The mouth doesn't work in isolation. It sits on a skull, which sits on a neck, which sits on a trunk. When anything in that chain is restricted, the mouth feels it.
This is one of the places where PTs and OTs can add the most to a feeding team, and where lactation-focused care most often needs backup.
The neck sets up the jaw
The position of the head and neck directly changes how far a baby can open their mouth and where their tongue sits. Try it yourself. Tuck your chin hard to your chest and try to open wide. Then turn your head fully to one side and swallow. It's harder.
A baby with limited cervical rotation or a lateral tilt is living in a version of that all the time. On their preferred side, they may latch well. On the other side, the latch is shallow, painful, or impossible. The parent is often told the problem is "the left breast" when it's actually the baby's neck.
Signs worth noticing
A consistent head turn or tilt preference
Feeding well on one side and poorly on the other
Flattening on one area of the head, or an asymmetrical face or jaw
Fussing when placed on the back, or when the head is turned a certain way
Arching, or a baby who seems to push away from the breast
Shoulders that ride up toward the ears, or a trunk that curves to one side
Any one of these can be a normal variation. Several together are worth a closer look, and a referral to a pediatric PT when torticollis or plagiocephaly is suspected.
The cranial piece
The bones of a newborn's skull are designed to move and mold during birth, and most remold over the following days and weeks. Sometimes that process is incomplete or asymmetrical. Because several of the nerves that control sucking, swallowing, and breathing exit through the cranial base, tension in this area can show up in feeding.
This is an area where gentle, skilled hands-on work and careful positioning can help. It's also an area where clinicians should stay within their training and scope.
Posture during the feed
Feeding posture is the baby's posture plus the parent's. A baby held with their head rotated away from their body, or with their trunk unsupported, has to use extra effort just to stay stable. That effort comes out of the energy they have for feeding.
Simple changes often help:
Line up the baby's ear, shoulder, and hip
Support the trunk so the baby isn't holding themselves up
Bring the baby to the breast instead of the breast to the baby
Try positions that don't require the baby to turn toward their tighter side
In Functional Lactation, we look at the whole structure the mouth depends on, because a tight neck can look a lot like a tight tongue.
Dr. Emily Spaeth, PT, DPT, IBCLC, is the founder of Be Well Baby® in Portland, Oregon, and teaches in Pacific University's Doctor of Physical Therapy program. If you're a PT, OT, or IBCLC who wants to work this way, join the waitlist for the Functional Lactation Intensive.
