Catherine and 12-week-old Mia are given traditional bodywork exercises for breastfeeding problems + what finally helped

Baby Mia is diagnosed with multiple pathologies

When I first met her, Mia was a healthy, mostly happy 12-week-old baby, who had a mild left head turning preference. But her mother Catherine had had nipple pain with breastfeeding from the start. She made an appointment to see me after seeking help from a well-known local International Board Certified Lactation Consultant (IBCLC). This IBCLC identifies as an ankylofrenula professional who also - like many IBCLCs today - practices orofacial myofunctional therapy.

Catherine showed me the lengthy report which the lactation consultant emailed to her after that appointment.

"I've been worried sick about this ever since," she said. "Can it possibly be true?"

I read the report quietly. In it, Catherine's IBCLC diagnosed

• Cranial nerve dysfunction (from in utero) due to tongue-tie

• Lip asymmetry with a slight pull to the left

• Tongue movement deviation to the left

• Jaw asymmetry

• Left sided head turning preference

• Tight buccal frenulum

• Mandibular retraction.

The IBCLC then reported that on suck assessment she'd found

• Lip blisters

• High palate

• Blanching tight upper lip frenum attached at the gumline

• No visible or palpable lingual frenum.

She also noted the following signs of impaired tongue mobility

• Slight divet in tip of tongue

• Mid-tongue dimple or bowl

• Groove down centre of tongue

• White coating of milk on the tongue

• Reduced peristaltic-like motion of tongue

• Poor cupping of the tongue

• Piston-like motion of the tongue with chomping

• Tongue not lifting high enough in the mouth.

The IBCLC did a breastfeeding assessment, finding

• Consistent, frequent tongue quivering indicating muscle fatigue and cranial nerve dysfunctions

• Phasic biting delayed on both sides

• Muscle compensation during sucking and feeding resulting in buccinator (cheek) and mentalis (lower lip) muscle overuse

• Narrow latch with reduced lip eversion

• Cheek dimpling

• Loss of milk whilst feeding

• Limited jaw excursions as the baby tires

• Clicky slurpy sounds

• Baby coming on and off the breast.

Moreover, the IBCLC reported that she'd read the baby's face for pathology, finding bags under baby's eyes, narrow cheek-bones, and pursed lips.

These pathologies are all corroborated, the lactation consultant wrote, by the fact that the baby doesn't like tummy time or riding in the car, but likes movement, such walking or bouncing on the fit ball.

This report and the accompanying exercises might seem unbelievable when I write about them here, but I am accurately reflecting reports and exercise instructions I've seen written for parents by providers who have a special interest in ankylofrenula.

Catherine is given many exercises to perform on Mia's mouth and face

The IBCLC then gave Catherine exercises to do with Mia, and referred her for osteopathy. If these didn't help after two or three weeks, the IBCLC recommended proceeding to lingual and labial frenotomies. The IBCLC did not use the diagnosis of posterior tongue-tie, but noted that the signs she'd observed were consistent with ankyloglossia and upper lip-tie.

One of the exercises the IBCLC had instructed this mother to do required placing her fingers behind the baby's mandible (or jaw) and drawing it forward a number of times each day.

Catherine explained to me that Mia didn't like it when she performed this exercise, in particular. "I didn't feel as though I should do it. But I was told it was best for the baby …" she said.

"Seriously? Applying shearing forces to that little joint?!" a physiotherapist colleague exclaimed later when I told her, quite horrified about the risk this manouvre posed to a baby.

The IBCLC also advised Catherine to express her milk after breastfeeds to collect the high fat content milk, which she was to feed to the baby later on, and had given Catherine other exercises which were intended to improve sleeping tongue posture, by building tongue strength so that Mia's tongue would touch the roof of her mouth at rest. The IBCLC said this would help broaden the baby's palate so that Mia didn't get sleep apnoea.

"Well," I said after a little while, choosing my words carefully. "Everyone who cares for you has wanted only the absolute best for you and Mia. It's not any individual practitioner's fault that parents receive so much conflicting advice. But it is a serious health system problem, that makes it very hard for families." I gaze at Catherine quietly as she nods, tears falling down her cheeks. How hard a woman tries to do the right thing for her baby!

"But truly, we can put all of this that you've been told aside. Let's start again together."

Catherine's practitioner's highly detailed observations aren't scientific, even though the use of medicalised terms and pathologies might make such reports seem highly scientific! With Mia, the lens of traditional bodywork which has such value in grown humans, has been extrapolated back and applied to infancy, resulting in the unhelpful pathologisation of this healthy, normally developing baby. Infant neuromotor function is dynamic, and dependent on context. There is no scientific or neurophysiological reason to think these recommended bodywork exercises will be helpful. Bodywork therapy in cases like this not only drives up costs and parental anxiety, without benefit, but risks baby developing a conditioned dialling up with oral contact such as milk or food.

Catherine's nipple pain resolves with a gestalt intervention

When I assessed Mia I found a rather delicate chin, and a left-sided head turning preference. But she was completely neurologically and anatomically normal. I observed that Catherine and Mia had substantial fit and hold problems during breastfeeding, with nipple and breast tissue drag.

We worked together on a gestalt intervention, and in the consultation Mia breastfed well, with good stability and excellent milk transfer. Catherine's pain dropped from four to zero on the painscale of zero to ten.

Afterwards, on follow up, there were no further breastfeeding problems for this mother-baby pair. Catherine's nipple pain resolved completely within a week. Her baby's left-sided head turning preference resolved within six weeks, with Catherine and her partner simply attending to the usual recommendations for a functional torticollis but not using any of the exercises the IBCLC had recommended.

Disclaimer: the case above is an amalgam of multiple cases that have presented to me, and is not derived from any specific or identifiable mother-baby pair who have seen me as patients. Names in this and all PBL articles are fictional. The baby in the picture at the top of the page, like Mia, may be causing her mother nipple pain because of the breast tissue drag that we can see as she feeds.

Recommended resources

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