Those of us familiar with infant massage may be surprised by the powerful impact this gentle therapy may also have for infants with breastfeeding challenges. By addressing an infant’s soft-tissue restrictions that may negatively impact breastfeeding, bodyworkers are in a unique position to work through the underlying causes of a difficult nursing relationship, and thus potentially improve the quality of life for these tiniest clients.

MusculoSkeletal Causes of Difficult Breastfeeding
Breastfeeding requires complex muscle movements of an infant’s jaw, mouth, neck, and upper torso, where the muscles of the throat and esophagus have to engage to facilitate swallowing. These movements all need to happen in a tiny person whose body is just getting accustomed to breathing air. Fortunately, most breastfeeding duos—mother and infant—get along just fine and are able to nurse without assistance.  
Still, even although the movements involved in breastfeeding are instinctual, some infants struggle to breastfeed because of musculoskeletal issues. Injuries sustained during birth or shortly after, and other developmental or health issues, can lead to difficulty breastfeeding.  
Infants must be able to lift and rotate their heads in order to successfully maneuver to the breast, adjust the head into a comfortable position, and achieve a proper latch onto the nipple. Infants with neck injuries or torticollis—a condition involving inflammation and an inability to move the neck—often develop a preference for one side or nursing position. When this happens, it can prevent the breast from draining effectively, causing discomfort, inflammation, and sometimes infection for the mother. While positioning the infant in his preferred position during feeding can help, this is an imperfect solution. Eventually, an infant’s difficulty turning his head will cause difficulty in other areas and make breastfeeding more complicated than necessary.
An infant also needs to be able to open his small mouth wide enough to surround the nipple and then use his tongue to move milk from the breast while massaging the it with his lower jaw. This requires movement and coordination of the mouth, temporomandibular joint, and muscles of the tongue. Without this necessary skill, an infant may not be able to latch on appropriately and breastfeed efficiently enough for his needs. When an infant is unable to remove the needed amount of milk from the breast, the breast will reduce the amount of milk it produces over time, lowering the supply or ending production altogether if the mother does not take an alternative approach to stimulating the breast, such as pumping or hand expression. This drop in production and its effects on an infant can be difficult for a parent struggling to maintain a feeding relationship without the use of alternative feeding products or equipment—most commonly, breast pumps, bottles, and supplements formula.
An infant may also be able to move enough milk from the breast to meet his needs, but may latch on in a way that injures the nipple, discouraging the mother from continuing the breastfeeding relationship.

Massage Therapy may Improve Breastfeeding
In the absence of other health complications, soft-tissue restrictions due to injury or unknown causes should be considered as primary contributing factors when an infant has difficulty breastfeeding. Massage and physical therapists primarily trained in soft-tissue treatments should be on the front line in correcting these issues.
Breast milk and maintaining a breastfeeding relationship are beneficial to the health of the breastfeeding mother and infant, so if issues with feeding can be corrected by a soft-tissue therapist, these therapies should be presented to parents as an option. A therapist should, of course, have an informed consent conversation with the parents, including risks and benefits of treatment and explanation of the therapist’s experience with this condition, before applying a preferred modality to an infant presenting for the services.
For example, “Joan’s” 3-month-old infant was born with the assistance of forceps and was unable to turn his head to the right. He was also unable to extend his head. The family pediatrician suggested encouraging him to turn to his nonpreferred side during breastfeeding, suggested a watch-and-wait approach, and recommended muscle-release surgery if there was no improvement. Joan was also experiencing difficulty breastfeeding because her infant chose to face the left side with his chin tucked in, creating breast preference and a shallow latch. Joan had discomfort when nursing and had multiple cases of plugged ducts and mastitis.
Joan saw a lactation consultant who, after evaluation, recommended bodywork for the infant. The massage therapist assessed the infant and discovered a reduced range of motion when rotating the head to the right and when extending the neck, consistent with the diagnosis of torticollis. The therapist also discovered trigger points on the sternocleidomastoid and capitis muscles, also known as the suboccipital muscle group. The therapist proceeded to use trigger point therapy to treat the infant, gently releasing and stretching each restriction, resulting in an increased range of motion and an improved breastfeeding relationship.
The skills to assess and treat a breastfeeding infant stem from a solid understanding of muscle anatomy that every therapist should have, along with an understanding of the movements involved in breastfeeding. The therapist also needs an understanding of behaviors and physiology specific to infants. Just as therapists do not need to know the rules of the sport to treat a professional athlete as long as they understand the movements and their effect on the player’s body, a therapist can successfully treat the effects of the movements involved in breastfeeding even if the therapist never learns the more complicated physiology of breastfeeding and breast milk production.

Conclusion
By learning the movements necessary for successful breastfeeding, massage therapists can closely translate the therapies they perform on adults to infants with breastfeeding challenges. Soft-tissue therapy can dramatically improve a difficult breastfeeding relationship for even the smallest infants. While gentle therapies such as craniosacral and Bowenwork are often promoted for infants, with skill and experience any soft-tissue therapy performed on adults can be modified for infants, who, after all, have the same soft-tissue systems as adults. Myofascial release and trigger point therapy, for example, can safely and successfully be used to treat infants as young as 3 months old. Because professional bodyworkers are in a unique position to treat the underlying causes of a difficult nursing relationship, parents and health-care providers alike should recognize the value of soft-tissue therapy for breastfeeding.

Grace Burnham, LMT, BCTMB, is a graduate of the Northwest School of Massage in Washington. Her practice is based in Tempe, Arizona, and focuses on injury treatment, massage during the childbearing year, and infants with breastfeeding challenges. Burnham can be contacted through her website www.azfamilymassage.com.