A brief gestalt intervention changes ultrasound measures of tongue movement during breastfeeding: case series

Abstract

Background Lactation consultants frequently advise adjustments to fit and hold (or positioning and attachment) with the aim of optimising intra-oral nipple placement. However, approaches to fit and hold interventions vary widely, with little evidence of benefits, and effects of fit and hold on infant tongue movement have not been examined. The aim of this preliminary study was to investigate whether a gestalt breastfeeding intervention alters tongue movement, using measurements from ultrasound imaging to determine nipple placement and intra-oral nipple and breast tissue dimensions. Methods Ultrasound measurements were conducted in five breastfeeding dyads, infants aged between four and 20 weeks, while feeding in their usual or ‘standard’ position and again after brief application of gestalt principles of fit and hold. Four of the mother-baby pairs, who had received comprehensive lactation support, reported persisting nipple pain. Three of these infants had difficulty latching and fussed at the breast; three had been diagnosed with oral ties. A fifth pair was breastfeeding successfully. Results Ultrasound demonstrated that the distance from nipple tip to junction of the hard and soft palate decreased, intra-oral nipple and breast tissue dimensions increased, and nipple slide decreased after a brief gestalt intervention. Conclusion These preliminary findings suggest that changes in fit and hold impact on infant tongue movement. Further research investigating short-and long-term outcomes of a gestalt breastfeeding intervention in larger cohorts is required.

Overdiagnosis and overtreatment of nipple and breast candidiasis: A review of the relationship between diagnoses of mammary candidiasis and Candida albicans in breastfeeding women

“…It aims to eliminate conflicting vectors of force, which will optimize intra-oral breast tissue volume and allow the intra-oral vacuum and associated mechanical load to be diffused over a larger surface area of the intra-oral nipple-areolar complex, so that concentrated stretching or bending forces no longer cause repetitive micro-trauma and tissue damage. 34 , 65 , 66 …”

“…34,36,37 A new 'gestalt' biomechanical model of infant suck and swallow, derived from ultrasound and vacuum studies and corroborated by real-time magnetic resonance imaging (MRI) analysis, contests previous biomechanical conceptions of infant suck and swallow. 34,65,66 In the gestalt approach to fit and hold, which derives from the gestalt biomechanical model, it is understood that women use a wide range of descriptors for their breastfeeding-related nipple and breast pain in the absence of fever or signs of mastitis. These descriptions are not diagnostic, for example, of nipple thrush or restricted oral connective tissues but are a spectrum of descriptions of the effects of repetitive tensile mechanical micro-trauma, causing tissue inflammation and experienced uniquely by each woman.…”

“…67 The gestalt model proposes that micro-trauma results from conflicting intra-oral vectors of force during breastfeeding. 34,65,66,68,69 The infant tongue is conceptualized as a supple, adaptive muscular hydrostat, which changes shape to conform to the amount of intra-oral breast tissue that is available. Intra-oral vacuum is generated by the inferior drop of the mandible, which the anterior and mid-tongue follow en bloc, in the context of a seal.…”