathologist if you have specific feeding difficulties that don’t seem to be improving. For example, if your child has a feeding or swallowing problem, they might have a range of behaviours that they demonstrate:

• Signs of reflux when the baby stiffens or arches their back during feeding, crying or fussing.
• Fall asleep during feeding, even though they haven’t finished their feed.
• Being fussy on the breast and continually latching on and off.
• The baby has a lot of wind due to not latching correctly.
• Coughing and gagging during mealtimes or having milk falling from their mouth.
• The baby might have a gurgly voice or a “rattle” after their feed, indicating that some of the breastmilk is going the wrong way.

So these things are red flags. If the baby is not taking enough food or fluid, they’ll become lethargic and sleepy. So if your child shows any of these behaviours and they are losing weight, you may want to see a paediatrician, a lactation consultant and a speech pathologist.

What would a speech pathologist do to help a newborn baby?

The first thing we would do is a thorough assessment before anything. Often that is done either with a lactation consultant or in communication with a lactation consultant.

You start with an in-depth case history, and that’s very involved. It includes looking at the pregnancy, family history, whether the baby is a first child and first pregnancy, what breastfeeding support the mother has around her, her previous breastfeeding experience, etc.

Then you observe the infant and their health. We examine the baby’s reflexes and conduct an oral exam, looking at their face and mouth. Then we watch a feed, which includes:

• how the mother and baby are positioned
• another is how mum and baby interact
• how the baby latches
• whether the baby can organise their suck-swallow-breath coordination, etc.

When the observation is complete, you make recommendations to the mum and lactation consultant

The recommendations will vary depending on what you find in the assessment, but are there some common recommendations that come up?

We work with the lactation consultant’s evaluation of the mum, her breastfeeding and whether there seems to be any nipple damage. Typically, the most frequent things to assess are whether the mum and baby are positioned well. In addition, do they have a good latching technique, and can the baby coordinate sucking, swallowing and breathing.

Also,  you need to make sure the baby has an unobstructed nasal airway – they’re not pushed into the breast. After conferring with the lactation consultant, you need to support milk production if the baby’s not draining the breast.

We might work with the lactation consultant to provide something like a nipple shield if that helps the baby latch. We might do oral-motor exercises (mouth and jaw muscle exercises). Plus, if we have to top up feeding because the baby’s not getting enough milk, but mum can produce the milk, we use a bottle to supplement.

But we use breastfeeding first and then supplement with a bottle (of expressed breastmilk). So, we try to ensure that the baby gets breast milk instead of formula at all times.

If we can do anything at all, it’s trying to prolong the time the baby receives breast milk, but it doesn’t matter if it’s from the breast or a bottle.

Talk to me about tongue and lip ties. Why do they seem to be becoming much more common – is it greater awareness, overdiagnosis or something else?

They’re overdiagnosed. We have the frenulum that attaches the underside of the tongue to the mouth, and that’s normal. There has been a 420% increase in surgeries for tongue ties, and they are over-diagnosed by some professionals.

The question is whether the tie is restrictive or not and does it has a functional impact on feeding or not? Currently, there’s no strong evidence to suggest that having a tongue tie affects your speech development or long-term feeding.

If it has a functional impact on feeding, that is when we would want to do something about it, like surgically release the tie. But we find that many people are not evaluating whether it’s restricting and has a functional impact.

Some people think that a tongue tie release is like a magical pill. It does not improve an infant’s feeding most of the time. Before surgery, you need a good evaluation of the child’s feeding technique to see whether the tongue tie impacts it.

When a child presents with feeding difficulties, it may be caused by other issues. So, we need a multidisciplinary assessment with a speech pathologist, lactation consultant and paediatrician to investigate. That’s the same for a lip tie. You’re looking at the baby’s function on the breast; if they can close their lips around it and maintain a seal during sucking, then there’s no problem.

Is there anything else you’d like new parents experiencing any breastfeeding difficulty to know?

Seek help from a speech pathologist and lactation consultant who will work together and a paediatrician. Go to professionals who have a good track record and adequate training in feeding and swallowing difficulties. There’s a lot of misinformation and conflicting information, and everybody tries to do their best, but I think it best to seek professional help. Don’t try and go it alone.

Also, the mum is as important as the child in this. So the mum needs to be supported and be happy and healthy.

In the end, be kind to yourself. That’s what we need mums to know.

Dr Kelly Weir is a researcher working across Griffith University and Gold Coast Health, specialising in infant feeding difficulties. She has over 30 years of experience as a speech pathologist in hospitals, including neonatal units.

More information

Tongue and lip ties – a multidisciplinary and evidence-based statement from the Australian Dental Association https://www.ada.org.au/News-Media/News-and-Release/Latest-News/Ankyloglossia-statement-4-June-2020

Find a speech pathologist https://www.speechpathologyaustralia.org.au/SPAweb/Resources_for_the_Public/Find_a_Speech_Pathologist/SPAweb/Resources_for_the_Public/Find_a_Speech_Pathologist/All_Searches.aspx?hkey=0b04c883-80b2-43e7-9298-7e5db5c75197

Published 14th June 2022