Breast feeding should be the most natural thing in the world, and for many new mums it is. However, when it isn’t working quite as well as it should it can be hugely distressing for both the mother and baby. Whilst no-one should feel bad if they find themselves unable to breastfeed their baby, there are plenty of reasons for giving breast feeding your best shot. Understanding why some babies struggle with breast feeding can help to identify possible solutions to the problem.
Musculoskeletal disorders are a common factor. These are muscle and joint problems usually resulting from either the birth process or the position of the baby in the uterus during pregnancy (intra-uterine constraint). These very often involve neck and jaw issues, but if a baby is distracted by musculoskeletal pain anywhere in their body, or indeed by a headache, it seems reasonable to assume that this could make feeding more challenging. Typical signs that musculoskeletal issues are a factor in breastfeeding problems include:
- the baby pushing off the breast
- arching the back when feeding
- milk dribbling out of the mouth when at the breast
- difficulty in achieving an effective latch, often due to not opening the mouth wide enough
- ineffective suckling, often giving the mother sore nipples
- distress or discomfort when being positioned for breast feeding.
A study published in the journal Clinical Lactation (2016) asked lactation consultants about their perceptions of musculoskeletal disorders affecting breastfeeding. The most common musculoskeletal issues were identified as congenital torticollis, sometimes known as “wry neck” (25%), and neck tension (14%). The most common latch issues were identified in this study as painful latch (24%), neck problems (18%), non-latching (9%), and tongue-tie (27%).
Looking for clues
So how would you know if your baby had a musculoskeletal problem? In addition to the feeding issues already described, babies with musculoskeletal and structural problems will often feel uncomfortable and may show this in a number of ways including excessive crying, sleep problems, and being generally unsettled. Sometimes there can also be very noticeable functional problems such as discomfort in certain positions and body positioning too.
Observations that parents might make which can indicate a musculoskeletal problem in a baby include:
- Erect head control (“military” posture when held upright)
- Preference to keep or turn head to one side
- Inability to turn head left or right
- Uncomfortable in certain positions, e.g. lying on the back or having the nappy changed
- Asymmetrical posture, e.g. lying in a curved “banana” shape
- Facial asymmetry: crooked smile, uneven eyes, an ear that “sticks out”
- Intolerant of the car seat
- Fusses or becomes frantic during tummy time
- Excessive back and neck arching
Need help? Here are some ways to get breast feeding on track…
There are a number of ways that you can get help.
Lactation Counsellors – These are specially trained professionals who can offer advice and support on all aspects of feeding your baby. They can also check your baby for tongue tie if you are concerned that this may be a factor. Your Health Visitor should be able to put you in touch with your local lactation counsellors.
Support Groups – It can also be very helpful to join a local group where support is available. Your local NCT and LaLeche league will offer weekly support grounds and there are often breastfeeding support groups at your local children’s centre or hospital.
Cranial Osteopathy – People are often surprised that babies may need physical therapy. There are many reasons why a parent may decide to bring their baby to an Osteopath, and these are typically linked to muscle and joint problems (i.e. “musculoskeletal”), and the effect that these may have on the child’s nervous system.
Muscle, joint and cranial problems can start as a consequence of the positioning of the foetus in the womb (intra-uterine constraint), and through the birth process. Lifestyle factors such as prolonged periods in car seats and lack of tummy time, can also have an impact on the musculoskeletal wellbeing of babies and infants.
At Surrey Osteopathic Care we are often referred babies from midwifes and health visitors. Sally has attended numerous post graduate training courses on paediatric care and is very experienced when it comes to dealing with feeding difficulties. Techniques used to care for babies are always very gentle and are designed to safely and effectively help little people. These include massage and soft tissue techniques, and gentle ways to improve function of the joints (often holding techniques or gentle vibration).
Every child visiting a Osteopath is individually assessed, and any musculoskeletal or cranial issues addressed, rather than “treating” a specific problem. For a baby brought to the clinic in relation to feeding issues, a visit might typically involve: Checking the around the throat area, jaw, upper neck and back of the skull (which can often be very tender due to the strains of the birth process); checking for tongue tie; releasing the muscles of the tongue; checking muscles that often compensate for other dysfunctions that affect feeding (these are quite diverse and include the muscles at the front of the neck, the diaphragm, and the shoulder girdle); and looking for any other spinal and cranial problems which might be making the baby uncomfortable or unable to relax in the feeding position.
The techniques described above are broadly described as “manual therapy”. In the study published in Clinical Lactation (2016), 91% of the lactation consultants who responded noticed breastfeeding improvement following manual treatment.
Support and the right care can make a difference!
It is recognised that early and consistent breastfeeding support can often make the difference in a mother and baby’s ability to establish a functional breastfeeding relationship. So, if you are struggling, don’t delay!
If you are experiencing difficulty breastfeeding your baby, seek support from a lactation counsellor, and if you think that musculoskeletal problems may be a factor, consult a skilled practitioner such as an Osteopath, who can offer hands-on care for your baby.