If a baby has high muscle tone (hypertonia) you may notice he seems to arch his back and hold himself very stiffly. A baby with this type of muscle tension may need to work harder at breastfeeding and expend more energy. You might find he is quite fussy at the breast and breastfeeding isn’t very comfortable for you, with no obvious explanation. This article discusses how high muscle tone can affect breastfeeding and shares ideas that may help a tense baby to relax and breastfeed more comfortably.
What causes high muscle tone in babies?
The position of a baby in the uterus, invasive birthing practices, pain or neurological disorders can all affect muscle tone. Babies who are very hungry can also have high muscle tone, including newborn babies or older babies who are very underweight. Contact your health professional for further information if you have any concerns. This article is not intended to be a substitute for advice from your health professionals.
High muscle tone and breastfeeding
Feeding difficulties that may be explained by high muscle tone and are described in Breastfeeding Answers Made Simple, 2010 include:
- A tight jaw—baby may be unable to open his mouth wide enough to take the breast properly.
- Clamping—baby may clamp down on the breast.
- Restricted tongue movements causing bunching, humping or retraction of the tongue.
- A tendency for baby to gag during feeding.
- Feeding pain and nipple damage for the breastfeeding mother
Feeding difficulties such as these can also have other causes however, for example an underweight or hungry baby may demonstrate body tension that can include tongue retraction. Or a baby may clamp down on the breast if they are struggling with a fast flow of milk or are in a shallow latch (the way baby attaches to the breast). In order to rule out positioning, latch or low weight gain as causes of either painful feeds or body tension/high muscle tone in your baby, include a lactation consultant in your health care team to ensure all aspects of breastfeeding are fully assessed.
Ideas to help with muscle relaxation
If your baby still seems tense once hunger or a poor latch have been ruled out, ideas that can help with muscle relaxation include:
- Skin-to-skin contact for several hours each day.
- A quiet environment so as not to over stimulate your baby.
- Swinging your baby in a blanket to calm him. Lie baby on a blanket or sheet, then using two adults hold the ends of the blanket and gently swing baby from side to side 1.
- Supervised tummy time—tummy time on a parent is most comfortable for a young baby e.g. with the mother leaning back in a reclining or laid back position. See the link from The American Occupational Therapy Association (AOTA) for safety guidance and precautions for tummy time.
- Physical therapy or cranial work may be helpful—see Does Cranial Therapy Work? or Cranial Osteopathy or Craniosacral Therapy for my Baby.
Specific ideas to help breastfeeding
- Skin-to-skin contact before a breastfeed.
- Try laid back or natural positions for breastfeeding. Lie your baby on his tummy (prone) on your abdomen to help to reduce his body extension and encourage his tongue to relax forward with the help of gravity. Conversely rugby hold may be helpful for some babies.
- Use the colic hold before a feed. Drape your baby over your forearm with their tummy facing down and their arms hanging freely, see picture.
- In some situations a well fitted nipple shield can be used as a suck training tool.
- Try the charm hold before a breastfeed, this is a variation of the colic hold (see sub-heading below) and is particularly useful for babies who are not extending their tongues.
- Finger-feeding—either with baby in a tummy down (prone) position or with your baby held in the crook of your arm can be used as a training exercise before a breastfeed, see What is Finger Feeding? for further information.
The Charm Hold
The charm hold is a version of the colic hold where the baby also sucks a parent’s clean finger in a tummy down position. This can also be used as a position for a finger feeding exercise as above. Baby can be lying on a parent’s lap as in the description below:
Lay the baby across his parent’s lap face down toward the floor with his hips flexed (bent). The parent supports the baby’s forehead with the heel of the hand and extends a clean index finger with smoothly trimmed fingernail for the baby to suck until the tight tongue relaxes and comes forward to snuggle around the finger. It may take several minutes for this to happen. It is called the Charm hold because it “works like a charm.” As soon as the baby’s tongue relaxes, he can be gently turned right-side-up and immediately offered the breast.
Alternatively the baby could be supported tummy down, astride a parents arm as in the colic hold. If baby’s chest is supported by the parent’s hand, rather than their elbow, the free hand can reach baby’s mouth for suck training with the heel of the hand supporting baby’s forehead2.
High muscle tone due to food allergy (or pain)
In her book Breastfeeding Works! Even With Allergies, Robyn Noble describes how food allergy related gut pain (or other causes of infant pain) can cause problems breastfeeding. Some babies may seem to be unable to latch or have sucking problems, or be very fussy and restless at the breast resisting the usual breastfeeding holds. When they are in pain, babies can hold a lot of tension in their jaw and clamp down on the breast causing painful sore or damaged nipples, creasing of the nipples and repeated cases of mastitis. Noble calls this the hypertonic bite response and says it can explain nipple damage even when outwardly the baby seems well latched. The author’s tips to help manage hypertonic bite response due to food allergy or intolerance include:
- Hold the breast firmly during a breastfeed to push more breast tissue towards the baby’s top lip
- Work to resolve baby’s pain through an exclusion diet for the breastfeeding mother (cows’ milk products are a common culprit)
For more information on food allergies and intolerances and how they could affect a breastfed baby see Milk Allergy in Babies and the book Breastfeeding Works! Even With Allergies by Robyn Noble (2015).
If your baby has more difficulty turning his head to one side than to the other, or holds his head to one side and prefers feeding in certain breastfeeding positions, he may have torticollis i.e. one of the muscles in the neck is very tight on one side3. This may have been caused by your baby’s positioning in the womb or after a traumatic birth and can be diagnosed by your health care professional.
Alison Hazelbaker has recorded a presentation on the ways torticollis can affect breastfeeding.
Hazelbaker indicates that torticollis may cause specific behaviours during a breastfeed including: jaw clenching, arm cycling, nipple compression, Vasospasm Symptoms including blanching or a white stripe on the nipple, exquisite pain, irritation to nerves, difficulty latching on one side, a shallow latch, retracted tongue, and the baby’s head may keep turning away from the breast. Hazelbaker notes that excess use of any kind of rigid seat or car seat can make the symptoms worse and that tummy time or physical therapy can be helpful. There is further helpful information in the presentation.
Tongue exercises for high muscle tone?
For further information on suck training or tongue exercises see your breastfeeding specialist or refer to Chapter 12 “Neurological Issues and Breastfeeding” in Supporting Sucking Skills In Breastfeeding Infants 2017 by Cathy Watson-Genna. The chapter includes:
- Tongue exercises that may help with high muscle tone
- How to relax a tight jaw
- The value of finger feeding for some situations
Contacting your health professional and IBCLC lactation consultant will help you identify whether any of these exercises are appropriate in your situation. Tongue exercises are best shown by someone familiar with their use and application. It may be that trying different breastfeeding positions for your newborn or some different latching tips are all that are needed.
Some symptoms such as not being able to open the jaw very wide, having a heightened gag reflex or pinching the nipple during breastfeeding can also be caused by poor tongue function due to a tight, short frenulum. You can check your baby’s tongue function with your IBCLC lactation consultant or tongue-te practitioner and see Is My Baby Tongue-Tied?
There are several ways to help relax a baby who has high muscle tone and there are specific exercises and techniques that can help a tense baby breastfeed. Babies who are underweight or in pain can also be tense, so it is important to rule out hunger or a physical pain as a cause of high muscle tone. Your health professional team will help you if you have any concerns that your baby has high muscle tone and your IBCLC lactation consultant will be a valuable member of the team if positioning, latch or low weight gain are causes of your baby’s body tension.