|Sleep Apnea from an Anatomical and Developmental Perspective|
Significance of the Delivery System
During Infant Feeding and Nurturing
in: ALCA News, Vol 7, Issue 1, April 1996, p26-29
Biography: Dr. Palmer is a full-time private-practice general dentist
with a special interest in the treatment of snoring and sleep apnea.
He is a member of the national, state, and local dental societies,
International Lactation Consultant Association (ILCA), Medical Associate of La
Leche International, State of Missouri Breastfeeding Task Force, American Sleep
Disorders Association (ASDA), Sleep Disorders Dental Society (SDDS), and a
member of two hospital “sleep” teams. He
has had special post graduate training in orthodontics, occlusion, TMJ, and
myofunctional therapy. He has spent
over 20 years observing and documenting the collapse of the oral cavity and
airway, as well as researching skulls and the history of breastfeeding.
Please download a printable version of the illustrations for this article from this link, viewable with free Adobe Acrobat Reader.
specialists provide the most important service of all the health care providers.
I make this strong statement because I believe breastfeeding is the key
to the best and cheapest form of health care.
The ramifications of NOT breastfeeding are significant.
Many are concerned only with the contents of the delivery system.
I believe one must also be concerned with the “delivery system”
itself since it will have a significant impact on the developing occlusion (the
way the teeth meet)1
and on total infant development. There
is no delivery system or artificial content that will ever replace the act of
feeding human milk direct from the breast.
purpose of this article is to discuss some of the important issues as to why the
“delivery system” itself must be evaluated.
The side effects of an improper delivery system will also be addressed.
teats, dummies, and thumbs (fingers, blankets, arms, etc.) are deleterious to
the development of the oral cavity and the airway. A good illustration would be to place your thumb on the
underside of a thin, softened rectangular piece of wax and push up.
The force of the thumb will push up and mold the wax into the shape of
the thumb. The sides of the wax will also move inward.
Thus, when the bottle teat, thumb, finger, or dummy press against the
still soft bones of the palate, these bones are molded into a narrow unnatural
shape. This can eventually lead to the poor alignment of teeth2 and explains the “V’ shaped arch as
described by TA Hunter of the NZ Dental Association as early as 1941 in the book
It also explains how the upper back teeth are pulled inward and cause a
mismatch of the teeth or what is better known as a malocclusion.
teats, but mainly thumbs, can impact the position of the upper front teeth by
pulling / pushing them forward and up, creating a “goofy” look.
Teats and thumbs can also retard the growth of the mandible and create a
retrognathic (back) lower jaw, causing an “open” bite in which the upper and
lower front teeth do not contact each other as they should.
Once you have this malocclusion a domino effect occurs that damages the
rest of the teeth. The damage that
occurs includes - loose teeth, sore teeth, bone break-down, and notches near the
problem that occurs during this same illustration is that of infringing on the
space in the nasal cavity. As one
pushes up on the roof of the mouth, the floor of the nasal chamber
is rising at the same time. Since
the bridge or the top edge of nose does not rise accordingly - you have a
decrease in total nasal volume. This
can have a dramatic effect on the individual’s breathing efficiency since the
size of the chamber is decreased. There
is a direct correlation between being healthy and ease of breathing.
challenge teat manufacturers have is the firmness of the latex or silicone that
their product is made of. If it is
too soft, it will stay compressed for a longer time after a suck and it will not
refill very easily. Teats made of
harder latex or silicone rebound and refill quickly.
The problem however, is that the harder the teat composition, the more it
will deform the hard palate.
anatomy of a suck as described by Woolridge4
states that during breastfeeding, a compression wave moves from the tip to the
back of the tongue against the underside of the nipple and breast tissue. This
peristaltic like motion pushes the milk ahead of itself, until it is expressed
out of approximately 15 pores near the tip of the nipple in a volume the baby
can easily swallow. A small amount
of “suction” or negative pressure is created to hold the nipple in place at
the junction of the soft palate, but the act of feeding from a breast is quite
different to sucking. The
breastfeeding infant develops proper perioral musculature (muscles around the
mouth and jaw) by the way it works its jaw muscles in this physiologically
normal process. The human nipple is
not harmful to the hard palate, because it has appropriate flexibility to
flatten and broaden. This accounts
for the fact breastfed babies have nicely rounded “U” shaped hard palates.
an artificial teat the infant does not caress the bottom side of the teat, but
rather has to squeeze it to express the contents. Depending on the hardness of the composition and the size of
the hole at the end of the teat, the milk either “gushes” or squirts in a
thin hard stream out the end, causing the infant to posture its tongue at the
back of the throat to prevent too much liquid from going down its throat.
This sets up a tongue habit described by some as a tongue thrust or
type of swallow, patterned through infancy, can become the usual swallow for
that child, persisting into adult life, with devastating consequences to the
oral cavity and the dentition. The
tongue thrust is also one of the causes of otitis media. As the tongue postures up and back, it can physically push
the soft palate up and obstruct the eustachian tube (auditory canal), or it can
prevent the Tensor Palatini muscle (the muscle that open the eustachian tube
during a swallow) from firing properly. Both
have the same effect of preventing the infant from equalizing the pressure in
its middle ear, decreasing circulation in the ear, and setting up a condition
for otitis media.
contributing factor to the collapse of the airway involves the infant NOT
receiving the mother’s immunological and antibiotic benefits that are normally
passed through the natural breast milk. Because
the infant does not receive these benefits, he/she is more prone to illness and
infection, and to combat these the body has to “kick in” its filtering
system - the tonsils and adenoids. The
tonsils and adenoids become inflamed and swollen thus decreasing the size of the
airway even more and further reducing the efficiency of airflow.
The enlarged adenoids can also interfere with the efficiency of the
eustachian tubes as discussed above.
the composition of the teat is on the hard side, the contents of the bottle will
“gush” excessively. On the
other hand, if the composition is too soft, the infant may have to suck
excessively to get the fluid out. With
this action, a strong vacuum force is set up in the throat or oropharynx area.
This can be devastating to the airway by collapsing the walls in the
throat area and decreasing the size of the airway, leading to even more
inefficiency of breathing. Add together the decreased nasal space and the decrease in
throat space, and you can see how the infant’s ability to breathe is affected.
decrease in the ability to breathe can have a harmful effect in the total health
of the individual, as an infant as well as an adult.
Decreased airflow leads to poor sleep quality, snoring, apnea, and
enuresis (bed wetting). Growth
hormone is related to sleep, obstructed airways lead to disrupted sleep, and
ultimately to the growth and development of the child.
delivery system of breastfeeding is so much healthier for the infant than bottle
feeding, but it is little appreciated. Breastfeeding
is often reduced by commercial interests to a nutritional issue, with occasional
reference to its immunological benefits. Bottles,
teats and dummies have become such a ubiquitous part of our culture that their
impact on the infant is rarely questioned.
I would like to solicit your help to educate mothers, doctors, other
lactation specialists, governments, and insurance companies on the importance
and benefits of breastfeeding, in the full sense of the word.
Breastfeeding is truly the cheapest form of health care!
only see what we know, therefore we must know to serve!”
Labbok, Miriam, “Does Breast-feeding Protect Against Malocclusion?
An Analysis of the 1981 Child Health Supplement to the National Health
Interview Survey”, Am J Prev Med 1987; 3(4) pp227-232.
Garliner, Daniel, “Swallow Right of Else”, Warren H. Green, Inc., 1979, ISBN
87527-1952-2. Order direct - (314) 991-1335
TA Hunter, New Zealand Dental Assoc., quoted in “MotherCraft”, M Truby King,
Pub Whitcombe and Tombs Ltd 1941.
Woolridge, Michael W., “The ‘anatomy’ of infant sucking”, Midwifery,
1986, Dec; 2(4): 164-71
Escott, Ros, “Positioning, Attachment and Milk Transfer”, Breastfeeding
Review, 1989 May 1(14) pp31-37.