Clicking while breastfeeding is something that worries a lot of mothers. But, luckily, it is rarely a reason for concern.
Firstly, it’s important to understand how a baby extracts milk from the breast, and then we can understand why it may “click”. The baby opens its mouth, comes onto the breast, and creates a seal with its face around the nipple, areola and surrounding breast tissue. Once this seal has been created, a baseline vacuum exists inside the baby’s oral cavity. The baby then drops the jaw and the tongue down together, and this increases the vacuum (or negative pressure) inside the baby’s mouth. The increase in the negative pressure is what helps to draw milk out of the breast. It is when the tongue and the jaw are down, that the milk flows into the baby’s mouth.
We also have the milk-ejection reflex, or letdown. The baby suckling at the breast triggers release of the hormone oxytocin from the brain. This hormone travels to the myoepithelial cells (muscle cells) that surround the lobules where the milk is made and stored. The contraction of these muscles squeezes milk into the milk ducts, and out of the nipple. During letdown, if the breast is very full or the muscle contraction is very strong, some women find their milk can even squirt across the room!
In order for the baby to cope with such a strong let down, they need to be positioned at the breast so they can quickly and easily drink all that milk. The best position allows for the baby’s head to be a little extended, and looking straight ahead. The Gestalt method of breastfeeding allows for this correct positioning at the breast. If they are feeding with a slight chin-tuck, they will not be able to drink effortlessly. If they are struggling at all, they will need to do something to slow the flow of breastmilk. One option is to come off completely. But often this is a last resort. More likely, they will simply release the vacuum (or negative pressure) in their oral cavity. They do this by slightly breaking the seal between the breast and their tongue. This is the “click” that is heard. As long as it is not causing pain for the breastfeeding mother, there is no reason to be concerned by this. It does not mean the baby is swallowing air (this has been disproven by recent ultrasound and MRI studies). It is simply a reflection of a fast let down and generous milk supply. Moving the baby to encourage a more head-extended position is about the only thing that needs to be done.
If a baby seems to be really struggling to cope with the milk flow, then an in-person assessment by one of our doctors is advised. There are a few medical conditions that can make co-ordination of breathing and sucking/swallowing more challenging and we are able to assess for these.
Many people worry that the clicking means there is a “tongue-tie” because, perhaps, the baby is unable to maintain a seal around the breast with its tongue. The baby only needs to elevate the tongue by 4-6 mm in order to breastfeed successfully. The outdated “stripping” model of breastfeeding assumed that the baby’s tongue movement was needed to help massage out the milk. This has been disproven, and the vacuum model of milk removal has taken over, where it has been shown the milk flows when the tongue and jaw are down, not up. If tongue movement is a little restricted, often we can overcome this just by filling the mouth with more breast tissue and ensuring a really deep face-breast bury. The presence of clicking should not be used to diagnose a tongue-tie.
-Dr Briony Andrew