Cranial nerve dysfunction and breastfeeding

In an ideal world, babies who are not able to effectively breastfeed would receive skilled lactation support and bodywork. Not being able to breastfeed is a red flag for underlying issues that get missed when the solution offered is to simply switch to bottle-feeding. Difficulty breastfeeding can be attributed to: musculoskeletal issues (eg. asymmetry or tight muscles), tongue tie, birth trauma, immaturity (if baby is premature or induced before initiating spontaneous labour) or cranial nerve dysfunction (CND) – where cranial nerves become stretched or compressed causing poor function.

CND is a term used in babies to describe a disruption, dysregulation or dysfunction in one or more cranial nerves in the pre-crawling period

Michelle Emmanuel

The goal of bodywork is to:

help normal function be restored in any structures that may not be working optimally due to injury or disturbance. When all the muscles and nerves associated with feeding are working as they should, a baby will suckle more effectively rather than burning extra calories by using inefficient compensations.

Catherine Watson Genna

As an IBCLC and craniosacral therapist, I regularly see issues with breastfeeding and my craniosacral skills allow me to detect CND as the cause in many of these cases. Optimal function of the cranial nerves is important for feeding and well-being. Located primarily around the face – eyes, ears, nose, mouth etc, many of our senses rely on these important nerves for our sense of sight, smell, hearing, taste and balance.  

There are twelve pairs of cranial nerves that originate at the brain stem, a region at the top of the spinal cord at the level of the back of the head/upper neck. The cranial nerves each have a unique function, mostly relating to the face/ head and neck. They can be purely sensory; affecting sensation. Or motor; affecting muscles. Or both. Sensory issues are harder to detect and may go unnoticed as they are subjective and the baby is unable to adequately communicate the sensation (can range from numbness to tingling or tickling / prickliness to pain). Motor dysfunction can be more obvious e.g. facial palsy when one side of the face has limited movement in the muscles – when smiling or crying there can be asymmetry of the mouth and eyes.

What can cause CND:

Causes include: Head trauma due to difficult deliveries eg. forceps, c-section (surgeons hands near the cranial base); Intracranial tension from the birth process; Restrictive inutero environments; Inflammation; Infection; Medications/ medical interventions e.g. anaesthesia/narcotics, vaccinations.

Note: For this article I will be focusing on full term, otherwise well babies (not preterm and no medical issues or syndromes)

Signs and symptoms

Can be mild, moderate or severe. Parents may not notice.

Signs may include:

• Head tilt/ head preference
• Facial asymmetry (e.g. of the mouth and/or eyes when smiling or crying)
• Difficulty latching to the breast, inability to latch, fussy at the breast, sore nipples, needing to hold the breast in place
• Difficulty extending or flexing the head/neck
• Difficulty swallowing – coughing, spilling or suck/swallow breathing coordination issues
• Difficulty chewing/ transitioning to solid food in older babies / children
• Hoarse or weak cry

The twelve cranial nerves

Here I will list the 12 cranial nerves and their function:

CN I: The olfactory nerve detects smells and innervates the tissues of the nose.

CN II: The optic nerve is involved in sensing light for vision.

CN III, IV, VI: Oculomotor nerve (III), trochlear nerve (IV) abducens nerve (VI). These three nerves innervate eye muscles and are involved in eye movement. Misalignment of the eyes can be related to a cranial nerve issue.

CN V: The trigeminal nerve has three branches that spread across each side of the face: the ophthalmic branch (around eyes), the maxillary branch (upper jaw), and the mandibular branch (lower jaw). It’s also a mixed sensory/motor nerve.

• Sensory: Sensation of the face, scalp, sinuses and mouth (front of the tongue and teeth) – the rooting reflex relies on this nerve which is important in  helping babies to locate the breast to feed).
• Motor: It innervates the muscles used in chewing and swallowing.

CN VII: The facial nerve is a nerve that runs in three directions across the face, on each side. It has both sensory and motor functions.

• Sensory: Receives taste sensations and information relating to position and movement of the face/scalp.
• Motor – It innervates the facial muscles, a muscle in the ear aswell as innervating glands/mucous/ salivary/ tear ducts

Impaired facial nerve transmission may cause a hypersensitivity to sound. It can also cause unequal jaw opening (other causes may include postural asymmetries e.g. torticollis). Facial nerve palsy can be really obvious and prevent latching in babies due to inability to use the muscles on one side of the face. Other babies may be able to latch but mums will have to hold the breast in place, or there can be lots of fussy (off and on) behaviour at the breast. Facial nerve palsy normally improves with time without treatment, but effective breastfeeding may not be possible until the injury is fully healed. Craniosacral therapy is a gentle way of identifying any nerve issues and speeding up healing by facilitating the body’s own self-healing mechanism.

CN VIII: The vestibulocochlear nerve has two branches – one for balance and one for sound.

CN IX: The glossopharyngeal nerve is both sensory and motor and innervates the palate and back of the tongue. This nerve is involved in swallowing and the gag reflex.

CN X: The vagus nerve a complex nerve with many, sensory and motor functions. It innervates muscles in the throat and back of the mouth / soft palate. This nerve travels down away from the face and regulates heart rate, breathing, sweating and muscles in the gut. Its dysfunction can also cause speech and swallowing disturbances.

CN XI: The spinal accessory nerve innervates the muscles of the neck and shoulder (trapezius muscles and sternocleidomastoid muscle). It is involved in the movement of the head and neck. It is often damaged during difficult births where forceps had to be used, or if a shoulder got stuck and the nerves were stretched in that area.

CN XII: The hypoglossal nerve is important for tongue movement. It plays an important role in the ability to latch to the breast, and in sucking. It is also important in speech and swallowing. Its pathway lies between segments of the occipital bone and disruption to the occipital segments during birth can influence the function of this nerve.  Nerve entrapment between the occipital segments can lead to disorganised tongue movements, affecting milk transfer when breastfeeding.

The brachial nerve plexus, while not a cranial nerve, is a bundle of nerves that originate in the neck. It is worth mentioning in this article as it is a nerve injury that I have treated and is associated with shoulder dystocia, large babies, vacuum delivery and forceps. Babies with this nerve injury have limited function of one arm and/or numbness/altered sensation.

What can help:

After birth if there is any misalignment of the cranial bones, a baby will try to self-correct these issues by yawning, sucking or crying. These actions can be successful in helping to move the cranial bones back in to a position of ease in the first weeks of life and therefore optimising cranial nerve transmission. Though other babies will need therapeutic support.

The medical system, unfortunately, is lacking in its ability to treat this issue in babies, often simply relying on time to heal. Breastfeeding is often a casualty of this approach. Babies should be referred to skilled bodywork practitioners who have experience working with babies in order to preserve the breastfeeding relationship.

Cranio is great at addressing the root cause of the issue. The baby’s body is facilitated into a healing state and any tension around the brainstem or any compression of the cranial bones that may be influencing nerve conductivity has the opportunity to release. Mothers often report an improvement in the breastfeeding ability of their baby.

Please get in touch to book a session for your baby if you feel your baby needs extra support to breastfeed. Toddlers who are having difficulty with solids may also benefit from this therapy.