Newborns commonly arrive in our offices with feeding issues. Problems transferring milk can show up as pain for the nursing mother, as a baby who grows increasingly frustrated and upset during feedings, or when a baby’s weight gain is insufficient for healthy growth. As trained Rolfers, we already have a facility for working with the most important consideration in babies who aren’t functioning well – helping them to receive more reliable support so that the pull of gravity enables the baby’s intact reflexes to function in their most coordinated fashion.

Difficulty feeding is an urgent situation, especially if the mother wishes to breastfeed. Lack of efficient transfer of milk from the breast results quickly in lowered milk supply, which can be very burdensome   to increase, if it can indeed be increased enough to meet the baby’s nutritional needs. Mothers can suffer with clogged ducts if the baby isn’t able to drain the breast, and this can lead to a painful case of mastitis, which may require antibiotics. Damage to the nipple from improper latch can cause pain and occasionally infection if the latch coordination does not change to prevent continued damage.

Bottle-feeding while working out nursing problems requires different coordination from the baby than breastfeeding. Getting milk from a bottle is significantly easier, so the baby is losing opportunities to develop good suckling coordination and may develop a strong preference for the bottle. When a baby is unable to latch and also resists the bottle, hospitalization may be required to ensure the infant’s healthy weight gain.

When the mother reports nipple pain with nursing, it’s important to ask a follow-up question to guide your approach: does the pain change when the baby’s position changes? If the pain is always in the same location regardless of the orientation of the baby on the breast, the solution might be work on the mother’s ribs and diaphragm in order to rebalance her body after the intense flexion patterns utilized in vaginal birthing.

Some babies present with a visibly short lingual frenulum, a ‘tongue-tie’, which looks like a short, posteriorly humped tongue. With anterior ties, the tip of the tongue can have a heart-shaped indentation due to the frenulum pulling the tongue down along the midline. Tongue-tie, or ankyloglossia, can sometimes be diagnosed based on appearance but is usually diagnosed by assessing function. Posterior tongue-ties are usually not obvious enough to make   a defensible diagnosis based on visual or manual inspection. There are several assessment tools used by pediatricians and lactation consultants to evaluate for tongue-tie. Some indicators that the tongue is restricted are feeling the baby using the jaw or gums to clamp the nipple, hearing clicking sounds during nursing, or seeing cheeks dimpling in an attempt to stabilize the mouth on the nipple. When the baby latches a finger or the mother’s nipple, one feels a flicking movement of the tongue, not a smooth wave motion from front to back of the tongue. Lateral movement of the tongue appears restricted, with the tongue needing to twist to reach the corners of the mouth. The tongue might not extend past the lower lip without the tip being pulled under. The normal newborn tongue should be able to extend at least halfway up to the palate with the mouth fully open. Tongue- tie commonly presents accompanied by gassiness and reflux or back arching.

Tongue-tied babies can undergo frenotomy or ‘revision’, which alters structure by using surgical scissors or a surgical laser to cut the frenulum either at midline or at the underside of the tongue (Genna 2013, 209). It is useful to work hands-on with baby prior to any revision to the tissue. Sometimes function improves enough with your work to get the baby’s nursing on track. The frenulum can be more or  less elastic independent of its length, and increasing elasticity in the muscles in the floor of the mouth can help coordinate nursing function despite a short frenulum (Genna 2013, 27). Choosing to have an infant’s  lingual frenulum revised is  not  a decision to take lightly: the procedure requires ‘stretches’ to be performed  daily by the parent to break apart any fibers that are reattaching. This is often upsetting for the baby and the parent and can lead to oral aversion behaviors by the baby. It is not uncommon for the procedure to seem to provide little or no improvement in milk transfer.

If your hands-on work and parent education alone is going to help the baby’s system become adaptable enough to resolve feeding issues, you will make a clear positive impact in a session or two. It is essential to work with the infant following revision, since the baby has been busy learning compensatory patterns to work around the structural restriction. Your hands-on work helps to update the coordination patterns to match the current structure.

Babies diagnosed with ‘disorganized suck’ without structural restriction benefit markedly from Rolfing® Structural Integration within a session or two. Rapid improvement occurs as tissues normalize to balance each other. This is not a Ten Series (rarely, if ever, indicated for a newborn; many of the goals of a Ten Series are either already functioning well or are not developmentally appropriate for a pre- walking infant). Babies with apparent limited motivation to seek out the nipple and draw in nourishment are generally the most difficult to help. This ‘lazy suck’ is more commonly associated with neurological impairment. It is often seen in babies with low tone. In newborns, balanced tone is characterized by a distinct flexion preference of limbs and spine: an orientation around the navel,  where the baby was connected to the mother in utero. If nursing and flexion tone don’t improve markedly in a session or two, it’s wise to advise the parents to talk with their pediatrician about getting a referral to Early Intervention (if they are in the U.S.). This is a free program sponsored by most states that provides in-home physical therapy and occupational therapy assessments and treatment for infants who qualify, so the infant gets regular focused instigations to get reflex behavior working. Your skilled hands-on help with detailed anatomical considerations including cranial nerves is invaluable alongside in-home therapy.

Sometimes imbalances obvious to the trained vision of a Rolfer are affecting coordination of suckling and swallowing. This could include the baby not being able to open her jaw enough to get a deep latch, or displaying asymmetry of the  neck and face (torticollis), or of the shoulders due to one getting briefly stuck in the birth canal.

Compression forces from sharing space in the womb with fibroids or from intense contractions of induced labor can be strong enough to have overpowered the baby’s ability to spring back. Via your hands, you can offer the infant the means whereby to return to full volume. Detailed information about relevant anatomy and interventions are best offered in a class format.

Tone is the first thing to assess when working with an infant. It is the basis for all function in the gravitational field. Bonnie Bainbridge Cohen writes, “Low tone indicates that we are having difficulty meeting the force of the earth’s pull; high tone indicates that we are overreaching to the pull of gravity; an even, balanced tone indicates that we have a comfortable relationship or balance with the earth’s force” (Stokes 2009, 16). Balanced tone we call ‘yield’, a continually renewed relationship of fully resting without collapsing or losing buoyancy. Aposhyan (1999, 64) states that “yielding is a quality of resting in contact” and stresses that the recognition of the contact (feeling the surface one is contacting) is key. “Yielding forms the ground on which the baby rests and organizes how the baby rests. For yielding to emerge fluidly, the parent-child relationship must be secure enough that the baby can sense the parent’s underlying support, which allows him to yield his weight to that support. Yielding provides the stable background from which all other movements up and away from the earth emerge” (Frank 2011, 25). The ability of a caregiver to yield and to offer secure supportive surfaces while handling a baby is imperative, as a parent’s arms are ground for a baby much of the time.

When working with a newborn, it’s essential to provide good quality support that allows the baby to freely yield. You can realize a deep sense of yielding into the support of the surfaces you are touching as you handle baby. A baby’s physical tone and ability to yield and receive support impact its ability to organize an efficient suckling pattern. When a baby doesn’t feel a secure sense  of support that he can rest into, he will attempt to provide ground for himself by contracting to try to stabilize from within. This internal bracing interferes with the coordination of reflexive activity such as seeking the nipple with the mouth and suckling. We don’t have to teach the baby to suckle appropriately to bring in optimal nutrition; we have to offer the background support of a secure surface and provide stimuli for the innate reflex action to occur.

You will likely handle the baby in several positions, including holding the baby upright against your chest or shoulder (you may work this way for the entirety of the session if the infant is suffering from reflux). Picking up a baby is a complicated matter! Your specific (and possibly narrated for the benefit of the parents) attention to providing a continuous feeling of secure support for the baby’s structure will educate parents and reinforce the baby’s sense of safety. When moving a baby, give clear attention to your own sense of support. Help the baby experience changes in location and body position as coherent shifting of points of contact, not a ‘rest here, now-I’m-going- to-move-you, now rest again’. Movements don’t start and end; they come out of and return to integrated yield. Encourage the yielding that is continuously operating in the background for newborns by providing continuous support that invites the baby to deeply rest toward ‘ground’: the table or your arms and hands. Position the infant in varying ways, including sidelying and on belly, so that different surfaces of her body have the opportunity to contact the supporting surfaces.

Educating and encouraging parents to provide increased support for the baby will help them provide the best foundation for their infant’s development. It’s delightfully convenient that the parent’s attention to his/her own comfort and sense of resting and ease is exactly what the baby needs  to perfect her ability to yield into support, which underlies her increasingly more complex movement.

Having a space well-appointed for nursing provides an opportunity for you to encourage increased ease in the mother, thereby improving the  security  of  trust in the relationship between parent and baby. The mother should be able to recline with feet supported (I use a small seiza bench and a firm, cushioned arm chair). Encourage a generous slumping down in the chair, with pelvis posteriorly rotated, so she is sitting more on her sacrum than on her ischial tuberosities, with her back supported by the chair. The baby then rests on the mother’s torso in  a  longitudinal or oblique position (position depends on what feels most comfortable for mama and baby), so that maximum contact is made between the baby and the  mother’s body or surrounding support. The baby’s belly contacting the supporting surface stimulates a toning up of the front side of the baby’s body (physiological flexion), which facilitates the functioning of the reflexes that get baby to the nipple and coordinate deep and effective latching. Our beloved gravity connects baby to mama. Mama generously rests into support, and pillows are provided to maximize the mother’s ability to yield into gravity/chair/ sofa. Until feeding is well established, avoid feeding positions that require baby being held on his posterior side as this interferes with reflexive movements that aid feeding. Mothers will often deny the need for personal comfort; use the opportunity to remind her that she’s establishing patterns that support her baby’s ability to utilize innate reflexes for feeding as well as allow the mother to deeply rest. This semi- reclined position improves reflex behaviors in both the mother and the newborn (Colson 2007).

If the baby produces jerky, flinging, or thrashing movements when attempting to latch, this is a sign that the baby doesn’t have enough physical stability to be able to rest into the support of gravity. These reflexive movements that you see aid the baby in finding and latching the nipple when the baby is appropriately supported.

Keep in mind that by the time you see a baby with feeding issues, the parents have been struggling for some time. It’s not uncommon that mothers of babies who are having difficulty feeding are attempting breastfeeding, then pumping, then giving baby the pumped milk in a bottle, then burping/changing/attending to baby, then washing bottles and pump parts to prepare for the next session. Often these sessions last three hours and have to be repeated every three hours. Babies with feeding issues often also suffer with reflux or gas pain and can be unrelentingly fussy. They can cry more often than not. Parents are exhausted as well as worried and feeling helpless. It’s hard to ‘know what to do’ when behaviors that are supposed to be innate don’t seem to be working well. Your coaching and reminders that the parents let go of anxious activation and release into support help create a foundation for optimal functioning.

Bottle-fed babies should be handled the same way, with attention given to comfort of the parent, maximizing skin contact between the baby’s front side and the caregiver’s,  switching  sides mid-feed, and stimulating the rooting reflex prior to offering the bottle nipple. “Infant grading (smoothness) of motions generally depends on stability . . . When prone on the semi- reclined mother’s trunk or abdomen, infants are capable of remarkably accurate movement.” (Colson et al., 2008 as cited by Genna.) This is true for bottle-feeding as well as breastfeeding.

Offer hands-on support to the caregiver giving baby a bottle or to the mother while nursing. Touch the parent, especially while she holds baby. Communicate support from ground through your own balanced awareness and structure. The way to affect a baby’s coordination system is by working with the baby’s gravity response system, which is best done by addressing the parent’s gravity response system, which is only done by accessing your own.

Working with babies demands that you show up with the ability to renew a sense of clear yield and returning to line. Your organization of weight to allow flow in movement is your most powerful tool when handling and touching newborns. Sessions with babies are often chaotic: babies may express distress; parents arrive stressed and sleepless. You may have both parents plus a grandparent or two show up at your office. Your ability to access ground and support for optimal ease and flow will be challenged by having to include several people, all of whom have complex feelings about the intense experience they are living through and the recent intensity of the birth experience. Many needs may appear during the short time you spend with the family. The baby may cry, the mother may cry, and you want to be flexible enough in your approach to be able to offer interventions that generate clear results, while assessing and honoring the needs of the relationships within the family. Some parents are okay with their baby crying a bit while you’re working; some have a deep need to comfort their child immediately. Your skill in returning again and again to your own support during all of the interactions creates the opportunity for the parents and the baby to rest into a deeper sense  of security in the midst of challenge. Your inner organization creates the space for an improved quality of support to emerge in the relationships between the parents and their baby.

There are many detailed anatomical considerations to investigate during a session  to  help  feeding  problems, and these are best presented in a class. You already have, however, excellent training in the most essential quality needed  as a foundation for all developmental movement: a robust, generous conception of gravity as support. A newborn’s needs are simple. Can we as practitioners become simple enough to allow him to activate his innate reflexes in a coordinated manner?

Rebecca Lisak is a Certified Advanced Rolfer, Rolf Movement Practitioner, craniosacral therapist, and Alexander Technique teacher. She comes to movement education from a performance background (music, theatre, and movement).

Bibliography

Aposhyan, S. 1999. Natural Intelligence. Baltimore, MD: Williams and Wilkins.

Colson, S. 2012. “Biological Nurturing: The Laid-back Breastfeeding Revolution.” Midwifery Today 101.

Frank, R. 2011. The First Year and the Rest of

Your Life. New York: Routledge.

Genna, C. 2013. Supporting Sucking Skills in Breastfeeding Infants. Woodhaven, NY: Jones and Bartlett Learning.

Stokes, B. and T. Verny 2002. Amazing Babies: Essential Movement for Your Baby in the First Year. Canada