Chiropractic Evidence-Based Management of Breastfeeding Difficulty

Summary of Key Action Statements in this Document 

1. When managing an infant with breastfeeding difficulties, the chiropractor should be aware that despite 90% of Australian mothers initiating breastfeeding, there are factors leading to suboptimal or premature cessation of breastfeeding. Despite recommendations of exclusive breastfeeding to six months of age, only 15% of Australian mothers do so. Chiropractors should work with other healthcare professionals to support exclusive breastfeeding to six months of age. 
   
   
2. Breastfeeding is beneficial to infant health, with evidence of improved cortical function, motor development, language development, intelligence, mental health and immune system function. Suboptimal or lack of breastfeeding is disadvantageous to infant and child health. Breastfeeding also confers health benefits to the mother. Chiropractors should work with other healthcare professionals to support exclusive breastfeeding to six months of age 
   
   
3. The chiropractor involved in the care of the breastfeeding mother and child needs to be aware of and understand the mechanics of normal breastfeeding. 
   
   
4. Chiropractors involved in the care of breastfeeding infants and children need to be aware of the range of factors which may impact successful breastfeeding. The chiropractor should understand their limited training in breastfeeding education and consider there may be factors that, either in the infant/child or the mother, may result in suboptimal breastfeeding and refer when appropriate. 
   
   
5. The chiropractor should be able to identify dysfunctional breastfeeding and make appropriate referrals to support the breastfeeding dyad. Recognition and appropriate referral of those with red flag indicators or signs of failure to thrive are paramount. 
   
   
6.  a) Thorough assessment of the paediatric patient should be undertaken by the chiropractor in infants with breastfeeding difficulties. Intersegmental ranges of motion of all spinal regions in three axes of motion should be undertaken, as well as full motion assessment of all extremity joints. A thorough assessment is essential in ruling out underlying pathology and providing an accurate diagnosis.
   b) Regardless of the presence of neurological or musculoskeletal dysfunction in infants with breastfeeding difficulty, collaborative care and support should be sought from an International Board Certified Lactation Consultant (IBCLC) as chiropractors are not adequately trained to assess causes outside of this scope.
   c) In the presence of red flag indicators, failure to thrive, or dehydration referral to both an International Board Certified Lactation Consultant (IBCLC) and paediatrician is recommended. 
   
   
7. The chiropractor should understand the impact and effect of the chiropractic adjustment, as significant changes may occur within the nervous and musculoskeletal systems. Improvement in afferentation by restoring proper spinal joint function facilitates appropriate neurological development and function, which may present as improved breastfeeding. 
   
   
8. Low-level evidence of chiropractic management has demonstrated improvement in 78-100% of those with breastfeeding difficulties; infants with breastfeeding difficulty may benefit from chiropractic management. 
   
   
9. The chiropractor should routinely measure an infant’s growth and development. Weight, head circumference, length and neurodevelopment in the infant with breastfeeding difficulties should be regularly measured and documented. Appropriate referral to an International Board Certified Lactation Consultant (IBCLC) or paediatrician may be necessary in cases of atypical development, cases that do not improve with chiropractic management, or worsening cases. 
   
   
10. The chiropractor should recognise when referral to other health care providers is indicated, and refer when appropriate. In the event of uncertainty, the paediatrician should be the primary referral. In the absence of indications of infant illness, referral to an International Board Certified Lactation Consultant (IBCLC) should occur, as chiropractors have limited education in breastfeeding management.