After birth, when your baby is placed on your belly, they use their reflexes to navigate toward your chest and begin to feed. These reflexes happen automatically and not by choice. Breathing and blinking are other examples of automatic, involuntary reflex responses. We do not need to think about them, they just happen when they are signaled.
In the breast crawl, babies use many reflexes to move themselves up toward the chest. The Montgomery glands on the areola secrete a fluid that smells like amniotic fluid helping the baby to find their way. As they get closer, they turn their head side to side, rooting for the nipple. They lift their head and then come forward to latch. When their chin makes contact with the chest, they open their mouth wide and come over the nipple and begin to suck. Be patient and allow your baby time to go through each step. The breast crawl should be practiced many, many times in the first weeks of life.
How the baby uses their whole body to latch and breastfeed/ chest feed
- A position that allows them to feel stable makes using their reflexes easier. They can focus on nursing rather than where their body is in space.
- Consider the direction gravity is pulling their body. Koala, side lying and laid back nursing use gravity to hold your baby on your body and give the baby more control during feeding. Other positions like cradle, cross cradle and football hold need the parent to hold onto and support the baby more because gravity is pulling the baby away from the parent’s body.
- Position your baby belly to belly with lots of contact with your body. Your baby’s ear, shoulder and hip should all be in a straight line.
- Babies use their hands to feed. Keep their hands free to be able to massage and mold the breast tissue. Using their hands, they stabilize their neck and shoulders.
- Avoid holding the back of their head. Neck extension can only happen if they are free to move their head forward and back with ease.
- With their head tilted slightly back, the jaw is able to come forward. This makes opening the mouth wide easier for a deeper latch and comfortable swallowing.
If they are unable to use each muscle as intended for feeding, they will develop compensations to get the task of feeding done.
Signs of tension in baby
- Shallow latch or unable to open their mouth wide
- Suck blisters
- Clicking during nursing
- Hungry soon after nursing
- Their body seems rigid or stiff
- Lays in a C-shape or banana curve position
- Leaks milk during bottle feeding
- Only wants to nurse on one side or in one position
- Clamping or biting at the breast/chest
- Irregular or infrequent stooling
- Breast refusal
- Hiccups, sneezing or excess gas
The parent may experience
- Pain when the baby is nursing
- Low milk supply
- Sore nipples
- Lipstick or misshapen nipple after baby unlatches
- Creased nipple after feeding
- Cracked or damaged nipples
- Plugged ducts
Causes of tension
- Baby’s position in utero can cause strain or tension in a muscle. It’s like when you sleep all night in a funny position and wake up with a crick in your neck.
- Birth - both very fast and slow births can manifest in tension in your baby’s body or injuries like fractures.
- Interventions during delivery like forceps or a vacuum put pressure on the baby’s skull.
- Cesarean birth skips over your baby getting the series of compressions to their head and body as they rotate and come through the birth canal.
- Swaddling restricts your baby’s movements and can make it difficult to stretch their bodies and move through muscle patterns.
- Oral restrictions create tightness and pulling of other areas of the body. The tongue is connected to the toes through the fascia system.(3)
Baby’s need to be able to move their head and neck comfortably for latching deeply and feeding. With the rooting reflex, they will turn their head side to side when the cheeks are touched. As your baby comes towards the chest/breast, they tilt their head back and the chin touches the breast which results in them opening their mouth. With their head slightly back, it is easier to open wide compared to if their neck has tension and is not comfortably able to tilt back. Their mouth will not open as wide and the latch will be more shallow.
Restriction of movement from tension decreases the range of motion a muscle will have. The muscles direct the growth of the bones in the face and jaw.(1) If the baby has a shallow latch or is not able to lift their tongue to press breast tissue into the roof of the mouth, the bones are instructed to grow tall and narrow rather than wide and flatter.. Over time, the effect can be seen with a narrow jawline, high palate, compromised airway development, sinus congestion and crowded teeth.
How easy or hard it is for your baby to feed at the breast can be great information for how to improve their latch and feeding skills. By addressing latching, tension and other challenges, you also give your baby a solid foundation from which the rest of their growth and development build from. Each developmental milestone relies on the muscle patterns previously learned, practiced and strengthened.
What to do if you suspect your baby has tension?
Were you told your baby’s latch looks fine or that they are gaining weight so everything is fine yet still have symptoms that point in the direction of tension? How a latch looks or weight gain alone give a complete picture of your baby’s ability to use their mouth and body in a functional way.
An IBCLC (International Board Certified Lactation Consultant) who has obtained the skills for assessing your baby’s reflexes, body tension and oral function can help you investigate further. They can identify what is causing the symptoms you see for yourself and in your baby and create a plan with you for targeting and resolving the root causes.
Breastfeeding is the parent and baby working together for comfortable and effective feeding. It should be enjoyable. When a baby has a hard time with nursing, the nursing parent compensates, often unknowingly, to make feeding easier for their baby. These compensations can make the experience less enjoyable and interfere with bonding with the baby. An effective care plan will address the parent's compensations as well.
Bodywork is part of the solution for addressing tension in the baby.(2) Your IBCLC will be able to give you the names of providers who have experience working with babies and have had positive outcomes. Providers who communicate with each other helps each practitioner understand what the other is seeing and recommending. You and your baby will get better care and often see results faster.