There are many factors that can contribute to breastfeeding difficulties including the size or shape of the nipple, infections involving the breast, low milk supply, excessive milk supply and musculoskeletal disorders [1,2] .
Why is good attachment so important for breastfeeding?
A good latch is required to stimulate the nipple so that your baby can suckle effectively . A good attachment involves a large proportion of the nipple and surrounding tissue inside the babies mouth. The tongue is forward over the lower gums but cupped around the sides of the teat. Experience of the mother and positioning of the baby are key factors in obtaining an effective latch 
Infant and Young Child Feeding: Model Chapter for Textbooks for Medical Students and Allied Health Professionals. Geneva: World Health Organization; 2009
What signs or symptoms may indicate a poor latch or suckling problem? 
- Pushing on and off the breast
- Arching the back whilst feeding
- Wind or Reflux following a feed
- Inability to open the mouth wide
- Gulping, choking or clicking sounds whilst feeding
- Milk dribbling from the mouth when feeding
- Ineffective or “lazy” suckling
- Distress or discomfort in certain positions whilst feeding
- Favouring one breast over the other
- Sore, cracked or bleeding nipples
- Very quick or very long feeding session
- Crying after feeding
- Regularly falling asleep at the breast
What should I do if I suspect my baby is having feeding difficulties?
Having a lactation consultant assist with proper technique can make a huge difference with many feeding issues. A poor latch leads to ineffective suckling with the baby not being able get adequate amounts of milk which may lead to poor weight gain, fussiness, tummy pains or excessive wind. Many babies with feeding difficulties may also feed for longer, more frequently and have to suck harder  which can cause irritation to the nipple as well as strain and tension in the muscles of your baby’s neck and jaw.
How can Osteopathy help?
Even with positions and techniques adequately addressed by a lactation consultant, some infants still have issues with feeding.
In these instances an osteopath would assess the muscles and bones making up your babies, head, neck, jaw and tongue to determine if there are any mechanical restrictions contributing your baby’s feeding difficulties.
The act of sucking for a newborn is an extremely complex mechanism that requires neuromuscular co-ordination of the tongue, jaw and oesophagus for your child to obtain enough milk for their growing body. If there is strain or tension in these areas osteopathic treatment may help release tension through the muscles, connective tissue and joints to encourage normal movement and function of the tongue, jaw and upper neck. When treating babies and children our osteopaths use Cranial Osteopathy, which is a particularly gentle form of osteopathic treatment that uses very light touch to help release strain and tension in the muscles, bones, joints ligaments and tendons of the body.
Another area of interest for an osteopath in their assessment of a baby with feeding difficulties is your baby’s pregnancy and birth history. During the birthing process an infants skull is subjected to tremendous force. Whilst the bones that make up the skull are designed to withstand this force by folding over one another, prolonged and difficult births may effect the mechanics of the head, upper neck and jaw .
Image modified from: Figure 4.7A The Pharynx: infant: https;//ebrary.net/7405/health/feeding_swallowing_processes_disorders 
In the above diagram you can see the how the tongue has attachments to the lower jaw (mandible bone) and the hyoid bone at the front of the neck. Trauma to this area during pregnancy or birth can lead to tightness and effect tongue movements as can compression through the back of the head which may lead to irritation of the nerve that controls movement of the tongue . This is important because movement of the tongue plays an essential role in breastfeeding which is why many lactation consultants and osteopaths will be particularly interested in observing how your baby’s tongue is moving whilst suckling.
Where can I go for more information?
There are a number of online resources and directories that will be able to help you find out more information in regard to breastfeeding or direct you to the right people if you would like to contact someone in person.
At Holistic Osteopathy we recommend the following websites:
Australian Breastfeeding Association – Here you will find a wealth of knowledge on all things breastfeeding related! You will be able to connect with other mums who are breastfeeding in your area and have access to a large information base.
Lactation Consultants of Australia and New Zealand – If you feel like you would benefit from visiting a qualified lactation consultant this directory will help you find a lactation consultant in your area.
KellyMom Breast Feeding and Parenting – This website is a great go to for evidence based information on all things breastfeeding and parenting
Ph: 5200 1044
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