Infant Body therapies and the connection to infant feeding

Infant feeding involves coordinated movement throughout the body. Whether an infant feeds at the breast or from a bottle, effective feeding requires the tongue, jaw, lips, cheeks, head and neck to work together, alongside breathing, swallowing, postural stability and the ability to maintain a comfortable, regulated state.

Feeding difficulties are not always explained by milk supply, feeding equipment or oral anatomy alone. Muscular tension, restricted movement, asymmetry and difficulties coordinating oral movements may also influence how an infant attaches, maintains a seal, generates suction and transfers milk.

Body-based therapies are sometimes used alongside skilled infant-feeding support to address musculoskeletal restrictions and movement patterns that may contribute to feeding difficulties. These approaches include physiotherapy, osteopathy, cranial osteopathy, craniosacral therapy and chiropractic care. Orofacial myofunctional therapy is another related discipline, although it is generally more appropriate for older children and adults who can participate actively in instructed exercises.

Understanding the relationship between oral function, muscular tension and infant movement helps families and practitioners consider which forms of assessment and support may be useful.

Birth, movement and infant feeding

Infants adapt to movement and positioning throughout pregnancy, birth and early development. Their feeding skills also develop as they gain experience coordinating sucking, swallowing and breathing.

Some infants demonstrate a preference for turning their head to one side, difficulty maintaining a comfortable feeding position, asymmetrical jaw movement or differences in their ability to attach to each breast. Others may struggle to maintain a deep latch, sustain suction or coordinate their oral movements efficiently.

These observations can have several contributing factors. An assessment of infant feeding therefore benefits from considering the feeding mechanism alongside the infant's movement, posture, oral function and the circumstances of the feeding dyad.

A body-based assessment may identify restrictions or asymmetries that warrant attention. This can complement a detailed feeding assessment, which considers attachment, sucking, swallowing, milk transfer and feeding comfort.

The Association of Tongue-tie Practitioners (ATP) discusses the relationship between manual therapy and infant feeding in its manual therapy and infant feeding guidance. Its infant-feeding support information also provides further context for families seeking feeding support.

Tongue-tie and oral muscle function

The tongue plays a central role in feeding. Its movement contributes to attachment, maintenance of a seal, suction generation, milk transfer and the coordination of swallowing. Effective tongue function depends on more than the appearance of the tongue or its ability to protrude.

A lingual frenulum is a normal anatomical structure beneath the tongue. When its structure restricts tongue movement and is associated with functional difficulties, the condition is commonly described as tongue-tie, or ankyloglossia.

Research into the lingual frenulum has demonstrated its close relationship with the connective tissues of the floor of the mouth. Mills et al. (2020) examined the histological structure of the frenulum and floor-of-mouth fascia, describing the frenulum as a fold involving fascia and overlying oral mucosa. The study also identified variation in fascial thickness and tissue composition. Martinelli et al. (2014) investigated the histological characteristics of altered lingual frenulum tissue in children undergoing frenulum surgery.

A restrictive frenulum may limit the tongue's ability to elevate, extend or move efficiently during feeding. An infant may compensate by changing jaw movement, recruiting other oral muscles differently or adopting an alternative feeding pattern. These compensations may affect the wider mechanics of feeding.

Research following frenotomy has examined changes in both breastfeeding function and oral muscle activity. Santos et al. (2023) assessed 20 infants before and seven days after lingual frenotomy. The researchers reported improvements in breastfeeding assessment categories, including positioning, latch and sucking, alongside a reduction in the measured electrical activity of the masseter muscle. This provides an example of research examining both feeding outcomes and the activity of muscles involved in feeding after division.

A tongue-tie is a structural restriction. Osteopathy, chiropractic care, physiotherapy and craniosacral therapy do not divide or remove the frenulum. Where a restrictive frenulum has contributed to altered movement or muscular compensation, body-based therapy may be considered as part of support for residual tension and movement patterns. Assessment for tongue-tie and decisions about whether division is appropriate remain separate clinical considerations.

Further information is available in Choosing Your Tongue-tie Practitioner and Tongue-tie Release in England: UK CQC Requirements.

Information about exercises discussed following tongue-tie division is available in Tongue-tie Release Exercises.

Muscular tension, fascia and whole-body movement

Muscles do not work in isolation. They are surrounded and connected by connective tissues, including fascia, which relates to structures such as tendons, ligaments and other supporting tissues. These tissues help support movement, transmit forces and allow structures to glide in relation to one another.

Fascial anatomy has been explored extensively by Thomas Myers in Anatomy Trains, which describes proposed myofascial continuities between different regions of the body (Myers, 2020). Systematic reviews have examined the anatomical basis of these connections. Wilke et al. (2016) reviewed anatomical evidence for proposed myofascial chains and found strong support for some chains, with varying levels of support for others. Krause et al. (2016) examined evidence for force transmission along myofascial chains and found evidence of tension transfer between some connected structures.

These findings provide a framework for considering how movement and tension may relate across connected tissues. The anatomical relationships are relevant to manual and movement-based approaches that consider the body as an interconnected system.

Connective tissue can also change following injury, inflammation, surgery and tissue healing. Collagen is an important component of connective tissue, and its organisation and composition contribute to tissue strength and mechanical behaviour. Martinelli et al. (2014) investigated collagen characteristics in altered lingual frenulum tissue, while Mills et al. (2020) examined the histological structure of the frenulum and floor-of-mouth fascia.

The relevance to infant feeding is that oral tissues, muscles and connective tissues operate together. A restrictive oral structure may influence local movement, and an infant may develop compensatory patterns in response to restricted movement or discomfort. These changes can be considered alongside the movement of the jaw, head and neck when assessing feeding.

A whole-body assessment considers these relationships rather than assuming that every feeding difficulty originates at the breast, bottle or tongue. The purpose is to identify movement patterns or restrictions that may be contributing to the individual infant's presentation and consider appropriate support.

The jaw and feeding mechanics

The mandible, or lower jaw, is the only freely movable bone of the facial skeleton. Its movement is important for attachment, jaw stability and the coordination of the tongue and other oral structures during feeding.

At the breast, the infant needs to maintain an effective attachment while coordinating tongue and jaw movement to generate the pressure changes involved in milk transfer. Geddes et al. (2008) investigated tongue movement and intra-oral vacuum during breastfeeding, demonstrating the importance of oral movement and pressure generation in milk removal.

Bottle-feeding also requires coordinated oral movement and suction, although the flow characteristics of the teat and the feeding position influence how the infant manages the feed.

Restricted jaw movement, asymmetry or excessive muscular effort may affect the infant's ability to maintain a comfortable and effective feeding pattern. Some infants demonstrate differences in how widely they open their mouth, how their jaw moves during sucking or how consistently they maintain a seal.

The relationship between the stomatognathic system and body posture has been discussed in the literature, including by Cuccia and Caradonna (2009). In infant feeding, it is useful to consider jaw movement alongside tongue function, head position and the infant's overall comfort rather than assessing these structures in isolation.

Facial asymmetry may also be observed alongside differences in head position or movement. These observations need to be interpreted in the context of the infant's development and clinical presentation.

Torticollis

Torticollis describes a head position in which the head tilts to one side, often with the chin turned towards the opposite side. Congenital muscular torticollis can involve tightness or shortening of the sternocleidomastoid muscle, although head-position preferences may have other causes.

An infant who finds it difficult to turn comfortably in one direction may struggle to achieve a consistent feeding position. This can affect attachment at one breast, positioning during bottle-feeding or the infant's ability to maintain a comfortable posture while feeding.

Watson Genna (2015) described how muscular and craniofacial asymmetry associated with congenital torticollis may influence breastfeeding mechanics. Positioning adjustments and support for comfortable movement can help the feeding dyad, while paediatric physiotherapy can assess and manage torticollis.

Families may be able to request an NHS paediatric physiotherapy referral through their GP. The appropriate pathway depends on local services and the infant's needs.

Skull shape

Infant skull shape can influence how the head rests against a surface and how comfortably an infant turns and positions their head. Positional plagiocephaly describes asymmetrical flattening of the skull, while brachycephaly describes a relatively broad, short head shape with flattening at the back.

Skull shape, head-turning preferences and neck movement may be considered together when an infant presents with feeding difficulties or positional asymmetry. An assessment of skull shape does not, by itself, explain a feeding problem, but it may provide useful context when considered alongside movement and oral function.

Further discussion is available in Infant Skull Shape and Infant Feeding.

Advice about sleep positioning remains important. Infants should be placed on their backs for every sleep, on a firm, flat surface, following current safer-sleep guidance (BASIS, n.d.; The Lullaby Trust, n.d.). Families can find further information from BASIS and The Lullaby Trust. Any advice about awake-time positioning or movement should be consistent with safe-sleep recommendations.

Osteopathy and cranial osteopathy

Osteopathy is a regulated healthcare profession in the UK. Osteopaths use clinical assessment and manual approaches to consider movement, function and musculoskeletal presentation. Cranial osteopathy is an approach practised by some osteopaths that uses gentle manual contact to assess and work with movement and tension.

In the context of infant feeding, an osteopath may consider the movement of the head, neck, jaw and associated soft tissues, as well as the infant's general comfort and posture. The intended focus may include musculoskeletal restrictions or compensatory patterns that could make positioning or oral movement more difficult.

Osteopathy does not release a restrictive lingual frenulum. Where tongue-tie has contributed to restricted movement or compensatory tension, osteopathic care may be considered alongside appropriate tongue-tie assessment and infant-feeding support.

Research has investigated osteopathic treatment alongside lactation care. Herzhaft-Le Roy, Xhignesse and Gaboury (2017) conducted a randomised controlled trial involving 97 mother–infant dyads with biomechanical sucking difficulties. The study found statistically and clinically significant differences in LATCH assessment scores between the group receiving osteopathic treatment alongside lactation consultations and the control group. It did not find a significant difference in nipple-pain scores between groups.

Fons et al. (2025) reported a pilot randomised controlled trial involving 40 healthy, full-term breastfed newborns with feeding dysfunction. The study examined osteopathic manipulative treatment alongside lactation support and reported greater improvement in feeding assessment in the treatment group.

Chen et al. (2026) reviewed the literature on osteopathic manipulative treatment for the breastfeeding dyad. Their scoping review identified 35 studies, including 19 with feeding-related outcomes. The authors concluded that preliminary evidence suggests osteopathic manipulative treatment may support feeding-related outcomes and identified a need for further interdisciplinary research.

The General Osteopathic Council maintains the statutory register of osteopaths in the UK. Families can use its register search to check a practitioner's registration.

Chiropractic care and gentle manual approaches

Chiropractic is a regulated profession in the UK. Chiropractors assess and manage musculoskeletal presentations using approaches that may include manual techniques, movement advice and soft-tissue work. The approach used with an infant should be appropriate to the infant's age, presentation and needs.

Where an infant has restricted movement, positional asymmetry or muscular tension, a chiropractor may assess the musculoskeletal contribution to the presentation. The relevance of this approach to feeding depends on the individual assessment and the way any intervention is delivered.

Chiropractic care does not treat or divide a restrictive lingual frenulum. It may be considered as a complementary approach where musculoskeletal factors are also being addressed, alongside direct assessment of feeding and oral function.

The General Chiropractic Council (GCC) is the statutory regulator for chiropractors in the UK. Families can find information about registration and professional standards through the GCC website.

Physiotherapy

Physiotherapy can be relevant when an infant has restricted neck movement, torticollis, asymmetrical movement, postural difficulties or other musculoskeletal concerns. Paediatric physiotherapists assess movement and function and may use positioning, handling, movement activities and other appropriate interventions to support development.

Where a feeding difficulty occurs alongside torticollis or a clear movement asymmetry, physiotherapy may help address the movement component while an infant-feeding practitioner assesses attachment, sucking, swallowing and milk transfer.

Families can ask about NHS paediatric physiotherapy services through local healthcare pathways. Some families may also choose to access private paediatric physiotherapy.

The Health and Care Professions Council (HCPC) maintains the statutory register for physiotherapists in the UK. Registration can be checked through the HCPC website.

Craniosacral therapy

Craniosacral therapy is a hands-on approach that uses gentle contact and is practised by some therapists working with infants. Practitioners may focus on perceived restrictions or tension and the infant's comfort and movement.

Families considering this approach in relation to feeding may wish to understand the practitioner's training, experience with infants and approach to working alongside other professionals. Craniosacral therapy is distinct from cranial osteopathy, which is practised by osteopaths registered with the General Osteopathic Council.

The Craniosacral Therapy Association provides information about its profession and practitioners through its website.

Myofunctional therapy

Orofacial myofunctional therapy focuses on the function and coordination of the muscles of the mouth and face. Depending on the individual, work may address tongue posture, lip seal, oral movement, swallowing patterns and related functional habits.

Most structured myofunctional programmes are designed for school-aged children, adolescents or adults who can understand instructions and actively practise exercises. They are therefore not generally a direct substitute for infant-feeding assessment or hands-on support for a young infant who cannot follow instructed exercises.

For older children and adults, myofunctional therapy may be relevant where oral function, tongue posture or swallowing patterns need further assessment and support. Suitability depends on the presenting concern and the practitioner's clinical scope.

The British Society of Myofunctional Therapy (BSMFT) provides information about orofacial myofunctional therapy and its practitioners through its website.

What does the research say?

Research on body-based approaches to infant feeding includes randomised controlled trials, observational studies and reviews. Some studies have reported improvements in feeding assessments when osteopathic treatment is provided alongside lactation support.

Herzhaft-Le Roy et al. (2017) found improved LATCH scores in the group receiving osteopathic treatment alongside usual lactation consultations. Fons et al. (2025) also reported greater improvement in feeding assessment in the treatment group in a pilot randomised controlled trial. The 2026 scoping review by Chen et al. brings together published research on osteopathic manipulative treatment for the breastfeeding dyad.

Research into tongue-tie and oral muscle function also helps explain why feeding can involve changes beyond the frenulum itself. Santos et al. (2023) reported improved breastfeeding assessment scores following frenotomy alongside a change in masseter muscle activity. Histological studies by Martinelli et al. (2014) and Mills et al. (2020) provide further information about the structure of the lingual frenulum and its relationship with floor-of-mouth tissues.

Research on myofascial chains provides a basis for considering connections between muscles and connective tissues in different parts of the body. Wilke et al. (2016) reviewed anatomical evidence for proposed myofascial chains, while Krause et al. (2016) examined evidence for force transmission along connected structures.

Together, these areas of research support continued investigation of the relationship between oral function, movement, connective tissue and feeding. They also provide a rationale for considering the infant's presentation as a whole, rather than assuming that every feeding difficulty has a single cause.

Infant-feeding support

Body-based therapy is most useful to consider within a wider assessment of the feeding dyad. A feeding assessment can examine attachment, oral function, sucking patterns, swallowing, milk transfer, feeding comfort and the practical circumstances of breast or bottle feeding.

An infant-feeding specialist may help identify the feeding difficulties that need attention and coordinate support with other relevant professionals. More information is available in What Does an Infant Feeding Specialist Do?.

An International Board Certified Lactation Consultant (IBCLC) has completed the relevant international certification process and can provide specialist lactation care. IBCLCs can assess breastfeeding and help families consider feeding strategies, positioning, milk transfer and other factors affecting the feeding dyad. Read more in What Is an IBCLC? Feeding Support Explained.

Families can search for an IBCLC through the Lactation Consultants of Great Britain directory or find information about certification and the international registry through IBLCE.

Further information about lactation support is available on the D-Restricted lactation page.

For bottle-feeding families, the choice of bottle and teat, feeding position and pacing can also influence the feeding experience. Further information is available in Choosing Bottles and Teats and How to Pace Bottle Feeds: A Calm, Practical Guide.

The appropriate combination of support depends on the infant's needs. Some families benefit from feeding advice alone; others may need assessment of oral function, musculoskeletal movement or both.

UK practitioner registers and directories

The following organisations provide information about professional registration or practitioner directories. Statutory regulators and professional associations have different roles, so checking a practitioner's status should include consideration of their registration, training, scope of practice and experience with infants.

• Physiotherapy: the Health and Care Professions Council (HCPC) maintains the statutory register for physiotherapists.

• Osteopathy and cranial osteopathy: the General Osteopathic Council (GOsC) maintains the statutory register for osteopaths. Cranial osteopathy is an approach practised by some registered osteopaths.

• Chiropractic: the General Chiropractic Council (GCC) regulates chiropractors in the UK.

• Craniosacral therapy: the Craniosacral Therapy Association provides information about the profession and its practitioners.

• Orofacial myofunctional therapy: the British Society of Myofunctional Therapy provides information about the profession and practitioners.

• Tongue-tie assessment and division: the Association of Tongue-tie Practitioners provides information about tongue-tie practice and professional standards. Its guidance can be considered alongside Choosing Your Tongue-tie Practitioner.

In England, providers carrying out regulated activities must meet the relevant Care Quality Commission (CQC) requirements. Further information about tongue-tie release and the regulatory context is available in Tongue-tie Release in England: UK CQC Requirements.

References

BASIS (n.d.) Safer sleep information. Available at: https://www.basisonline.org.uk/

Chen, A.I. et al. (2026) ‘Osteopathic manipulative treatment for the breastfeeding dyad: a scoping review’, Journal of Human Lactation, 42(3), pp. 595–619. doi: 10.1177/08903344261430249.

Cuccia, A. and Caradonna, C. (2009) ‘The relationship between the stomatognathic system and body posture’, Clinical Anatomy, 22(5), pp. 556–565.

Fons, D. et al. (2025) ‘Osteopathic manipulative treatment for management of feeding dysfunction in breastfed newborns’, Journal of Osteopathic Medicine, 126(8), pp. 383–391. doi: 10.1515/jom-2024-0133.

Geddes, D.T., Kent, J.C., Mitoulas, L.R. and Hartmann, P.E. (2008) ‘Tongue movement and intra-oral vacuum in breastfeeding infants’, Early Human Development, 84(7), pp. 471–477. doi: 10.1016/j.earlhumdev.2007.12.008.

Herzhaft-Le Roy, J., Xhignesse, M. and Gaboury, I. (2017) ‘Efficacy of an osteopathic treatment coupled with lactation consultations for infants’ biomechanical sucking difficulties: a randomized controlled trial’, Journal of Human Lactation, 33(1), pp. 165–172. doi: 10.1177/0890334416679620.

Krause, F., Wilke, J., Vogt, L. and Banzer, W. (2016) ‘Intermuscular force transmission along myofascial chains: a systematic review’, Journal of Anatomy, 228(6), pp. 910–918. doi: 10.1111/joa.12464.

Martinelli, R.L.C., Marchesan, I.Q., Gusmão, R.J., Rodrigues, A.C. and Berretin-Felix, G. (2014) ‘Histological characteristics of altered human lingual frenulum’, International Journal of Pediatrics and Child Health, 2(1), pp. 5–9. doi: 10.12974/2311-8687.2014.02.01.2.

Mills, N., Geddes, D.T., Amirapu, S. and Mirjalili, S.A. (2020) ‘Understanding the lingual frenulum: histological structure, tissue composition, and implications for tongue tie surgery’, International Journal of Otolaryngology, 2020, article 1820978. doi: 10.1155/2020/1820978.

Myers, T.W. (2020) Anatomy Trains: Myofascial Meridians for Manual and Movement Therapists. 4th edn. Elsevier.

Santos, H.K.M.P. de S. et al. (2023) ‘Effects of lingual frenotomy on breastfeeding and electrical activity of the masseter and suprahyoid muscles’, CoDAS, 35(2), e20210262. doi: 10.1590/2317-1782/20232021262.

The Lullaby Trust (n.d.) Safer sleep overview. Available at: https://www.lullabytrust.org.uk/baby-safety/safer-sleep-information/safer-sleep-overview/

Watson Genna, C. (2015) ‘Breastfeeding infants with congenital torticollis’, Journal of Human Lactation, 31(2), pp. 216–220. doi: 10.1177/0890334414568315.

Wilke, J., Krause, F., Vogt, L. and Banzer, W. (2016) ‘What is evidence-based about myofascial chains: a systematic review’, Archives of Physical Medicine and Rehabilitation, 97(3), pp. 454–461. doi: 10.1016/j.apmr.2015.07.023.