Laryngomalacia, also known as “floppy larynx”, is a congenital condition where tissues are softer around the voice box and collapse in, partially blocking the airway. These babies tend to present first with feeding difficulties, struggling to transfer milk, and as such, lactation consultants are among the first health professionals to notice it. It may not be until around 2 months that the characteristic squeaky breathing becomes a noticable pattern. I have seen this condition quite a bit in the last few years (and most likely missed this in my first few years of being an LC), I write this article to share my experience as I have found it difficult to find information on the internet that specifically pertains to how breastfeeding looks in these babies.
What to look for:
Squeaky noise when breathing in.
Noisy when feeding or during sleep or when lying on their backs.
Low weight gain.
Poor milk transfer (breast and/or bottle); lots of pauses when feeding; long inefficient feeds.
Spilling or choking or coming off the breast to breathe.
Mouth breathing (babies should breathe through their nose).
Weakness eg. floppy arms.
Chest retractions – skin sucking in around ribcage eg tracheal tug – when the skin sucks in at the bottom of the neck, between the collar bones.
Reflux is common
Breastfeeding can be challenging for these babies, as they understandably prioritise breathing over feeding. They may seem stressed when breastfeeding, stop feeding before taking a full feed and struggle to gain weight. Some babies do better when feeding from a bottle, though others struggle with bottlefeeding too; taking a long time to feed and needing to pause often. Mothers benefit from support from an IBCLC experienced in this area. We have tools to assess milk transfer and can support you with a feeding plan. It can be helpful to do a 24 milk production assessment; weighing the baby before and after feeds for a day, to work out how much extra milk baby needs. Many mothers end up predominantly pumping their milk for their baby. Though, a few babies will gain enough weight with smaller, very frequent feeds. Upright positioning or any position that ensures the babies neck is extended (to open the airway) is often better in these babies.
It is important to see a doctor for diagnosis. A GP will likely refer to an ENT (ear, nose, throat) doctor. Most babies improve with time, the condition is usually outgrown during the first year of life. For babies with mild to moderate laryngomalacia, treatment is usually to wait and watch, weighing baby regularly to ensure the baby is taking enough milk to thrive, though I have worked with a few babies with severe laryngomalacia who needed to be hospitalised or have surgery.
Have you breastfed a baby with laryngomalacia? Please feel free to leave a comment below to share your breastfeeding journey so that other mothers may benefit from your experience.
Cranio is a holistic, gentle treatment that supports the nervous system to down-regulate, which triggers the body’s own self-healing mechanism. Because it is so gentle, it is perfect to use with babies. Plus babies systems are so potent and ready to shift easily back to balance – some just need a little cranio support.
Because cranio is not well known, parents may not know the kinds of things that cranio is good at addressing. Here are the top six issues I see in my cranio/lactation practice:
1. Your baby had significant bruising around their head after birth
Some babies complete their birth journey looking pretty beat up!
Check out the squashed nose and facial asymmetry on this little bub, I had the pleasure to treat. He was not able to latch onto the breast without a shield and had issues transferring milk (before cranio).
And that bruise on his head -ouch!
If after birth, your baby had significant bruising, forceps marks, chignon from vacuum extraction, a cephalohematoma or other abnormal head shape, it is a sign that baby has undergone some difficulty during birth and would benefit from cranio. Hospital staff are used to these kinds of injuries and often dismiss it, knowing that superficially these marks do disappear over the following weeks to months. But there can still be underlying physical and emotional tensions that are not yet integrated. These stress imprints remain in the tissues in obvious and less obvious ways. Babies may be very sensitive to touch on their head and may react strongly to clothes being pulled over their head. Other infant interventions like suctioning or fetal scalp monitors may also impact the tissues, in less obvious ways but may still be held in the system.
Cranio can find these holding patterns in the body and facilitate their system to gently release, leaving a sense of peace in the baby’s system.
2. Labour was prolonged or very fast
Babies have their own experience of birth, often linked to their mothers, but with their own unique pressures and stresses. If they have felt stuck for any reason or under a lot of pressure for a long amount of time this can influence their bodies, in particular the nervous system and the neck. They may have felt scared or panicked. If a prolonged labour ended up in emergency c-section then the baby may also feel disoriented, this can show as arching at the breast or pushing with the feet, the baby can feel stuck in the birth sequence of pushing from the uterine walls.
On the flip side, a fast birth may be a shock to the baby and can show up as activation in their nervous system.
Cranio acknowledges the birth experience and allows these physical and emotional tensions to release leading to happier well-adjusted babies.
3. You have been told your baby has a tongue tie
There is much controversy around tongue tie recently. Research is lacking around posterior tongue ties and lip ties, but that doesn’t mean they don’t exist. It helps to have bodywork before undergoing a tongue tie release. Cranio is a form of bodywork that can address other issues that may mimic the symptoms of tongue tie such as, cranial nerve dysfunction, tight fascia or general nervous system activation. If a couple of cranio treatments improves breastfeeding then the tongue tie procedure may be avoided; if it doesn’t, then the parent can feel confident that the procedure is necessary. It is also recommended to schedule a cranio treatment within 48 hrs of the tongue tie release, to optimise function and to reset the nervous system.
4. Your newborn has difficulty latching to the breast
Newborn babies have natural instincts to latch themselves to the breast after birth, if they can’t then there is usually a good reason for it. Often the mum feels like she is doing something wrong, but it is actually because the baby is in pain, tense, stressed or medicated from birth. Perhaps there is a tongue tie or tight jaw muscles? Cranial nerve function can be impeded due to compression of cranial bones which can affect tongue function and sensation. The earlier cranio treatment is given the better in these circumstances.
5. Your baby cries a lot
Babies cry to communicate and once that need is met usually stop crying. If your baby cries inconsolably or with a high pitch then they may need some cranio support. Some babies have musculoskeletal pain or discomfort from birth. Others have a strong need to tell their birth story through memory crying. I have successfully treated babies who have cried excessively since birth. Cranio provides deep listening as well as addressing any physical tensions and may help get to the root cause of their suffering.
6. Baby has a head preference/torticollis or breastfeeding is painful on one side
This gorgeous little guy needed a few cranio sessions for torticollis that was affecting latch at the breast and also causing him discomfort.
Babies with a stiff neck tend to have trouble with positioning and latch. Tight inutero environments and/or asynclitic positions during birth may impact the neck/shoulders and jaw and other parts of the body. This can cause breastfeeding difficulties which tend to be slow to resolve on their own. Cranio helps the body let go of these restrictions and then breastfeeding often becomes easier.
Birth is a formative experience. Its impact is imprinted in the tissues of the body and can influence the health and wellbeing of the person from infant to adulthood. Early cranio treatment can prevent future difficulties such as headaches, anxiety and more.
As the twig is bent, so grows the tree
Often an hour or so of skin to skin after birth helps the mum and baby to integrate the birth experience and let go of any held tensions; sometime this doesn’t happen, sometimes it does – but bub needs more support.
Occasionally I am asked to do an antenatal breastfeeding consult. This is a great idea for all women planning to breastfeed, but particularly for mothers having subsequent babies with a history of difficult breastfeeding issues; those that did not breastfeed for as long as they had planned. There is also a huge benefit of this personalised care for women with specific medical problems who suspect there may be supply issues, Having the right information and resources up front can help to optimise milk supply and breastfeeding success.
Forming a relationship with a lactation consultant beforehand makes it that bit easier to obtain help post-partum. Mums can be overwhelmed, exhausted and in pain and can be shocked to find out that there is not a lot of support within the system. This varies depending on place of birth or whether there is a free lactation clinic within the bounds of their locality. Child health nurses do their best but are often time poor and their breastfeeding education varies from individual to individual. Dads/ partners are often the ones to call private lactation consultants when they have reached a dead-end of support for their partners. For this reason it is often recommended that partners also attend breastfeeding education consults so they have the information and tips to provide support.
Having a basic understanding of the physiology of breastfeeding and what to expect from a breastfeeding newborn can make a huge difference to stress levels of new parents. Some private health funds do cover antenatal lactation consults. For a slightly cheaper option the Australian Breastfeeding Association does some great group classes on weekends – I used to teach these myself. Unfortunately you cannot rely on many hospital based breastfeeding classes – the information is minimal and sub par (please correct me if things have improved since I had kids).
If this sounds like it would be helpful, please get in touch to set yourself up for a smoother breastfeeding experience – $130 for 1.5hr consult.
I am offering a monthly clinic for babies to receive biodynamic craniosacral therapy – by donation. All babies should have the opportunity to receive cranio, regardless of their parents’ financial situation. This is a great opportunity for your baby to experience this gentle therapy. Read below for more details….
Pre-crawling babies (babies who have not received cranio before will be prioritised)
Cranio is a light touch form of bodywork that is non-manipulative. Jenny uses a listening touch to calm babies nervous system, sparking a biological process, unique to each individual, to release held tensions, stresses and trauma from the body. Babies often find it to be deeply relaxing. Parents often report that baby is calmer, easier to settle and more comfortable in their body.
Cranio may help:
fussy, hard to soothe, irritable babies
babies who have had an assisted birth (vaccuum /forceps/ C-section)
babies who experienced a fast birth or excessively long birth
babies who vomit frequently
newborns who do not wake for feeds
babies with digestive or sleep issues
premature babies or babies who have been separated from their mother.
Thursday 22nd October – 9.30 – 2.30
Thursday 26th November – 9.30 -2.30
Thursday 17th December – 9.30 – 2.30
Pregnancy and Breastfeeding Clinic – 74 Nollamara Ave, Nollamara.
Donation based – suggestion at least $10. (*usual cost $60). If you find the treatment to be helpful for your baby, I would appreciate a facebook review.
Places are limited and by appointment only. So book early through the website or phone 0435 309 397.
I recently had the privilege of working of with two babies who had a head preference and cranio was very helpful in increasing range of motion and infant comfort.
One little boy had significant torticollis from inutero positioning. This prevented him from latching well to the breast. His mum was “amazed” by the improvements. She herself booked in for a few sessions of cranio, it was so interesting to see the same constrictions show up in her body too. Baby shows much more progress when you help to release the jaw/neck tightness in mum.
Another baby I worked with over three sessions had significant neck tension and discomfort, which we suspected was from an external cephalic version (ECV). He was in a breech position and was assisted to turn head down while inutero by health professionals. His mother noted how painful the procedure was for her as she felt his head when it hit her pelvis. For the baby this can be a disorienting experience and, by the sounds of it for this baby, painful too as his head came into contact with her pelvic bones. He was extremely unsettled since birth. After two treatments, he was noticeably more comfortable in his body, sleeping better & crying less.
It is important to note that mums also need to be involved in treatment. It still astounds me to feel the same constriction patterns arise in the mums body. Often full healing is not possible until the tight jaw/shoulders/neck resolve in mums body. Mums and babies are so connected and often mirror each other body patterns.
Cranio is such a gentle and sensitve way to approach these kinds of injuries. Often if touch is the cause of the injury (despite best intentions), then the spacious empathic listening touch of a craniosacral therapist is the perfect way to create a sense of safety around touch in order for the body to release tensions and trauma.
This week I worked with two mothers who were struggling with low supply due to insuffient glandular tissue (IGT). They didn’t feel their milk come in, they had minimal breast growth during pregnancy and they were needing to top up with almost full feeds of formula. Noone had mentioned to them the possiblity of IGT.
IGT is not well known among health professionals working with mothers and babies, or other mums. They are often given well meaning advice that does not work and may feel as though they are doing something wrong or failing their baby. They are not! Unfortunately there is not a lot of research behind this heartbreaking condition. Diana Cassar-Uhl (IBCLC) has contributed to the field of knowledge through research and written a fantastic book. We do know that the glandular tissue, where milk is made and stored, is underdeveloped, but not necessarily why. It can be hormonal or due to circumstances surrounding periods of breast development (inutero and during the teenage years). Mums may make as little as a few drops of milk or up to 3/4 of the milk, but despite their best efforts to increase supply need to supplement with formula (or donor milk).
It is often not until they consult with an IBCLC that they understand the reasons behind their milk supply struggles and then get to set realistic expectations around increasing supply or to make peace with their breastfeeding journey. Understanding their body and its limitations clears any doubt or confusion. IBCLC’s do have tools up their sleeve to support mums to work out exactly how much milk they make and tools to support supplementing at the breast. Ultimately the diagnosis can be healing in and of itself.
If this resonates please seek the emotional support and knowledge of an IBCLC.
For a more detailed discussion of IGT see this resource.
Did you know that cranio can help to wake up sleepy babies? I have worked with many babies whose mothers have plenty of milk but they are unable to stay awake long enough to drink it. This is a frustrating situation. Relying on a breast pump and topping up with a bottle is a full time job and also runs the risk of bottle preference (where baby gets used to a constant flow of milk).
Sometimes there is a tongue tie that is causing the baby to tire when breastfeeding.
Sometimes they are born too early. This includes babies induced. Being born at 38 weeks may be considered 2-4 weeks early for that particular baby.
Sometimes there has been a medicated birth and the baby has not fully integrated the medication / anaesthesia into their system. Anaesthesia or opioid medication has a dissociative effect on the nervous system. It is helpful because there is a temporary separation from a painful experience but on a more subtle level, there is a separation from the body.
This is where cranio comes in. I have treated sleepy babies who are not yet fully present in their bodies due to a medicated birth – one session of cranio can bring them out of a dissociative state and into the present moment – it breaks the pattern in the nervous system. This is why cranio is also helpful for anyone who has recently undergone surgery.
*I say all this with no judgement. I, too, have had a highly medicated, induced birth. My son was too sleepy to breastfeed when he was born and his first feed was a bottle of formula. I didn’t know about cranio back then (or expressing colostrum) and wish I was able to arrange this gentle treatment for my son.
After 4.5 years at Baby Steps Health Centre, I have made the decision to leave so that I can focus fully on building Flow Cranio & Lactation. I have thoroughly enjoyed my time working there and am grateful to the team for their support and expertise.
But all good things must come to an end.
If you first met me through Baby Steps please let your friends and family know to book me for lactation support through my business rather than the clinic.
If you, or your baby, have benefited from my lactation or cranio support – please tell your family or friends or other mothers at mothers group. Or consider writing a google or Facebook review.
The topic of posterior tongue tie (PTT) and lip tie (LT) is a controversial one. Research is limited and opinions are divided. I have worked with mums who have found treating these issues to make all the difference in their breastfeeding journey. However I do have concerns around some current practices including:
routine stretches / oral exercises / active wound management
laser frenectomy for breastfeeding problems that have not been thoroughly assessed by an IBCLC
laser frenectomy for babies to prevent future issues
The prescription of routine stretches/exercises after a laser frenectomy varies between providers. These are well intentioned, with the idea that they will prevent the lingual frenulum from reattaching or scarring. A recent client was advised to do them 6 times a day, for 21 days! There is no scientific evidence to prove that they do in fact prevent reattachment – and what of the risks? We know that they can cause oral aversion and exacerbate feeding issues. Babies are very orally sensitive. We need to respect when they are telling us “no”. Overriding this can potentially disrupt the parental bond. As a craniosacral therapist, working with the nervous system, I have a unique perspective as I am able to assess the impact of persistent stretches on babies systems. Babies respond to difficult experiences with a fight or flight response. But because they are physically unable to run away or fight, they can easily shift into freeze – a dissociative state. This is a protective survival mechansim and, unless treated, can become a lifelong pattern. Undergoing a laser frenectomy can be a traumatic experience for both mother and baby. With care and sensitivity the body can integrate this trauma with minimal lasting impact. It is my opinion that constant stretches for weeks afterwards interferes with the integration of the trauma, instead driving it deeper into the body.
My other concern is that babies with feeding problems are able to undergo the procedure without a full feeding assessment by an IBCLC. Nipple pain and milk transfer issues may not be related to the oral anatomy. An IBCLC can help to rule out nipple infections and positioning and attachment issues potentially avoiding surgery. Also, 1-2 sessions of cranio/bodywork beforehand may address issues such as myofascial tightness / jaw issues / cranial nerve impingment that can impact breastfeeding. Then, if no improvement in feeding, laser frenectomy can be trialled, often as a last resort.
Non-surgical management strategies can be effective first-line therapies for management of functional limitations associated with ankyloglossia. Surgical management should be considered only after non-surgical management has failed to address the functional issue that led to the diagnosis.
Finally, the procedure is often done to prevent future issues. Parents have a lot of fear around future issues with speech or dental issues. These aren’t yet substantiated by evidence. Social media perpetuates this fear. In my humble opinion, the only reason to treat PTT and LT in babies is for feeding issues.
“Further research is needed regarding other reported adverse health outcomes, such as problems with speech, malocclusion, lingual gingival recession and obstructive sleep apnoea as evidence of a consistent causative relationship is lacking. No evidence exists to support buccal or labial frena causing problems with feeding or speech.”
That said …despite no evidence, I have seen lip ties interfere with attachment/seal at the breast. And I have seen lip ties contribute to decay at the top of the central incisors.
Laser frenectomy (compared to scissors frenotomy) needs much more consideration as it is a longer and more traumatic procedure. Here in Perth, parents have a few options, my preferred referral is to one that does not recommend stretches and where it is a requirement that every baby is thoroughly assessed by an IBCLC before the procedure. The good news is, if babies do need to undergo laser treatment for tongue tie or lip tie, just one session of cranio can help them to integrate the experience, bringing them out of fight or flight or a dissociative state. This has lasting positive impacts on feeding and the nervous system.
For some babies, getting stuck in the birth canal, then being born via caesarean, can be a disorienting experience. Especially so, if anaesthesia or opioid medication was used at the time.
Babies are active participants during birth, they will push off the walls of the uterus with their feet, twist their bodies and turn their heads in order to facilitate the birthing process. It is a biological sequence encoded into their bodies. They are programmed to do this. If this sequence is interupted, at any point, the sequence may still be cycling in their system. A baby may frequently arch and twist at the breast, or push/kick their feet off surfaces.
These movements often arise during a biodynamic craniosacral therapy session. The baby is supported to complete the sequence or to express these movements. Afterwards the baby no longer has a need to keep acting out these movements – the arching, pushing and kicking stop and the baby feels complete and settled.