Breastfeeding Difficulties: When the Problem Isn't What You Think

You've had the latch checked. You've seen the midwife, the health visitor, maybe a lactation consultant. You've tried every position, every pillow, every tip from every website. And you're still struggling.

If that sounds familiar, I want to tell you something that might reframe everything: the problem might not be where everyone's been looking.

Breastfeeding difficulties are almost always approached as a feeding problem — a positioning problem, a latch problem, a supply problem, or a tongue-tie problem. And sometimes they are exactly that. But in my experience, working with hundreds of families as both an osteopath and an accredited infant feeding coach, the most common reason feeding doesn't improve despite good feeding support is that there's a physical component — in the baby's body — that hasn't been addressed.

And that physical component isn't something a lactation consultant, midwife, or health visitor is trained to find. It's something an osteopath is.

The piece that's most often missing

A baby's ability to feed effectively depends on a remarkable combination of oral function, muscle coordination, neck movement, jaw alignment, and cranial mechanics — all working together in perfect synchrony, dozens of times a minute, for every single feed.

When any of these pieces aren't working freely, the whole system is affected. A baby with tension in the base of the skull may struggle to open their jaw wide enough for a deep latch. A baby with tightness on one side of the neck may only feed comfortably on one breast, or from one position. A baby with restricted tongue movement may tire quickly at the breast, taking in air as they work harder to compensate. A baby in general discomfort — from a long labour, a rapid delivery, a difficult position in the womb — may arch away from the breast, push off, or simply seem too distressed to settle into feeding at all.

None of these things show up in a standard feeding assessment. They're not visible from observing a latch. They require hands-on assessment of how the baby's body is actually moving and functioning — which is exactly what an osteopathic assessment involves.

Why feeding support alone sometimes isn't enough

Feeding support — from a midwife, health visitor, lactation consultant, or breastfeeding peer supporter — is invaluable, and I work closely with many of these professionals. But it's designed to optimise feeding technique: positioning, attachment, milk removal, supply. It's not designed to assess or treat the physical restrictions in a baby's body that can make optimal feeding mechanically impossible, however good the technique.

This is why some families spend weeks working with feeding support professionals, doing everything right, and still not getting there. The technique is sound. The advice is right. But the baby can't execute what's being asked of them because something in their body is in the way.

Once that physical piece is addressed — through cranial osteopathic treatment — many families find that the feeding support advice they'd already been given suddenly starts working. Not because the advice changed, but because the baby's body is finally able to act on it.

Tongue-tie: important, but not always the whole story

Tongue-tie is one of the most common explanations parents are given for breastfeeding difficulties, and sometimes it really is the primary factor. But in my experience, it is frequently only part of the picture — and occasionally not the significant factor at all.

As an accredited tongue-tie assessor and infant feeding coach, I assess tongue function as part of a full feeding assessment — looking not just at whether a frenulum is visible, but at whether the tongue is actually restricted in a way that is affecting feeding, and what else might be contributing alongside or instead of that restriction.

What I often find is that a baby has both a tongue-tie and significant neck and jaw tension — and that releasing the tongue-tie without addressing the physical tension leaves the baby with a tongue that can now move more freely, but muscles and joints that still aren't working as they should. Osteopathic treatment before or after a frenotomy — or instead of one, in cases where the restriction isn't the dominant factor — can make a substantial difference to the final feeding outcome.

What actually happens when you come to see me

Your appointment will start with a conversation — about your pregnancy, your birth, what feeding has been like, and what you've already tried. I'll ask about your baby's behaviour at the breast: do they latch and slip off? Feed for very short bursts? Prefer one side? Seem frustrated or distressed? Click during feeds? These details help build a picture of what's likely going on before I even assess your baby.

I'll then carry out a physical assessment — looking at how your baby moves their head and neck, how they open their jaw, how the tongue functions, and how freely the cranial bones and base of the skull are moving. This is gentle and unhurried, and your baby will often feed during the appointment, which gives me a chance to observe the feeding directly as well.

From there, I'll give you an honest picture of what I've found and what I think is driving the difficulties — whether that's a physical restriction I can treat, a tongue-tie that warrants referral, a combination of both, or something that's more likely to be addressed through adjusted feeding technique. I won't recommend treatment that I don't think is going to make a difference, and I'll always signpost you to other professionals where that's the better next step.

You don't have to have exhausted every other option first

Many families come to me after weeks or months of struggling. I wish more of them came earlier — not because earlier is always better clinically, but because those weeks and months of difficult feeding take a real toll. On the baby, on the mother's confidence, on the breastfeeding relationship, and on the physical experience of feeding when sore nipples and a baby who won't settle at the breast become the norm.

If feeding isn't working and you've been told everything looks fine, or you've had a frenotomy that didn't make the difference you hoped for, or you're simply at a loss — please don't assume you've run out of options. There may be a physical piece that hasn't been looked at yet.

You can read more about osteopathy for babies and children and tongue-tie assessment, or book an appointment directly. And if you'd like to talk through whether coming to see me makes sense before you commit to booking, I'm always happy to have that conversation on the phone first.

Feeding is hard enough. You shouldn't have to figure this out alone.

— Sally