The infancy period is a time of intensive development, in which proper nutrition plays a fundamental role. However, for many newborns and their parents, the process of feeding, instead of being a moment of closeness, becomes a source of frustration and anxiety. Together with our expert - Aleksandra Derkacz, an experienced speech therapist and neuro-speech therapist, a specialist in early speech intervention - we talked about the possible causes of feeding difficulties in newborns. Observing a baby who sucks with difficulty, cries at the breast or bottle, or gains weight alarmingly little, can be a source of great stress for parents. What symptoms should worry us? What role does the structure of the oral cavity play and how can an early speech therapy consultation help both the child and the mother?

Feeding difficulties: what should worry?

Feeding difficulties in infants can have various causes, but it is important for parents to be aware of the symptoms that require consultation with a specialist. The most common problems our expert encounters are those related to the mechanics of suction.

What symptoms should parents pay attention to and prompt them to visit a speech therapist?

• Discomfort and pain in the mother during breastfeeding: Breastfeeding should not be painful. Sores, cracked nipples or severe pain may indicate incorrect attachment of the baby, often resulting from restrictions in the oral cavity.
• Ineffective sucking in the baby: This is manifested by, among others, short sucking sessions, the baby quickly getting tired at the breast or bottle, frequent waking up for feeding, as well as audible smacking or smacking, which may indicate a loss of seal during sucking.
• Excessive regurgitation or choking: Although occasional regurgitation is physiological, its intensity or frequent choking on food requires diagnostics.
• Excessive muscle tension: Observing strong tension in the baby's mouth, neck or shoulder girdle during feeding may suggest compensatory sucking mechanisms.
• Poor weight gain: This is one of the most objective indicators of problems with taking in the right amount of food.

"In general, the baby will cope, right? Because sucking is a primary function for him (...), so he will do it in various ways," explains Aleksandra Derkacz. However, it is important that these "ways" are physiological and effective, and not a source of problems.

Shortened frenulum: it's not just about the tongue

One of the key anatomical elements influencing the mechanics of sucking is the frenulum - both sublingual and upper lip. The sublingual frenulum is a fold of mucous membrane connecting the lower surface of the tongue with the floor of the oral cavity. Its shortening can significantly limit the mobility of the tongue, which is necessary for proper gripping of the nipple, creating a vacuum and effective transport of milk. Similarly, a shortened frenulum of the upper lip can make it difficult to evert it correctly and seal the grip.

"Frenulae can be of various types. As speech therapists, we have our own typology, scales for assessing frenulum shortening in terms of tongue mobility, but also attachments," explains Aleksandra Derkacz. Assessing a frenulum requires specialist knowledge and experience.

When is intervention necessary? Frenotomy and therapy

Not every shortened frenulum will automatically qualify for a frenotomy procedure. The decision to undergo surgical intervention should be preceded by a thorough functional assessment conducted by a speech therapist or lactation consultant, sometimes a pediatric surgeon or laryngologist. However, if shortening the frenulum clearly disrupts the sucking function, leads to problems with lactation or insufficient weight gain of the child, the procedure may be necessary and often brings immediate improvement.

However, it should be remembered that cutting the frenulum itself is often only the beginning of the road to improving the function. "It's not like we'll just cut the frenulum and nothing will be done about it. Unfortunately, the place where the cut was made heals, a scar appears (...) If it is not stimulated, not massaged, a hard coating forms," ​​warns the expert. Therefore, regular massages and speech therapy stimulation of the place after frenotomy, as well as exercises to improve the functioning of the tongue and lips, are crucial after the procedure.

Pacifier: a soother or an enemy of development?

The issue of the pacifier arouses many emotions. Is it a friend or an enemy of proper development?

The need to suck in infants is very strong and is not limited only to taking food. Non-nutritive sucking plays an important soothing and regulating function. A child can fulfill this need at the mother's breast, sucking its own fingers, a blanket, and also a pacifier, which helps the mother "catch a breath".

"The pacifier (...) was created for this purpose, and it was created a long, long time ago, to fulfill this function of a soother in a child," explains Aleksandra Derkacz.

However, using a pacifier should be conscious. The problem occurs when:

• The pacifier is poorly selected: The shape of the pacifier is important. Anatomical, flattened models are usually better than round "balls", which can perpetuate an incorrect position of the tongue.
• The pacifier is used too long and too often: "Generally, it is worth quieting down this pacifier around the first year of life," advises Aleksandra Derkacz. Using a pacifier for too long can disrupt the development of the bite and perpetuate the infant type of swallowing.

Consequences of untreated problems and the importance of early prevention

Undiagnosed and untreated feeding difficulties or limitations resulting from a shortened frenulum can have long-term consequences. They can affect the further development of oral functions, such as biting, chewing, and in the future also articulation and speech development. They can also contribute to the consolidation of an incorrect respiratory path (through the mouth instead of the nose) and malocclusion.

That is why early speech therapy and neurological therapy intervention is so important. The specialist will not only help diagnose the cause of the problems, but will also implement appropriate therapy, teach parents the necessary exercises and massages, and advise on the selection of possible accessories (e.g. an appropriate pacifier, if necessary).

Appeal to parents: your attentiveness and cooperation with specialists are key

Dear parents, if you observe any difficulties in your infant related to feeding, disturbing symptoms during feeding or problems with gaining weight, do not hesitate to seek professional help. Your intuition combined with the knowledge and experience of specialists - a speech therapist, lactation consultant, pediatrician - is the best way to provide your child with optimal conditions for healthy development. Early diagnosis and appropriately selected therapeutic activities can significantly improve the comfort of feeding and prevent many problems in the future.

The article is based on an interview with Aleksandra Derkacz, a speech therapist and neurological therapist, conducted as part of the Healthy Kids CLUUb.