Tips From A Physical Therapist

Jazmin Nevarez, Social Media Manager, Milk Snob

We recently partnered with Physical Therapist, Elizabeth Morel, and our community was able to ask her a couple of questions about feeding, sleep, biting, torticollis, and much more! We have gathered this incredibly helpful information in one place so you can come back, read it, and refer to it! Here are a few questions our community asked and Morel's answers to each question:


My baby is having a hard time feeding – they are biting instead of sucking. What are your recommendations?

"This is what I get the call for the most in my practice. A baby that is biting instead of sucking often has difficulty curling their tongue like a 'U' and holding the nipple up to the palette to creating a vacuum seal. The seal consists of the cheeks, upper lip, and the tongue. The jaw should not move much. In cases where oral dysfunction is present, the tongue and jaw move together as one unit, creating a biting pattern. This can be quite painful for the lactating parent and also inefficient for the baby.  These difficulties can affect the bottle just as much as the breast. To achieve proper function we work on the movement of the tongue left and right and in and out, and up and down. The strength of the jaw and cheeks, and the tension of the floor of the mouth are also key factors.  The relationship between the frenulum (string under the tongue) and the floor of the mouth matters greatly as well, as the tighter and shorter the frenulum, the more difficult it is to maintain a proper seal. Lastly, tone and strength throughout the oral structures as well as postural control muscles need to strongly be considered as they can pull on the head and neck which will affect the baby’s latch."

"When not eating, cooing, or crying, a baby’s tongue should rest up on the palate and the lips should be closed. Why is it so important that the tongue sits on the palette? It is probably the most crucial piece of infant development that we can talk about, but isn't talked about enough. One reason is because the tongue shapes the palette. The width of the jaw and the upper palette creates the shape of the gumline, influencing how much room there is for your adult teeth to come down.  If your tongue is too high and narrow, then you're not going to have enough space for your baby teeth to come out and the adult teeth to come in, leading to crowding. Realistically, you want space between each baby tooth. When babies have a 'perfect' smile that means there is not enough space for the adult teeth to come down, leading to palate expansion or even worse, tooth extraction."

 "The roof of the mouth is the floor of the nose, which means when your palette is high and narrow, your palette can push up on your nose and create a deviated septum. When you have this, it makes it really hard to nasal-breathe. For proper day to day function, a human’s goal should be to nasal-breathe all the time. When you breathe through your nose, it filters out dust, bacteria, allergens, and viruses. Nasal breathing with tongue to palate allows maximum oxygen to the brain, allowing more deep and restful sleep, and better overall function. It allows better hormone production and nervous system function. When we breathe through our mouths we tend to breathe faster and not only has this been linked to sickness, enlarged tonsils, and poor sleep, but has also been linked to anxiety."

I have been told my child has Torticollis – is this permanent and how can physical therapy help?

 "Due to our long working hours, and types of job settings, babies experience more in utero constraint patterns now more than ever. When a baby sits in one position in utero, they often maintain that same strain pattern at birth. If not identified and treated, this can lead to a diagnosis of torticollis. A diagnosis of torticollis is tricky, because the definition of torticollis is the shortening of one muscle, the sternocleidomastoid. This neck muscle brings the same ear to the shoulder, but turns the head in the opposite direction. Though this muscle is tight in many babies, its often not the only muscle affected. As stated above, the tension pattern often runs from the ear all the way down to the hip.  Another factors that may anecdotally affect tension in the neck is the tension on the floor of the mouth. The neck muscles are intertwined with the feeding muscles and therefore when one is tight, it creates a pull on the others. I often see in my practice that babies who have tongue ties, often have torticollis like symptoms, and vice versa. Treatment of both the body and mouth simultaneously give me the best results. I work on the tension pattern all the way down the body as well as the mouth in order to give the longest lasting results, and do so in a gentle manner. Straight stretches are less effective than active movement and gentle range of motion in my experience. When babies are crying, they’re incapable of learning at that time. Therefore, I keep my therapy focused and happy, even if that means in short spurts."

Is tummy time that important?

"Yes and no. Tummy time is very important because you need to build up the muscles in the back, the legs, the buns, and the neck. These are the muscles we use for posture control and they're the muscles that hold us up. Should we be starting from day one? Yes! Do I care if your baby's umibilical cord is still in? No! From 0-4 weeks it's okay to keep your baby on you for as long as you want, utilizing that as your tummy time! From there, you can proceed onto the floor as you get max results from being on a horizontal surface. You want to use the roll in and roll out method (I utilize a technique called NDT) to gain strength, vestibular maturity, and to keep the baby engaged without becoming overwhelmed. Is tummy time the most important activity? In my opinion, no. For physical development, I believe that side-lying play yields better outcomes since you're working on the deep more, stabilizers, vestibular system, and rotational muscles. We are not robots after all."

What are your top tips for sleep training?

"Before considering sleep training methods, I believe you should make sure your baby doesn't have any underlying conditions. One of these being reflux. Your baby may be waking often because their milk continues to rise in their throat, causing discomfort. Another one of these is gas. Gas can be painful and wake a baby often. Last, they may be waking due to sleep apnea. Getting latch issues under control will help with aerophagia reflux as well as gas. An ENT and sleep specialist team can determine if your baby is having apnea episodes. After these issues have been addressed, then and only then will it be appropriate to decide what method of sleep assistance you will use."


She is amazing for answering all of these with such helpful and thorough explanation! Don't forget to follow her for more of this informative content: @littlemoverspt