July 17, 2012
Supporting the "Popping" TMJ (Temporomandibular Joint)
Body structures need to line up properly in order to work well. Intrauterine positioning can cause deformation of the jaw so the condyle of the mandible no longer fits nicely into the little hollow in the temporal bone of the skull, limiting mouth opening. During the birth process, ligaments or muscles on one side of the jaw can be stretched, displacing the condyle from the little disk that normally cushions the joint. If the condyle no longer tracks with its' disc, the jaw will be unstable on that side. If you place your fingertips gently over the TMJ while the baby sucks, you will feel a popping sensation as the baby opens the mouth when the disc clicks back into place. It is also possible for the disk to be displaced and not return to it's normal position.
Babies having TMJ problems may have difficulty opening the mouth widely enough to latch on deeply, or they may have difficulty getting into a smooth sucking rhythm. Both can cause low milk transfer.
If you suspect that the TMJ is making the baby's sucking efforts less successful, you can try some fingertip pressure above and behind the joint on the affected side (see photo). If this is the right intervention, the joint will feel more stable and the baby will immediately suck more effectively. In this case, you can teach the mother to support the same area while she nurses, particularly when that side of the jaw is facing upward. Mother's arm may provide sufficient support for the jaw when the affected side is facing downward.
Remember that jaw support doesn't eliminate the problem, but may help the baby compensate. Body work (osteopathic or chiropractic treatments, physical or massage therapy, etc) can help restore normal biomechanics. The muscle activity of breastfeeding can also help normalize the bony parts of the face over time.
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