By Dr. Mirav Newman, PT, DPT
Feeding your baby is one of the most discussed topics among new moms, parents, professionals, pediatricians, and people who support newborn babies.
Some options include breastfeeding and bottle feeding, pumping for breast milk, purchasing formula, and probably others.
Hopefully, your baby feeds without too much trouble, regardless of your choices. However, sometimes, obstacles and difficulties arise. Some babies struggle with latching, nursing, bottle drinking, gas, and reflux. The following is a good summary of some of the main issues that may be giving you and your baby trouble and some suggestions for help.
When breastfeeding, mom and baby should be skin-to-skin and chest-to-chest. The baby should be able to tilt their head back and gape the mouth open to initiate the latch with the lower lip making contact with the lower nipple/areola first to achieve a deep suck with a wide-open mouth and a well-aligned head, neck, and spine. Similar to a baby bird’s position, reaching its beaks up and out of the nest. Sidelying is also a good alternative for mom and baby with the support of the tumtum wedge behind them to help with alignment and easier positioning and adding more flow control.
Muscle weakness and difficulty with tummy time are often at the top of the list of problems that affect babies’ feeding negatively. Use the tumtum wedge to help make tummy time easier and improve muscle strength. Anterior cervical (front of the neck) and jaw muscles are best stimulated in prone (tummy time). Chin tuck or capital flexion naturally occurring in tummy time helps with suck-and-swallow control and efficiency. “The chin tuck position aligns and stabilizes the head, neck, jaw, and tongue muscles to optimize sucking and swallowing. Chin tuck also stabilizes the visual system for midline organization.” The chin tuck is ideally facilitated on the tumtum.
Pace feeding may help babies control the milk flow if they struggle with jaw strength and stability or even tongue coordination. Left sidelying on an incline can also help slow the flow from a bottle and give the baby more control.
Tension and ties are often a concern for babies struggling with feeding; there is much information about tension and tethered oral structures, such as lip and tongue ties. If your baby is diagnosed by a doctor or trained professional via a functional evaluation, there are several ways to treat the cause. Some treatments include tongue and lip revisions (release) with laser or surgery, manual therapy, bodywork, and physical and occupational therapy. Discuss your options with a trained preferred provider.
Torticollis and head-turning preference may also cause some feeding problems because the baby is unable to hold their posture or suck symmetrically. They may have some weakness in the musculature around the cervical/neck area, jaw, mouth, lips, and tongue. If you notice any asymmetry, early referral to a trained pediatric physical or occupational therapist is recommended early for the best outcomes. Positioning using the tumtum may help improve symmetry and help prevent and reshape a skull with a flat spot, as directed by a professional.
Reflux is a common struggle for babies. Sometimes, babies arch their backs and extend their bodies to tell us they are having pain. Reflux or GER and GERD respond best to lying on the left side and prone positioning. These positions are best for keeping the stomach fluid away from the lower esophageal sphincter. Stomach emptying varies from 35-75 minutes after feeding. Left side-lying and tummy time improves stomach emptying and keeps the all-fluid diet away from the sphincter. Discuss your concerns with your pediatrician if your baby excessively cries, arches their back, or has trouble gaining weight. Some medications can help.
In addition, “…review of the literature shows that head-of-bed elevation is not supported by research. The recommended positions for infants experiencing GER symptoms are prone or left lateral side lying.” Use the tumtum to help with these positions. It was designed precisely at the perfect angle to help in these situations. Bucket seats, such as car seats and rounded bouncy seats, are not helpful for babies with reflux. They often increase pressure in the abdominal cavity.
Gas and colic can be difficult to manage and distressing for new parents. Research shows probiotics are most effective for helping babies with “colic,” and second in line is manual therapy, including massage. Providing infant massage while your baby is lying on the tumtum is soothing and comfortable for your baby. You can position them on their back and roll a towel under their buttocks to help the core activate for better bowel evacuation.
Allergies and sensitivities are always a consideration. Note any changes in stool color or consistency, rashes, and other irritable symptoms. Discuss these concerns with your pediatrician.
Good job getting through this very early and most basic level of care for your baby. Before you know it, you will be ready to research which method is best for starting solids!
Reach out to us for questions or support with feeding.
References:
1. Pfister, Susan, and MA CNNP. “Evidence-Based Treatment of Gastroesophageal Reflux in Neonates.” (2012).
2. Ellwood J, Draper-Rodi J, Carnes D Comparison of common interventions for the treatment of infantile colic: a systematic review of reviews and guidelines BMJ Open 2020;10:e035405. doi: 10.1136/bmjopen-2019-035405
3. Pocket Guide for Lactation Management. Cadwell, K. Turner-Maffel, C. Third Edition, Jones and Barlett Learning LLC, 2017.
4. Sargent, Barbara PT, PhD, PCS; Coulter, Colleen PT, DPT, PhD, PCS; Cannoy, Jill PT, DPT, PCS; Kaplan, Sandra L. PT, DPT, PhD, FAPTA. Physical Therapy Management of Congenital Muscular Torticollis: A 2024 Evidence-Based Clinical Practice Guideline From the American Physical Therapy Association Academy of Pediatric Physical Therapy. Pediatric Physical Therapy 36(4):p 370-421, October 2024. | DOI: 10.1097/PEP.000000000000111
5. Williams E, Galea M. Another look at “tummy time” for primary plagiocephaly prevention and motor development. Infant Behav Dev. 2023;71:101839. doi:10.1016/j.infbeh.2023.101839
6. Accessed on 12/8/2024 https://spritelypt.com/2017/12