By Effath Yasmin, RCST®, IBCLC — Founder, Nourish & Nurture
Key takeaways
- A baby who can latch, move the tongue and suck may still struggle to organise those skills into a sustained, effective feed.
- Breastfeeding depends on coordinated sucking, swallowing and breathing that keeps adapting throughout a feed.
- Behaviours such as pulling off, arching or crying are information to investigate, not a diagnosis.
- Birth history gives context, but the baby’s current feeding presentation guides assessment.
- Biodynamic craniosacral therapy can widen clinical attention, alongside — not instead of — lactation science and medical assessment.
Exploring the relationship between infant feeding function, whole-body organisation, autonomic regulation and the inherent capacity for Health.
Adapted from my presentation, “Restoring the Breastfeeding Dyad: A Biodynamic Approach to Autonomic Regulation and Infant Feeding Function,” delivered at the Biodynamic Craniosacral Therapy Association of North America (BCTA/NA) Summit 2026.
The clinical inquiry that changed how I observe infant feeding
Much of my clinical work over the years has been shaped by curiosity, particularly when the observations before me do not entirely correspond with the explanations available to me. As an International Board Certified Lactation Consultant (IBCLC) and a Registered Craniosacral Therapist (RCST®), I have had the opportunity to examine infant feeding through two distinct yet potentially complementary disciplines. One provides a detailed understanding of lactation physiology, oral function, milk transfer and breastfeeding management, while the other invites a wider perceptual inquiry into the organisation of the living system, its adaptations and its inherent capacity for Health.
In working with mothers and infants experiencing complex breastfeeding challenges, I have repeatedly encountered situations in which the individual components required for feeding appear to be present, yet the infant remains unable to feed effectively. A baby may demonstrate adequate tongue movement, achieve attachment at the breast and initiate sucking, but struggle to sustain feeding or transfer sufficient milk. Another infant may demonstrate an organised sucking rhythm during a non-nutritive assessment, only to become distressed, disorganised or avoidant when milk flow is introduced. These observations have led me to question whether our conventional assessments, although essential, always capture the full complexity of the feeding experience.
The distinction I have come to appreciate is that the presence of an individual functional capacity does not necessarily establish the infant’s ability to organise that capacity into a sustained, coordinated and adaptable activity. Breastfeeding requires much more than the mechanical ability to latch or move the tongue. It requires the integration of multiple physiological systems, each responding to changing demands while remaining coordinated with the others and with the maternal system.
This understanding has gradually shifted my clinical attention from asking exclusively what is not functioning towards investigating how the infant is organising itself, where compensatory effort is being directed, what resources remain available and how the infant responds when those resources are supported. It has also brought me to a question central to my biodynamic practice: where is Health already expressing itself within the infant, even when feeding appears difficult?
Understanding the physiology before expanding the framework
An important principle in my clinical practice is that expanding our perspective should never mean abandoning established physiology. In fact, a wider clinical inquiry becomes meaningful only when it is grounded in a sufficiently detailed understanding of what the infant and maternal systems are required to accomplish. Breastfeeding is a dynamic interaction between two physiological systems, each contributing to and responding to the other. On the maternal side, milk synthesis, storage and ejection involve mammary gland function, endocrine regulation and local mechanisms that respond to milk removal. Prolactin supports milk synthesis, while oxytocin mediates milk ejection through the contraction of myoepithelial cells surrounding the milk-producing alveoli. On the infant’s side, effective milk removal depends on attachment, coordinated tongue and jaw movements, intraoral vacuum generation, swallowing and airway protection. These processes must remain sufficiently integrated for feeding to continue safely and effectively.
Our understanding of even these fundamental mechanisms has evolved considerably through scientific investigation. In 2005, Ramsay and colleagues published an ultrasound study of the lactating human breast that challenged anatomical descriptions which had remained largely unquestioned for decades. By examining 21 lactating women, the researchers demonstrated that the milk ducts were relatively superficial, readily compressible and did not exhibit the prominent lactiferous sinuses traditionally depicted beneath the areola. Their findings suggested that these ducts function primarily as pathways for milk transport rather than substantial reservoirs for milk storage. This research was significant not only because it revised our anatomical understanding, but also because it illustrated how established clinical assumptions can persist until better methods of observation become available (Ramsay et al., 2005). Wiley Online Library
I find this particularly relevant to the way we investigate infant feeding difficulties. If improvements in imaging technology can fundamentally alter our understanding of maternal breast anatomy, it is reasonable to remain equally curious about the infant’s feeding mechanisms, especially when clinical presentations do not correspond neatly with our existing explanatory models. Scientific knowledge advances when observations are examined carefully enough to challenge assumptions, and I believe that same intellectual discipline should inform our clinical assessments.
Research into infant sucking mechanics offers another example. Geddes and colleagues (2008) used submental ultrasound imaging alongside simultaneous intraoral vacuum measurements to investigate how infants extract milk during breastfeeding. Their findings demonstrated that the downward movement of the posterior tongue coincided with increasing intraoral vacuum and milk flow, with peak vacuum occurring when the tongue reached its lowest position. This provided important evidence that vacuum generation plays a major role in milk removal, challenging earlier explanations that emphasised a predominantly peristaltic stripping action of the tongue. What interests me clinically is the degree of coordination required for this process, because the tongue is not simply moving independently; its movement must be organised in relation to the jaw, the nipple, milk flow and the infant’s ongoing swallowing and respiratory activity (Geddes et al., 2008). ScienceDirect
The complexity becomes even more apparent when we consider the integration of sucking, swallowing and breathing. Sakalidis and Geddes (2016), in their systematic review of breastfeeding physiology, examined the mechanisms of milk removal and the coordination of sucking, swallowing and respiratory patterns in healthy term infants. Their review demonstrated that these relationships are variable, influenced by maturation and capable of changing within a single feeding session. This challenges the tendency to imagine feeding as a fixed sequence of discrete motor activities and instead directs our attention towards a continuously adapting physiological process. An infant must not only generate the movements necessary to extract milk but also respond appropriately to variations in flow, manage the milk bolus and maintain respiratory stability throughout feeding (Sakalidis & Geddes, 2016). PubMed
More recently, Genna and colleagues (2021) demonstrated the value of quantitative ultrasound analysis for examining tongue kinematics during infant feeding. Their work provided a means of assessing tongue movement patterns with greater precision and included observations of differences in sucking rhythmicity during breast and bottle feeding in an infant with torticollis. Such findings are particularly interesting because they invite us to consider how oral motor performance may vary in relation to the broader functional presentation of the infant. However, they do not independently establish that a particular fascial restriction or bodywork intervention causes or corrects a feeding difficulty. Rather, they offer a scientific basis for asking more precise questions about the relationships between posture, movement, coordination and feeding performance (Genna et al., 2021). The Physiological Society
From individual function to whole-system organisation
The more closely we examine feeding physiology, the more evident it becomes that identifying individual functional capacities is only one part of understanding an infant’s feeding performance. An infant may demonstrate an adequate non-nutritive suck during assessment but become disorganised when milk flow introduces the additional demands of swallowing and respiratory coordination. Similarly, a baby may achieve an apparently effective latch but gradually lose rhythmicity, become fatigued or demonstrate increasing compensatory effort as feeding progresses. In such circumstances, it may be insufficient to conclude that the infant possesses normal oral function simply because certain movements can be elicited during examination. We must also investigate whether those movements can be integrated and sustained within the complete feeding task.
I use the term organisation to describe this integration of individual capacities into a coordinated functional activity. It is important to distinguish this clinical use of the term from the broader perceptual meaning of organisation within biodynamic craniosacral therapy. In feeding assessment, organisation refers to observable relationships between posture, oral movement, swallowing, respiration, behavioural state and milk transfer. In biodynamic practice, the term may describe a practitioner’s perception of coherence or ordering within the whole system. Although these perspectives may inform my clinical curiosity, they represent different kinds of observations and should not be treated as equivalent forms of evidence.
This distinction has become increasingly important in my work because I am interested not merely in whether an infant can perform a function, but in how effectively that function can be sustained and adapted under changing conditions. The ability to latch does not necessarily establish efficient milk transfer, just as the ability to suck does not guarantee that the infant can coordinate swallowing and breathing throughout a feed. Capacity describes what is available to the infant, whereas organisation concerns how those capacities function together.
Adaptability reveals how effectively that organisation responds when the demands of feeding change.
Behaviour as information rather than explanation
One of the challenges in clinical practice is that feeding difficulties frequently present through behaviour before their underlying mechanisms become apparent. An infant may pull away from the breast, arch, cry, repeatedly detach and reattach, become unusually sleepy or demonstrate apparent refusal. These behaviours are often described using terms such as oral aversion, feeding resistance, poor latch or disorganised sucking. Although such descriptions can be useful, they may also lead us towards premature explanations if we fail to distinguish what we have observed from what we believe those observations mean.
When an infant repeatedly pulls away from the breast, for example, the behaviour itself does not establish whether the infant is responding to rapid milk flow, discomfort, airway challenges, sensory demands, fatigue or an accumulation of previous feeding experiences. Similarly, an infant who becomes distressed when feeding is initiated may be demonstrating a protective or avoidant response, but the presence of distress does not independently establish its cause. The clinical responsibility is to investigate the conditions under which the behaviour occurs, what changes when those conditions are modified and whether the infant demonstrates an ability to recover when appropriate support is provided.
This is where I have found the principle of recovery as clinical data particularly valuable. Rather than observing only the moment of difficulty, I am interested in how the infant returns towards functional organisation. When positioning is adjusted, milk flow is managed differently, feeding demands are reduced or the infant is given an opportunity to settle, what changes in the observable feeding pattern? Does the infant regain rhythmic sucking, demonstrate more effective swallowing, sustain attachment or recover from distress without further escalation? Such observations can provide information about the infant’s available capacities and the circumstances that support or challenge their expression.
This approach does not replace investigation of medical, anatomical or physiological causes. Persistent coughing, choking, poor growth, respiratory difficulty or other concerning feeding signs require appropriate clinical assessment and, when indicated, medical referral. Rather, observing the infant’s response to support adds another dimension to our understanding of function and adaptability, allowing us to investigate not only the presence of difficulty but also the conditions under which feeding becomes more manageable.
The significance of the infant’s prenatal and birth history
An infant’s feeding presentation does not emerge independently of the developmental journey that precedes it. From intrauterine development through labour, birth and early postnatal adaptation, the infant undergoes a succession of physiological and mechanical experiences that contribute to the circumstances in which feeding is established. The transition from intrauterine to extrauterine life requires substantial changes in respiration, circulation, sensory processing and behavioural regulation, while birth itself involves different patterns of compression, rotation, traction and positional adaptation depending on the circumstances and mode of delivery.
Within my clinical assessment, I therefore consider the infant’s prenatal, birth and early postnatal history alongside the current feeding presentation. I am interested in the infant’s position and movement preferences, postural asymmetries, range of motion, muscular tone, respiratory behaviour and responses to handling or feeding. These observations may help identify areas requiring further assessment, particularly when feeding difficulties coexist with persistent positional preferences or limitations in movement.
However, I am careful not to assume that a particular birth experience necessarily explains a subsequent feeding difficulty. A Caesarean birth, instrumental delivery or prolonged labour does not, by itself, establish the presence of cranial, fascial or neurological dysfunction. Equally, an apparently uncomplicated birth does not exclude the possibility of later feeding challenges. The infant’s history provides a context for inquiry, but the current clinical presentation must remain the primary basis for assessment and decision-making.
This distinction is especially relevant when working within therapeutic disciplines that place considerable emphasis on prenatal and birth experiences. While the developmental continuum can offer a valuable framework for understanding the infant’s journey, causal interpretations must remain proportionate to the available evidence.
Where is Health? The biodynamic orientation
An important contribution of biodynamic craniosacral therapy to my clinical thinking has been its orientation towards Health as an inherent organising principle of the living system. Within the biodynamic framework developed and articulated by Franklyn Sills, practitioners are encouraged to attend not only to expressions of restriction, strain or dysfunction but also to qualities of organisation, resource and coherence that may be perceived through trained therapeutic contact.
I find this orientation valuable because clinical assessment can so easily become dominated by the identification of problems. We examine what is restricted, what is inefficient, what is poorly coordinated and what requires correction. While such observations are necessary, they can inadvertently narrow our attention to dysfunction as though it represents the entirety of the infant’s presentation. The biodynamic question of where Health is expressing itself invites a different quality of inquiry, one that recognises the infant’s existing capacities and the possibility that meaningful resources may be present even within a difficult feeding experience.
In practical terms, this means remaining attentive to moments of functional organisation that might otherwise be overlooked. An infant who struggles to sustain feeding may nevertheless demonstrate periods of coordinated sucking, spontaneous postural adjustment, effective swallowing or recovery following distress. These observations do not negate the feeding difficulty, but they provide important information about capacities that remain available and may be supported.
The biodynamic framework also introduces a particular quality of practitioner presence. Before establishing contact, I attend to my own state, the quality of my attention and the relational circumstances in which the infant and caregiver are being met. Contact is negotiated through caregiver consent and continuous responsiveness to the infant’s behavioural cues, with the understanding that the infant’s responses should guide whether contact is maintained, modified or withdrawn. Within this receptive orientation, I may perceive changes in tissue tension, movement, settling or qualities of ease that biodynamic practitioners describe through concepts such as tissue motility, fluid tide, potency and dynamic stillness.
It is essential, however, to recognise that these concepts belong to the theoretical and perceptual framework of biodynamic craniosacral therapy and should not be presented as established physiological mechanisms. A practitioner’s perception of tissue ease or fluid movement does not independently demonstrate a change in circulation, autonomic function or neurological organisation. The clinical question remains whether any perceived change is accompanied by an observable and meaningful difference in the infant’s feeding performance, comfort, adaptability or regulation.
This is the intersection that continues to interest me: can the disciplined perceptual observations of biodynamic practice generate clinically useful questions that can subsequently be examined through established assessment methods and scientific investigation?
Restoring the breastfeeding dyad through a wider clinical perspective
When I return to the clinical experiences of baby A and baby N, I am reminded that breastfeeding difficulties are rarely experienced by the infant alone. They unfold within a relationship in which maternal physiology, emotional experience, feeding expectations and the infant’s functional capacities are continually interacting. In baby A’s case, ineffective feeding was accompanied by declining maternal milk production and the emotional weight of a previous breastfeeding experience that had not unfolded as her mother had hoped. In baby N’s case, persistent feeding difficulties and distress had created considerable uncertainty for a family who had worked extensively to establish breastfeeding.
Their journeys required more than an isolated examination of oral structures or latch technique. They required attention to feeding physiology, infant behaviour, maternal milk production, postural and functional observations, the feeding environment and the emotional experience of the mother–infant relationship. Over the course of their care, both infants progressed towards breastfeeding, illustrating the value of continuing to investigate complex feeding presentations rather than assuming that the initial difficulty necessarily defines the infant’s future capacity.
At the same time, I recognise that individual clinical outcomes cannot establish which component of care contributed to a particular improvement. When several interventions or forms of support are provided, changes in feeding may reflect multiple interacting influences, including maturation, improved feeding management, maternal milk production, changes in infant function and other factors. The significance of these cases therefore lies not in proving the effectiveness of a particular modality, but in demonstrating why a comprehensive and responsive clinical approach may be necessary when the presenting symptoms do not adequately explain the underlying feeding difficulty.
For me, restoring the breastfeeding dyad means attending to the conditions in which the mother and infant can participate in feeding with increasing effectiveness, responsiveness and confidence. It is not simply about achieving attachment at the breast, but about understanding the relationship between maternal milk availability, infant feeding competence, physiological adaptability and the experience of feeding itself.
The responsibility of clinical inquiry and future research
The development of lactation science provides a compelling example of how careful observation, technological advancement and scientific investigation can progressively refine clinical understanding. Research into breast anatomy, intraoral vacuum, tongue kinematics and suck–swallow–breathe coordination has challenged earlier assumptions and offered increasingly precise explanations of feeding physiology. These advances remind us that clinical knowledge should remain open to revision when better evidence becomes available.
I believe biodynamic craniosacral therapy has an important responsibility in this regard. If practitioners perceive meaningful changes in tissue behaviour, whole-system organisation or qualities of settling during therapeutic contact, the next step should be to investigate these observations with greater precision rather than assume that their physiological significance is already understood. We need to distinguish observation from interpretation, document our findings consistently, examine alternative explanations and explore whether perceived changes correspond with measurable clinical outcomes.
In infant feeding, this could involve systematically examining changes in sucking rhythmicity, milk transfer, postural function, behavioural regulation, feeding tolerance or recovery following appropriately defined interventions. Such investigations would require clear operational definitions, suitable comparison methods and an openness to findings that may support, refine or challenge existing therapeutic explanations. This is not an argument that all aspects of clinical experience can be reduced to a single measurement, but rather that claims about clinical effectiveness should be examined through methods capable of evaluating them.
My own inquiry has increasingly led me towards this distinction between what we know through established scientific investigation, what we observe in clinical practice and what we perceive through the specialised training of biodynamic craniosacral therapy. Each can contribute to the development of better questions, but they do not carry the same evidentiary status.
The future of integrative clinical practice, in my understanding, depends on our willingness to maintain these distinctions while continuing to investigate the relationships between them. Intellectual curiosity becomes most valuable when accompanied by the discipline to question our interpretations and the humility to revise our understanding.
Towards a more integrated understanding of infant feeding
What began for me as an inquiry into infants who could latch but could not sustain effective breastfeeding has gradually developed into a broader exploration of function, coordination, adaptability and whole-system organisation. The more closely I examine infant feeding, the more I recognise that its apparent simplicity conceals an extraordinary degree of physiological integration, involving multiple systems that must continuously respond to one another and to the changing demands of the feeding experience.
The contribution of biodynamic craniosacral therapy to my work has been to expand the quality of attention I bring to this complexity, particularly through its orientation towards Health, its emphasis on receptive observation and its invitation to recognise the infant as more than a collection of isolated functions. The contribution of lactation science has been to provide the physiological understanding, clinical assessment methods and measurable outcomes through which feeding function can be evaluated.
I do not see these disciplines as interchangeable, nor do I believe that one should be used to justify the assumptions of the other. Instead, I see an opportunity for a more thoughtful dialogue in which established science informs clinical understanding, careful observation generates new questions and biodynamic perceptual experience becomes a possible starting point for further investigation rather than a substitute for evidence.
Ultimately, the inquiry is not merely whether an infant can latch, suck or swallow, but how these capacities become organised into a sustainable feeding experience, what conditions support that organisation and how we can respond more effectively when it becomes difficult.
Perhaps our greatest opportunity as clinicians is not simply to become more skilled at identifying dysfunction, but to become increasingly precise in recognising function, understanding adaptation and investigating the conditions through which Health and feeding competence are expressed.
References
- Ramsay, D. T., Kent, J. C., Hartmann, R. A., & Hartmann, P. E. (2005). Anatomy of the lactating human breast redefined with ultrasound imaging. Journal of Anatomy, 206(6), 525–534. https://doi.org/10.1111/j.1469-7580.2005.00417.x
- Geddes, D. T., Kent, J. C., Mitoulas, L. R., & Hartmann, P. E. (2008). Tongue movement and intra-oral vacuum in breastfeeding infants. Early Human Development, 84(7), 471–477. https://doi.org/10.1016/j.earlhumdev.2007.12.008
- Sakalidis, V. S., & Geddes, D. T. (2016). Suck-swallow-breathe dynamics in breastfed infants. Journal of Human Lactation, 32(2), 201–211. https://doi.org/10.1177/0890334415601093
- Genna, C. W., Saperstein, Y., Siegel, S. A., Laine, A. F., & Elad, D. (2021). Quantitative imaging of tongue kinematics during infant feeding and adult swallowing reveals highly conserved patterns. Physiological Reports, 9(3), e14685. https://doi.org/10.14814/phy2.14685
Based on the presentation delivered at the BCTA/NA Summit 2026.
About the author
Effath Yasmin is an International Board Certified Lactation Consultant (IBCLC) and Registered Craniosacral Therapist (RCST®), and the founder of Nourish & Nurture in Malad East, Mumbai. Read more about Effath.
Is your baby struggling to feed? We offer lactation consultations, tongue tie assessment and craniosacral therapy for babies and breastfeeding in Mumbai and online. Book a session or call +91 98200 06706.
This article is for educational purposes and does not replace individual assessment. If your baby has persistent coughing, choking, poor weight gain or breathing difficulty during feeds, seek medical advice promptly.
Featured image by pvproductions on Freepik.