Series: Breastfeeding Challenges & Solutions
In January, we began a new series on breastfeeding challenges and solutions. Continuing my open book about my own struggles to breastfeed and its affect on my career, I shared with you my recent challenges and solutions with my daughter, Matilyn. Thrilled to share with you that last week Matilyn and I marked 6 months of exclusively breastfeeding (EBF)!
Why have a shared this journey? Three main reasons:
1st: I understand that nursing is a mother’s choice and either way she needs support. Breastfeeding requires a support system along with a lot of patience and understanding.
2nd: Breastfeeding positively affects the growth and development of the child’s face.This positive impact may lessen the need for orthodontics in the future! (Yes, it seems like I’m trying to put myself out of a job.)
3rd: The struggle to find answers about my son's difficulty with nursing, lead me to drastically change the way I practice healthcare. My approach turned holistic, collaborative, and even more compassionate.
This month's focus is on Wry Neck or Torticollis.
Although I've been sharing my journey with my daughter, there are lessons from my son's struggle that are common to others and in need of discussing. Most importantly, it’s about torticollis. If you haven’t heard of this before, you’re not alone. It’s not something often discussed with new moms.
Have you ever awakened after sleeping and feel a tight neck on one side? Uncomfortable right?! Having a tight neck for one day is tough, can you imagine if you had that every day? Well, that unfortunately can happen and my son had it as a baby.
My son had infant torticollis. Learn more about infant torticollis here.
It causes the head to tilt. The baby may tend to always look in the same direction. That’s what my son did. Hard to admit, but I didn’t notice this in my son. A tight neck may also complicate nursing. In my case, my son struggled to nurse on one side more than the other. Thankfully a local lactation consultant helped connect the dots for me!
I had left the hospital with minimal guidance on nursing my son. I was instructed to hold him one way for one side and another way for the other. As an exhausted new momma, I obliged.
While at an infant massage class, the physical therapist (PT) asked if she could teach me some stretches to help my son. When I mentioned this to the lactation consultant, she encouraged me to follow up with the PT. She explained that my son may have infant torticollis.
A referral for the comprehensive PT evaluation had to be ordered by a pediatrician. Our pediatrician at that time was extremely reluctant and told me it would not help with breastfeeding and my child was fine but I could do it if I wanted. I pursued it anyway and was very grateful!
The PT was part of the collaborative care my son needed to address our difficulty to nurse, his mouth breathing, poor sleeping, and his initial failure to thrive.
Thank you, Dr. Jenny Thurner for your contribution to this series.
The Effects of Torticollis on Breastfeeding
By Dr. Jenny Thurner
What is Torticollis?
Torticollis in infants usually occurs when a muscle in the neck becomes tight, weakened, or thickened, causing the chin to point toward one shoulder and the head tilts toward the opposite shoulder. The most common form of torticollis is congenital muscular torticollis (CMT), which affects infants and is generally observed within the first 2 months of life. A common thought is it can happen if a baby is lying a certain way when inside her mother. All babies are born with some type of muscle and body restriction; however, not every baby can work these restrictions out on their own once in the world.
Signs your baby might have torticollis:
- Your baby always seems to be looking to the same side
- Your baby’s chin seems to be pointing to the side instead of in the center of her body
- One shoulder looks higher than the other
- Your baby lies on her back in the same exact position
- One ear may look a different shape than the other ear
- Your baby feeds better on one breast better than the other
- Your baby can’t latch onto one of your breasts
- Your baby can only latch on and feed in a certain position
- You or your baby exhibits any of these behaviors during breastfeeding: jaw clenching, nipple compression, vasospasm, exquisite pain, shallow latch, retracted tongue
- Your baby doesn’t like it when you try to put her in a new position, or quickly moves back to the position she likes best
- When placed on her tummy, she just cries
- Your baby has a misshaped head
A baby with torticollis may find it difficult to latch, trouble sucking, and causing you pain. Muscles in the neck connect with the tongue muscle. This can make it hard for your baby to use her tongue well, and she may not get enough milk which can affect your supply. Babies who are showing head preferences as well as having difficulty with feeding, typically are having sensory integration challenges. This means they are having trouble with function: disruption, dysfunction, and dysregulation.
In order to help your baby who has torticollis, regardless if breastfeeding or bottle feeding, focus needs to be on various types of positioning and freedom of movement patterns. Babies respond well to simple strategies. Therefore, when started early, the response to these strategies are very successful in helping your baby develop symmetrical movement patterns and posturing. A physical therapist who specializes in torticollis can help you learn the “why” your baby choses to turn or tilt her head in a certain way. In my experience, her neck tightness stems from trunk and body restrictions, tight oral restrictions, and/or body dysregulation.
Tummy time is a key component in helping your baby work out her restrictions when started early. Chest-to-chest tummy time is encouraged for the first 2-3 weeks of life. Thereafter, you can start placing your baby on a flat surface with supervision. Watch to make sure she can turn her head to both sides. What if your baby dislikes tummy time? In my experience, a baby who does not like tummy time is more dysregulated than her peer who enjoys playing on their stomach. There are strategies to help you and your baby overcome this very important obstacle in her development. Tummy-time-play is the foundation of overall neurological development including eye-hand coordination, muscle strengthening, head control, cognitive exploration, just to name a few.
Helping you and your baby create a flow of ease with breastfeeding sometimes needs to be a collaboration of resources. A lactation consultant can promote positioning and muscle activation strategies. If your baby does not respond promptly to various positioning, a referral to an infant pediatric physical therapist is recommended to reduce the risk of craniofacial deformity (head misshaping) and developmental problems. Don’t wait and see! Advocate for you and your baby, and seek assistance from someone with expertise in treating torticollis.
Flat Head Syndrome
About Jenny Thurner, PT, DPT, CIMI
Jenny Thurner is a doctor of physical therapy and certified infant massage instructor. She has focused her career on pediatrics over the last 10 years. She is an evaluator for Indiana First Steps Early Intervention program, and she owns her own private practice, Valpo Therapy Kids, LLC. Within her private practice, she specializes in the infant population (birth – 12 months); more specifically birth to pre-crawling.
Dr. Thurner is also a certified infant massage instructor through Infant Massage USA. When she was a foster parent, she cared for a sweet young baby who was exposed to drugs in utero, with outwards signs of withdrawal and colic. After sleepless nights and trialing every therapeutic trick in her toolbox, she knew she was missing something to help calm this baby. This is when she expanded her training to seek answers to help not only the baby she was caring for, but also other infants who were experiencing dysregulation. There are many reasons for a dysregulated baby; not just drug exposure. Therefore, she researched and learned strategies that seem to help a dysregulated baby reach their optimal function and gain happiness. One of these strategies was infant massage.