25% of babies without neurological damage have suction-swallowing problems (LaMantia et al. 2016). It is a figure not negligible. In addition, 80% of children with developmental disorders present these difficulties. The relationship is important to the point that there are authors who wonder if early sucking and swallowing problems can be predictors of developmental problems. The results are not clear but at the clinical level the interrelation is without doubt.
One of the hypotheses is the alteration of sensory-motor nutrition-swallowing circuits. Perhaps because of a disruption of the development of the rhombencephalon neurons. These neurons are necessary for motor and sensory coordination of the structures of the oropharynx. It could be due to genetic or environmental aspects. Another hypothesis is peripheral involvement of hypoglossal, accessory or glossopharyngeal cranial nerves. This due to compressions or manipulations of the neck and head around the delivery. Normally in longer and more complex deliveries. There is another important nuance in this last hypothesis. The relationship with cervical dysfunctions. Mothers often refer to better suction in one breast than in the other. This related to the position of the baby when breastfeeding.
How to make a differential diagnosis
Faced with these two hypotheses, it is convenient to look for clinical signs that direct in one direction or another. The treatment in Integrative Pediatric Manual Therapy would have somewhat different objectives and means.
In the hypothesis of peripheral dysfunction linked to cranial nerves and their output we can find linked clinical signs. On the one hand cranial asymmetries in the area of the base or the position of the ears. An especially narrow, impacted or asymmetric occipital. It is possible to find a clear limitation of active and passive ROM in neck rotation. There are other clinical details that may be relevant, but this is the most characteristic.
If this is confirmed, treatment with PIMT on the cranial base can quickly awaken orofacial function. This is measurable and objectifiable by anthropometric measurements or by cervical ROM measurement. Of course evaluating the orofacial function. It will also be necessary to guide the family for orofacial stimulation. This point is key. As well as advice that facilitates good breastfeeding such as skin-to-skin contact for example.
In the circuit hypothesis, the shape of the skull does not show cranial alterations or obvious cervical limitations. There are no variations in function depending on the position of the head. PIMT treatment focuses on improving sensorimotor circuits with precise stimulation. Teaching the family to collaborate in this stimulation, which will have to be daily and repeated.
Finally, never forget to pass an AIMS motor skills scale to these babies. The risk of a developmental impairment is present. Objective evaluation in pediatric physiotherapy is always necessary.
LaMantia AS1 Moody SA, Maynard TM, Karpinski BA, Zohn IE, Mendelowitz D, Lee NH, Popratiloff A. Hard to swallow: Developmental biological insights into pediatric dysphagia. Dev Biol. 2016 Jan 15;409(2):329-42.
Parnell Prevost C, Gleberzon B, Carleo B, Anderson K, Cark M, Pohlman KA.Manual therapy for the pediatric population: a systematic review. BMC Complement Altern Med. 2019 Mar 13;19(1):60.