How can Physiotherapy help with Infant Feeding?

Mastitis is a very common condition in lactating women that can occur at any time during lactation, but most often occurs during the first six weeks postpartum. Mastitis is often clinically defined as a tender, red, swollen area of breast tissue, associated with flu-like symptoms, and a temperature of greater than 38.5 degrees C. However, the literal definition of mastitis refers to any inflammation of the breast, which may or may not be caused by a bacterial infection.
Areas of breast engorgement, or “blocked/plugged ducts” can also present with redness, swelling and pain, though an infection is not necessarily present. Prompt treatment of blocked ducts and mastitis is important, as evidence suggests that there is a progression from breast engorgement or blocked ducts to non-infectious mastitis, to infectious mastitis to breast abscess.
The physiotherapy treatment of blocked ducts and mastitis involves a technique called therapeutic breast massage. The breastfeeding parent is positioned in a comfortable position, and the therapist uses stroking motions starting at the areola and moving toward to armpit. The pressure applied is initially very light and becomes firmer as tolerated. This is alternated with the hand expression of milk to clear the area of milk stasis. The goal of therapeutic breast massage is to aid in fluid drainage toward the local lymph nodes. Some physiotherapists will also use ultrasound to reduce inflammation and help clear areas of milk stasis. The physiotherapist will also provide education on symptom management at home, including heat/ice, self-massage and positioning, as well as guidance on when to return for further treatment, and when to seek care from a physician.
There are several infant factors that can also contribute to breastfeeding difficulties, such as tongue and lip ties and torticollis. In tongue and lip ties, the tissue connecting the tongue and lips to the mouth is shortened, tight or thickened, leading to impaired mobility. This can affect how well an infant is able to latch on to the breast, as well as how efficiently they can transfer milk while breastfeeding. A physiotherapist can use a screening tool to help identify the presence of a tongue or lip tie and refer a breastfeeding family to a practitioner that is able to release these tissues (often a family doctor, pediatrician or dentist). A baby who has had a tongue or lip tie may also develop tightness in the muscles of the jaw and neck because of the altered suck mechanics necessary to breastfeed without proper tongue and lip mobility. A physiotherapist can use gentle soft tissue techniques and stretching to normalize the tone in these muscles.
Congenital Muscular Torticollis occurs when an infant is born with a restricted neck range of motion because of tightness in the sternocleidomastoid muscle. The infant’s head may rest in a rotated or side-flexed position due to this tightness, which can then lead to difficulty in achieving a good latch. A physiotherapist can help to identify when torticollis is present, and treat it with stretching and soft tissue techniques as well as provide the parents with a home stretching and strengthening program, and tips on positioning and tummy time.