This post is inspired by the most recent addition to our extended family. Born a few weeks premature, my adorable new friend was having trouble latching to his mother’s breast and the lactation therapist recommended a Physical Therapist trained in CranioSacral Therapy. I developed a protocol which comprises elements of different techniques and schools of thought for the most comprehensive approach.
It is important to note that mobility develops proximal to distal. Oral motor mobility is dependent on shoulder/neck stability, which is dependent on trunk/pelvic stability. The lips, cheek and tongue are dependent on jaw stability. There are so many forces at work here and like any physical activity, efficiency of movement pattern and optimization of body alignment and muscular activation are key.
1. Encourage womb like state (begin with hips flexed, extremities into mid-line)
2. Begin with gentle rhythmic rocking of pelvis (anterior-posterior, then lateral movements)
3. Trunk rotation (assessing tightness/asymmetries along lumbo-sacral junction and upward through thoracic vertebrae)
4. Head/neck rotation (may need to depress shoulders before ranging the head/neck)
***These movements should be rhythmic, fluid and gentle. Give guided and gentle pressure through end range, after passively ranging the motion allow for active engagement from baby.
5. Gentle traction/offloading of lumbar spine (guided through sacrum for bony landmarks)
6. Gentle traction/offloading of cervical spine (guided through occiput for bony landmarks)
1. External massage:
-Temporalis to mandible (following from origin to insertion of this muscle with gentle consistent light pressure to release any constriction and to increase activation)
-Masseter: gentle pressure on the muscle belly into the cheeks and back forming circular movement with finger pads
-Sinus cavities: gentle pressure along the eyebrows from more proximal to distal(following the arch of the brow in the direction of the eyebrow follicles, placing finger back in start position as opposed to running fingers back and forth against the grain of the eyebrow hair follicles)
-Lips: begin around the lips lightly stretching the skin above the lip downward into a frown and the skin below the lips into a grin, feel for any possible restriction of the skin or tissue. Then begin distal to proximal following the lips to the center and ending with a gentle pull out into a pucker for both the top and bottom lip.
2. Internal massage
-using one finger place gentle pressure on roof of mouth, wait for suck response and use graded movements to facilitate rhythmical hard palate pressure.
-feel for tongue movements as you move finger from tongue to roof of mouth
It is important that the baby and mother are in the optimal position to allow the child to utilize his body in the most efficient manner and for the mother to be able to relax her upper body as much as possible to allow for successful latching and feeding.
-With one hand under the occiput and one hand cupping the breast(pushing down and out with the hand in a U-shaped curve about an inch from the nipple on either side to express a few drops of milk before allowing the baby to latch)
-Ensure more room under nipple to allow for lower jaw and surrounding musculature to activate more
-“Sniffing position”: my husband, the Emergency Medicine Doctor, uses this term as the optimal position for intubating, since the baby’s nose is tipped up just a bit. Your baby’s arms can be free to “hug” your breast, one on either side. Let your baby’s body stretch out on the pillow underneath
-Compress the breast by moving your finger and thumb together as you did to express the drops of milk. Sometimes this is called “sandwiching” the breast.
-During the widest phase of the baby’s rooting, when the mouth is wide open and the tongue is forward, lead with the chin and keep the baby’s body uncurled in the slight “sniffing” position.
-You will know he is on when the mother feels a strong rhythmic pulling.
-Make sure that his lips are curled out, the tip of his nose is touching the breast, and more than just the nipple is in his mouth.
-If you are not sure he is well latched-on, try letting his head come away from the breast, just slightly. A well latched-on baby will not let the nipple slip out.
Get more information at www.dinopt.com or contact me for further discussion at firstname.lastname@example.org.
By Rebecca Talmud, PT, DPT, Owner Dinosaur Pediatric Physical Therapy
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