Physiotherapy Support for Breastfeeding

What?! Physiotherapy can help with breastfeeding/chestfeeding issues?

Yes! A physiotherapist with additional training in lactation can be a valuable team member to help you and your baby meet your feeding goals.  Physiotherapists are experienced in the management of pain, inflammation, ergonomics, positioning, anatomy, muscle function and more which can all relate to breastfeeding.

So how can a physiotherapist knowledgeable in lactation help?

There are several ways that a physiotherapist can help.  A physiotherapist that has training in breastfeeding can look at the mechanics of an infant’s feed. The infant’s positioning, latch on to the breast, mobility and muscle tone all impact their ability to feed effectively. Newborns have several reflexes, known as Infant Reflexes, or Primitive Reflexes. A reflex is an involuntary movement that may occur on its own during normal infant movement, or as a response to certain actions. The purpose of these reflexes is for infant survival.  Some reflexes are important for infant feeding, such as the rooting and sucking reflexes. Others can be stimulated unknowingly when they are not needed and cause the infant to struggle at the breast.

Some infants have tension in their neck or jaw that prevent a wide-open mouth position, or struggle to use their tongue effectively. In some instances, certain exercises or massage techniques may be helpful.

Congenital torticollis is a condition where an infant’s head is tilted to one side and rotated to the opposite side. ‘Congenital’ means from birth. Studies worldwide have found the incidence rate to be between 0.3% to 1.9% of infants[1]. It occurs due to tightness in the sternocleidomastoid muscle which runs from just behind the ear, down to the collar bone. There may also be weakness in the neck on the opposite side. Although the cause remains unknown, it is thought to be caused by the infant’s positioning in the uterus during pregnancy, or potentially an injury to the muscle during birth. This neck position can lead to feeding difficulties, sometimes seen as a preference for one breast over the other. Treatment is necessary to prevent restrictions in neck movement and promote normal skull and facial growth.  Often a referral to a physiotherapist with experience in pediatrics is beneficial.

Some lactating parents struggle with inflammation which can cause mastitis and blocked ducts.  Mastitis is inflammation of the breast tissue.  Studies have shown the incidence rate of mastitis to be around 20% of lactating people in developed countries[2],[3]. A physiotherapist can assist with management of the

inflammation and help determine the underlying cause. Additionally, there may be considerations for the lactating parent and their recovery from birth.  A healing pelvic floor from a vaginal delivery or a sensitive incision from a cesarean birth may benefit from some alternative positions, such as feeding in a laid-back position or side-lying. A physiotherapist could also help a chestfeeding parent troubleshoot positioning if they are experiencing pain or discomfort in other areas, such as their neck, back, or wrist.

What if I have concerns about my baby’s weight gain or milk supply?

Physiotherapy intervention as part of a team approach can be of value in these situations to optimize positioning and latch. Ultimately, concerns about weight gain and milk supply are best discussed with an International Board Certified Lactation Consultant (IBCLC) or a physician or nurse practitioner that is knowledgeable about lactation.