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What's a baby got to be tense about? (What is tension?)

If you've been following me on Instagram, I've been sharing some resources from others regarding infants, "tension", feeding, and development. "Tension" seems to be a hot term these days. But why would a baby be tense? Certainly they aren't worried about how the stock market is doing, or the state of the pandemic. Their boss isn't hounding them about their productivity standards... What causes "tension" in babies and how does PT help?

To answer this, let's talk about what some practitioners mean when they refer to "tension" in babies.

Digestive discomfort:

When you visit the pediatrician or are working with an IBCLC or lactation professional, often the practitioners are assessing your baby head to toe and typically asking how feeding and digestion are going. They will ask about how often baby is soiling diapers, and advice may vary on how often is "normal" in breastfed babies. You as the parent may have picked up on signs of digestive discomfort such as reflux or excessive spitting up, difficulty burping after feeds, gassy tummy, colic or other behaviors which can be indicative of digestive discomfort such as arching the back during or after feeds.

Positional clues:

Your doctor, LC, or you may pick up on some observations such as balled or clenched fists, elevated shoulders, a preferential side toward which baby turns and/or tilts their head, or a curvature or rotation of the whole torso (see pic below of my youngest). Baby may snore and sleep or rest with their mouth open.

Observations of increased "tension" in newborns may be balled or clenched fists, elevated shoulders, a preferential side toward which baby turns and/or tilts their head, or a curvature or rotation of the whole torso.

Behavioral signs:

Some other things may be increased fussiness or crying (aka colic), discomfort in the carseat, poor tolerance to tummy time, difficulty putting baby down to sleep (wants to contact nap or difficulty transferring from arms to crib).

Feeding difficulty:

Increased tension is commonly associated with difficulty feeding for many reasons, one of which could be the presence of tethered oral tissues (a tongue tie and/or lip tie). Often with ties (and often without!), there is oral motor dysfunction due to restricted range of motion of oral structures. Tension or increased tone in the upper body may result from baby compensating for those restrictions (sort of like how you might walk differently if you had pain or wore a walking boot on your foot from an injury). You may experience this as having pain while breastfeeding or nipple trauma, notice baby clamps down, grips your breast with their lips, has a shallow latch, or pops on and off the breast or bottle frequently. If you're feeding bottles, you might notice baby collapses the nipple, or has difficulty managing the flow. Gagging, choking/coughing, dribbling, clicking noises and difficulty coordinating breathing are all signs you should see a lactation consultant whether you are breastfeeding or bottle feeding, or possibly a therapist (such as myself, and/or a speech or occupational therapist, preferably one who understands oral ties) for an evaluation. The presence of tongue or lip ties are another symptom of midline tissue restriction that often co-occurs with these other issues.

Tomato, tomAHto

My feeling is that the word "tension" has become a catchall. Yes, some of these issues can be due to tone, tightness, weakness, restricted range of motion, etc. And "tension" may be a comfortable term to describe what can sometimes physically manifest as the things I described above. But in therapy terms, there is so much more to unpack. In PT terms, we recognize these things as nervous system dysregulation, compensation, neuro-motor dysfunction, and habitual/positional problems that require parent/patient education, skilled manual therapy (sometimes referred to in this population as 'bodywork'), and activity modification. My approach is, and has always been, to empower clients to understand what's happening and to teach them how to manage it. So, while this might sound like a lot of complicated stuff, in my view, it's important for parents to understand because you are the ones advocating to your other providers on the need for this. So, it's important for therapists to utilize and teach terminology that is recognizable to other healthcare providers. Therefore, I try and provide descriptions and education for better communication for all involved in the care plan, utilize evidence-based practices as often as possible, and instruct clients in how to manage in a hands-on manner on their own.

We will work as a team to optimize your baby's outcomes and help you get on track with your breastfeeding or developmental goals.

So, how does PT help?

Physical therapy can sometimes catch these signs early, teach you about positioning, provide manual therapy and teach you the techniques to relieve tissue restriction and keep your baby rolling along with sequential development, and provide education with respect to avoidance of things which can contribute to flat spots or molding of the head. We can assess and guide you in positioning and ergonomics for feeding, holding, and wearing or carrying your baby. We can educate you on your baby's reflexes and neurological regulation, developmental progression, and help anticipate when issues may arise in the future. Together with you, your lactation consultant, pediatrician, and any other providers you're working with, we will work as a team to optimize your baby's outcomes and help you get on track with your breastfeeding or developmental goals.

My next article will break down some of the specific ways you can help your baby!

If you have questions, please feel free to comment or click the button below to send me an inquiry!

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