Depending on the severity of the situation, some neurological defects in babies can cause
breastfeeding problems. It is important to understand how these central nervous system disorders affect a baby's feeding and what to expect.
Encephalocoele:
In babies with encephalocoeles, a portion of the brain hangs out of the skull in a skin-covered sac. If it is large and a significant amount of abnormal brain is in the sac, then the baby may be severely mentally retarded. This would cause serious breastfeeding difficulties as the
suck, swallow, and breathe reflexes are controlled by the brain. With impaired function, the sucking mechanism is difficult to establish, which means that both breast and bottle feeding are difficult for the baby.
Spina Bifida:
This is one of the most serious neural-tube defects where a portion of the spinal cord and meninges (a membrane that covers the spinal cord) sticks out of a defect in the spine, usually in the lower back. The baby may have some weakness or utter paralysis of the legs in addition to bladder and bowel control problems post-babyhood. If there is a brainstem defect as well, the baby may not be able to breastfeed. Surgical correction is critical and is performed within 24 to 48 hours after birth. The good news is that successful spina bifida surgeries may allow babies with this condition to breastfeed.
Micrencephaly and Macrencephaly:
Micrencephaly is the condition of having an abnormally small brain; macrencephaly is the condition of having an abnormally large brain (not to be confused with having a large head). Babies with micrencephaly may show few signs other than mental retardation, but with macrencephaly, the range is much greater -- the baby may be normal or may present with severe retardation. Because brain function is impaired, feeding difficulties may arise as sucking, swallowing and breathing are controlled by the brain.
Miller-Dieker Syndrome:
Otherwise known as lissencephaly, or "smooth brain." There is a characteristic facial appearance, delayed growth and mental development, and multiple abnormalities of the brain, heart, kidney and gastrointestinal tract. As a result, babies with this defect may have
failure to thrive and severe feeding difficulties. Death tends to come in infancy or early childhood.
Chemical Senses - Taste and Smell:
Chemical senses are critical to the breastfeeding experience. Research has shown that full-term babies can identify sweet, bitter, sour and salty tastes; premature babies respond to sour or bitter and show stronger sucking in response to sugar-water than plain water. Unfortunately, there is little information about the early development of smell. We do know that babies born with holoprosencephaly lack the ability to smell. This may cause problems with breastfeeding as babies rely on this sense to detect and root for mom's milk. Full-term babies typically have well-developed senses of smell and preferences can be seen at this stage. (Babies less than one week of age can distinguish the smell of their mother's breast pad from another.) Research on preterm babies is limited, but most show similar responses to full-term infants. It is common for preterm babies to have feeding problems, as many have poor coordination of sucking and swallowing. Some have an aversion to feeding as they may have dealt with stressful procedures around their mouth (such as those involving tubes). Little is known about whether or not any taste or smell disorders are present in babies with feeding problems.
Sources:
Avery GB, MacDonald MG, Seshia MMK, Mullett MD. Avery's Neonatology: Pathophysiology & Management of the Newborn, 2005.
Riordan J, Auerbach KG. Breastfeeding and Human Lactation. Jones and Bartlett.
