I have referred these babies to pediatric physical therapists who work with the babies and give mothers exercises to do at home which helps tremendously.   This is just an observation, but I wonder if babies with T-T and other midline issues compensate with positioning that aggravates a subtle underlying muscle weakness on one side that becomes apparent as time goes by.  In an oro-motor conference I attended several years ago, the therapist mentioned unilateral oral motor weakness or strength imbalance as being a cause of sore nipples.  These babies benefit by being positioned with the strong side down which causes them to relax and not overcompensate by biting on the breast.   This has helped amazingly in my practice when I have seen these babies.  My digital oral assessment also includes bite strength because of this info.  



-----Original Message-----

From: Lactation Information and Discussion [mailto:[log in to unmask]] On Behalf Of Lisa Marasco IBCLC

Sent: Thursday, January 22, 2015 10:44 PM

Subject: Torticollis



Following this thread with interest. I just graduated a mom and baby whom I saw 12 times, starting at a few weeks of age; baby is now almost 4 months. Initial presentation was for painful and ineffective feeds. Baby had posterior tongue restriction and some lip restriction, with problematic reflux. They were referred to a chiro/CST person who started working with him.  Baby's posture looked fine in the beginning, but one day a few visits later I weighed him and he was curved like a "C" on the scale. I wondered how I could have missed that! (I hadn't) We got him back in quickly and mother says that after the treatment, the baby's body started straightening out and looked great in less than 24 hrs. Miracle cure, right?  He was good for a couple of weeks, then it happened again. I googled more on torticollis and learned that it can show up later, as his did, and that it can come and go. There is even a syndrome (Sandifer's) that includes intermittent torticollis and reflux. So interesting.  This has been a very tough case. Tongue and lip were released and the suck problem improved, with support of CST. Only meds soothed the reflux-- mom's diet was already great. While he is now sustaining on his own, breastfeeding is more of a necessity and not so much something to enjoy. 



~Lisa



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