Clicking is a common issue mamas have when their baby's are breastfeeding. During breastfeeding the middle portion of the tongue lifts up and creates a vacuum with the palate. When the seal of the vacuum/suction is broken, we get the clicking sound.
Why is my baby clicking when they are breastfeeding and what can I do to help?
We know the reason behind the audible sound of clicking– loss of suction/vacuum by the tongue losing its seal. But what's even more important is why the baby is losing suction! And like most things, this requires teamwork. The one person I always recommend is an airway and tie savvy IBCLC. I recommend IBCLCs because they have the most training in breastfeeding and are capable of supporting a wider variety of needs. If they can't help you, they also tend to have an awesome network of people they trust that can.
So below are a list of reasons why baby may have clicking and who to see based on your child:
Poor latch and clicking: If you have painful or sore nipples, your baby has milk coming out the side of the mouth, your baby chomps/chews instead of sucks, it takes a long time to feed, they pop on and off, you have a forceful letdown or your milk supply is “low” then an IBCLC is your gold standard for assistance. An IBCLC specializes in lactation and breastfeeding. They can help you with positioning your baby and you for the most support and comfort. IBCLCs can make sure the baby is latched well, in a position that is comfortable for both mom and baby, and able to transfer milk as well as do weighted feeds which are awesome if you're also concerned about weight gain and if baby is getting enough on the breast. They also help with milk transfer, supply, expression, clogged ducts and calming the baby to breastfeed.
Torticollis and/or plagiocephaly and clicking: torticollis is where the child's neck tilts to one side and looks to the other as if they are looking at the sky. You may notice your baby only likes to look in one direction. Plagiocephaly often comes with torticollis and is when a baby gets a “flat spot” on their head. I want you to take a second and tilt your right ear to your right shoulder and look to the left and try to swallow. It is anything but easy. If your baby can't easily turn their head to neutral, you notice a flat spot or your baby nurses better on one breast, or one breast is painful or baby pops off or clicks more while nursing, I highly recommend a bodyworker (more info down below).
Facial, jaw and skeletal asymmetries and tension with clicking: First off, these can be super subtle and everyone is a little asymmetrical, even models! We aren't chasing perfect symmetry. Instead we are looking if the baby can turn and tilt their head in both directions or if we can move their hips in all directions. Or sometimes we look at our cute babies and think that one eye looks a little bigger than the other or the chin is tilted to the side. These changes are often a result of where the baby was in utero (always pushing on one spot, “nestled in,” breech, etc) or birth (fast birth, long birth, asynclitic birth, “stalled” birth, cesarean, forceps, vacuum) as well as the position you put your baby in now.
Tension and asymmetry can also show up as “really strong babies” who are able to lift their head up super early or frequently arch back or they are constantly popping off the breast and flailing around. We may look in their mouth and feel tension or tightness at the floor of the mouth which is preventing the tongue from movinf. It can also do the opposite and be the “lazy baby” or “floppy baby” that struggles to nurse because they are too tired. We may see them flop around but for them it requires more strength for them to nurse because they have to work harder to get the same amount of milk. Your baby isn't lazy, they just need extra support. And that support is through a bodyworker.
It also takes muscle strength, mobility and coordination of the mouth and body working together to efficiently and effectively create the vacuum. There's a saying that “what's happening in the body is happening in the mouth.” This is because if there is tension throughout the body, there will be a natural pull and compensation that we will as in the mouth. This is another reason bodywork is so helpful because it can help with that coordination and strength so your baby is hitting their oral and motor milestones!
Oral Motor Dysfunction: I'll admit this is NOT my area of expertise which is why I prefer to always work with an SLP or OT trained in myofunctional therapy and oral motor dysfunction. A lot of people immediately jump to tongue ties, but there's other areas where the suction can be lost to cause the clicking sound. As a chiro, I don’t have training in feeding concerns and proper swallowing mechanics- that lies with the SLPs and OTs. But, just a few instances of oral motor dysfunction are when the cheeks are overworking and you might see their little cheeks moving in and out as the nurse. Or maybe they are chomping down and you see their jaw moving rapidly up and down trying to pull the muscle out with pure strength instead of the vacuum. Or maybe you see your child has a really tight chin and can’t open their mouth wide. Or maybe the tongue needs more strength and endurance, but has range of motion. And sometimes the jaw is working to create a suction rather than the tongue. The possibilities are endless. That's why it's important to connect with a provider who is also an infant feeding specialist (SLP or OT with extra training) and an IBCLC to make sure you are treating the cause and that the baby is physically prepared if they do need a release.
Tongue tie and clicking: If the mid-tongue is restricted (previously referred to as a posterior tongue tie), then it can not properly lift to create the seal needed to prevent the clicking. If you think your baby has a tongue tie, I highly recommend first reaching out to an SLP trained in oral motor dysfunction and myofunctional therapy first. They will have preferred providers who they have worked with that they trust to perform a frenectomy or frenotomy (“release”). Although plenty of people market themselves as being tie savvy, you will want someone trusted by others in the airway and tie community.
Premature birth, low birth weight, developmental delays, family history of Ehlers-Danlos Syndrome or hypermobility: early breastfeeding is driven by reflexes and the coordination of suck-swallow-breath which is learned around 34-46 weeks inutero. If your baby was premature, it's important you work with an SLP or OT trained in feeding therapy to help improve that coordination. If your baby also arches a lot or is a “floppy or lazy baby” it's important to work with a provider who understands pediatric motor development (PT or chiro) who can help support your child through developmental milestones which will also support feeding milestones.
Structural abnormality and airway protection: okay, I'm going to preface that this is not the “norm” so please take a deep breath before reading this. It is NOT meant to scare you as it is to remind you that there is more to clicking than tongue ties as there are occasionally more complex issues that cause clicking. But google is a scary place so before you jump down that hole and freak yourself out, please ask for help from a qualified professional. If your baby has chronic congestion that you can't seem to clear with saline rinses, they constantly gurgle or it sounds like they have a hoarse cough or sounding voice, or if they constantly turn their neck and it looks like they are looking up at the sky, a pediatric SLP trained in feeding and the appropriate referral to ENT or GI depending on other signs and symptoms.
Will clicking stop on its own?
Oftentimes we hear the audible clicking sound disappear around 4.5-6 months of age. Unfortunately this doesn't mean that the baby is suddenly free of their oral motor dysfunction. While the sound itself disappears, it's usually because the baby has built up enough compensations that we no longer hear it. Around that same time the baby also gains a lot more midline strength and they can use that development to mask the oral dysfunction. You can think of it as the baby creating their own “band-aid” but not actually fixing the root cause.
Will clicking improve or go away on its own with a tongue tie release? How about a lip tie?
If the baby ONLY has a tongue tie and no sign of oral motor dysfunction, torticollis, plagiocephaly, asymmetries, muscular tension, muscular compensation, nervous system dysregulation (constant fight or flight or the “lazy baby”), reflux then a frenectomy (tongue tie release) may be the magical key that stops the clicking and discomfort you're having. And for those families, it truly does feel magical. But for many that isn't their reality.
For others it takes a little bit of time as the baby develops strength, coordination and endurance for the new tongue range of motion. It takes time for the tongue to relearn how to move and stabilize. I know when I broke my arm it took me about 6 weeks to regain strength and it can take this long for many babies to fully restore function as well.
Unfortunately many babies need more TLC than that because compensation and functional issues don't magically disappear. That compensation can go back as early as 13-16 weeks inutero when we first see babies sucking and swallowing. Even if they are “only” a few weeks old, those movement patterns have already been learned and need to be corrected. The reason I highlighted the different providers is because for many babies, clicking needs exercises before feeding, suck training, bodywork and developmentally appropriate strength.
As for the lip tie revision, that will not correct the clicking sound. If your baby is unable to widen their lips, open their mouth or phalnge their upper lip, it may help with that. It may also help any smacking sound you hear, but it won’t help clicking as that is the loss of suction by the mid-tongue.
My baby seems uncomfortable. Should I stop breastfeeding and switch to bottle feeding if they are clicking?
I don't often like to make absolutes, but I will say you most likely shouldn't stop breastfeeding if clicking or gassiness or aerophagia are your main concerns. Especially if you want to breastfeed! I personally would exhaust all other options before stopping. The main reason being that it may not make a difference! There's a reason your child is clicking and switching to a bottle doesn't correct the WHY. Oftentimes these kids are later diagnosed with “reflux” and given medication when they should have been given speech therapy, OT, and bodywork!
<<Side note: Just as moms who want to breastfeed can continue to do so, if you don't want to breastfeed, please give yourself permission to stop. If you are mentally or physically exhausted or you don't want to breastfeed, you are also allowed to listen to and respect your body's requests. You can switch to bottle feed your baby. You are still an awesome mom. I would simply recommend you still reach out to the providers to get to the root cause while switching.>>
Your Support Team for Clicking with Breastfeeding
IBCLC: I recommend finding your state or local tongue tie group on Facebook to find a tie savvy IBCLC who will know when and who to refer to if you need additional support. They will also be able to address any pain, discomfort and positioning you may need help with.
Bodyworker: Unpopular opinion-the best bodyworker is the one you have access to who is trained in pediatrics and oral/airway health. This may be a pediatric chiropractor, PT, OT, massage therapist trained in craniosacral therapy or craniosacral fascial therapy (CFT). I honestly don't believe one credential is superior to the other as much as the knowledge the provider has sought out. Ask your IBCLC or local tongue tie group for recommendations and utilize who is available and who you feel comfortable with.
SLP or OT trained in feeding therapy and myofunctional therapy: I love recommending myofunctional therapy for adults but when it comes to little people, they can't “do myo” because it requires them to actively participate in therapy. For peds, I love an SLP trained in myo AND feeding therapy/oral motor dysfunction because they are able to look at the baby through multiple lens to see what they need the most.
Release provider: I would highly recommend using the release provider recommended by your other parts of your team as they are the trusted providers in your area. This could be an ENT, pediatric dentist or periodontist depending on your area and who has the most knowledge around ties.
