Sometimes babies struggle to breastfeed efficiently. It’s not that they don’t want to or that they have a preference for some other feeding method – it’s that they can’t, or least can’t do so comfortably. This may be due to structural issues related to an instrumental or C-section delivery, a long pushing stage or their position in utero (eg breech, multiple birth or biocornate uterus). Structural issues can also be congenital.
So what do we mean when we say ‘structural issues’? When we look at a newborn baby what we expect to see is symmetry, normal reflexes, an organised suck swallow breathe (SSB) pattern, and a willingness to go to the breast. We want to see that structurally and neurologically all is as it should be. But sometimes we see issues with newborns which can affect breastfeeding. These issues include:
- Torticollis, ie a head tilt to one side or a preference for turning head to one side.
- Jaw or tongue asymmetry
- Torsion in the spine
- Deep neck creases
- One ear or eye appearing higher on one side of the face
- One shoulder higher than the other, or very tight shoulders that inhibit baby’s ability to extend the arms
- Baby’s chin tucked into his chest, or head extended giving the impression of a baby who has very good head control
- A baby who cries every time he has his nappy changed – hips might be tight
- Unwillingness to go to the breast
- Failure to latch
- Bobbing on and off the breast
- Poorly coordinated Suck Swallow Breathe (SSB) pattern.
- Clamping tightly when feeding at the breast
More often than not, these issues are related to how the baby was born, and do not resolve on their own. While there are no clear results in scientific evidence that bodywork resolves structural and neurological issues that affect breastfeeding, anecdotal evidence shows us that it does. I see this in my own practice, especially with babies born using vontuse suction or C-section. Sometimes these babies have torticollis which can make positioning difficult or mean that they can only feed comfortably on one side. Sometimes I see babies who have a weak suck or a disorganised SSB (possibly due to a trapped cranial nerve), or have some kind of tension/restriction in the cervical spine. I also saw a baby recently whose left arm was slightly internally rotated, making positioning at the breast difficult for him. According to the osteopath who treated him, the arm had been pulled out of its’ normal range of movement during an emergency C-section delivery.
Bodywork, which is a general term that refers to any kind of manual therapy that involves the application of light touch or pressure, can help with most of the issues I have listed above. Bodywork could, for example, be osteopathy, cranial sacral therapy, amatsu therapy or physiotherapy. Other types of bodywork which are not yet available in Ireland (to the best of my knowledge) include Bowen Therapy and Myofunctional Therapy. The thing to stress here is that any kind of bodywork for babies is very gentle. It involves the lightest touch and does not hurt babies in any way. The kind of touch that is applied to babies during these treatments is sometimes compared to what it feels like to have a coin placed on your arm.
Most lactation consultants I know will refer babies for bodywork when they think they need it, because they have seen the results and know it works. However, the notion of bodywork is still quite controversial among many medical professionals in Ireland. They may view it as something new and fashionable and possibly a bit dodgy. But the thing is, bodywork isn’t new. Many cultures have been doing it in some form or other for centuries. I remember how my Indian friend Rakhi’s Dad massaged his new grand daughter everyday for around 6 weeks – it was just part of the normal for this Indian family. While many parents in Ireland do now bring their babies to massage classes, it is a relatively new practice here. My guess is that Victorian notions of how human babies should be cared for (ie not cuddled, not spoiled), and some of the subsequent baby care manuals of the 1950s in which mothers were encouraged to keep an emotional distance from their babies, have played a significant role in disconnecting us from our babies. Although babies can’t speak to us, their bodies can tell us a lot about what is going on for them. So we need to pay attention, read our babies’ body language and seek help when we feel something isn’t right.
If you are think that your baby has structural issues and want to take her to a bodyworker, ask around for recommendations and only go to someone who is accredited and who has an additional paediatric qualification. And if you are struggling with breastfeeding, consider booking a consultation with me or another IBCLC. You will find a full listing of IBCLCs in PP here http://www.alcireland.ie/.
Other thing you can do which can help to address asymmetries and structural issues are baby wearing and tummy time.
- The Osteopathic Council of Ireland https://www.osteopathy.ie/
- The Irish Association of Cranio Sacral Therapy http://www.iacst.ie/
- Amatsu Therapy Association https://www.amatsu.info/
- Upledger Institute http://upledger.ie/
- Contact Details for paediatric Physiotherapist Patricia Weldon http://www.iscp.ie/find-a-physio/patricia-weldon
References and further reading:
- Benefits of Bodywork http://www.ankyloglossiabodyworkers.com/benefits-of-bodywork.html
- Video on Why Bodywork is Necessary for Tongue Tied Babies https://www.youtube.com/watch?v=ciTx4KkerWU&app=desktop
- Torticollis http://www.birthinjuryguide.org/birth-injury/types/infant-torticollis/
- Breastfeeding and Craniosacral Therapy: When it can Help, Dee Kassing BS, MLS, IBCLC, RLC
- Birth Trauma – A Baby’s View http://www.craniosacral-therapy-information.org.uk/Articles/Birth%20trauma%20-%20a%20baby%27s%20view.pdf
- Efficacy of an Osteopathic Treatment Coupled with Lactation Consultations for Infants Biomechanical Sucking Difficulties- A Randomised Controlled Trial 2016, J Herzhaft-Le Roy, MD, DO, IBCLC, M Xhignesse, MD, MSc, I Gaboury, PhD https://www.ncbi.nlm.nih.gov/pubmed/28027445
- Mandibular asymmetry and Breastfeeding Problems: Experiece from 11 cases – Virginia Wall, Robin Glass 2006 JHL
- Manual Therapy in Children: Proposals for an Etiologic Model – Heiner Biedermann, MD 2004
- Applications of Craniosacral Therapy in Newborns and Infants Part 1 by John Upledger, DO, OMM – Massage Today May 2003, Vol 03, Issue 05
- Mother’s Accounts of Bringing their Babies for Bodywork http://latch.ie/mothers-accounts-bringing-babies-bodywork/
For HCPs who work with babies and would like to learn more about bodywork, I can recommend:
Jaye Simpson’s 5-hour online and interactive Structure and Function Course https://jayesimpsonpresents.wordpress.com/
Also worth doing are the Michelle Emanuel webinars on GOLD Learning https://www.goldlearning.com and the webinar on ILCA ‘Case Studies on the Referral of Infants for Bodywork: Clinical Signs and Lactation Outcome’ by Carmela Beaza MD, IBCLC.