Feeding Baby
By Dr. Mirav Newman, PT, DPT
Feeding your baby is one of the most commonly discussed topics amongst moms, parents, professionals, pediatricians, and others who work to support babies and parents. There are many ways to feed your baby: common options include breastfeeding, bottle feeding, whether it be with pumped milk or with formula (or a combo) and of course, others like SNS feeding, tube-feeding and more.
Hopefully, your baby feeds without too much trouble, regardless of your choice. However sometimes obstacles and difficulties arise. Some babies struggle with latching, nursing, bottle drinking, gas, and reflux. This blog is meant to address some of the main issues that may be causing baby trouble, with some suggestions to help.
When breastfeeding, mom and baby should be skin-to-skin and chest-to-chest. 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 beak up and out of the nest. Sidelying with the support of the tumtum wedge behind them to help with alignment and easier positioning and adding more flow control is a great alternative position to try.
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. The front of the neck and jaw muscles are best stimulated in 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 skilled provider like an infant feeding specialist (SLP, OT, PT, or IBCLC).
Torticollis and head-turning preference can also cause feeding problems as it is hard for baby 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 asymmetries, or preference to one side, seek the assistance of a trained pediatric physical or occupational therapist for the best outcomes. Positioning using the tumtum may also help improve symmetry.
Reflux is a common struggle for babies. A baby with reflux may arch their back and extend the bodies to tell us they are feeling discomfort. Reflux or GER and GERD respond best to lying on the left side and tummy time 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. Sometimes medications can also 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 tummy time or left 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 as 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.
Take it one day at a time, and know that you are doing a great job taking care of your little one. Before you know it, you will be getting ready to research which method of feeding solids is a good fit for your family!
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.0000000000001114
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/2017/12/23/3-months-chin-tuck/.
