Written by Elizabeth Donnellan, Director & Physiotherapist
We did everything right with feeding — so why is my baby still unsettled?
Your midwife checked the latch. Your lactation consultant watched a full feed, maybe more than once. You've had your supply checked, tried a nipple shield, perhaps even had someone look at a possible tongue tie. And yet your baby is still unsettled — arching, feeding for what feels like hours, happy on one side and miserable on the other, or just generally "colicky" with no clear reason why.
If this sounds familiar, you're not imagining it, and you haven't missed something obvious. There's often a piece of the puzzle that simply isn't part of a standard feeding assessment — because it isn't about the feeding technique at all. It's about the baby's own body.
What usually gets checked
Feeding support is normally built around three things: how the baby is attaching (the latch), how the baby is positioned, and what's happening with supply — often checked by looking at the breast or nipple after a feed. There’s no way to actually know what a women’s milk supply is - a breast pump mimics but is not exactly the same as a suckling baby, so the volume expressed cannot be an exact indicator.
This is genuinely valuable, well-established care, and it solves a lot of feeding difficulties. It's just not designed to look at one thing: whether the baby's own body is physically able to do what feeding requires.
What's rarely checked: tension and restriction in the baby's body
Birth — however it happens — can leave a baby with areas of tightness or restriction, most commonly through the neck (often called torticollis) but sometimes through the wider body as well. A baby with this kind of tension may:
• Strongly prefer turning their head one way
• Seem uncomfortable or unsettled feeding on one particular side
• Arch, twist, or resist certain positions
• Struggle to stay settled through a feed even when latch and supply look fine
None of this shows up when someone watches the feed or checks the breast — because the issue isn't in the mechanics of the latch, it's in what the baby's body will physically allow.
It's also worth knowing this tightness doesn't only come from the birth itself. By the final months of pregnancy, babies have much less room to move — and for some, that means settling into one position for a long stretch of time before they're even born. Babies from a multiple pregnancy (twins or more) tend to have even less space, which is part of why tightness and one-sided preferences are more common for them too.
It's not just the neck — the mouth matters too
Oral function is the other piece that's easy to miss. A tongue tie or oral restriction is sometimes noted visually, but whether it's actually restricting movement — the tongue's ability to lift, extend, or move freely — is a different question, and one that needs a hands-on functional assessment rather than a look in the mouth.
Our speech pathology and physiotherapy team are trained specifically in this kind of assessment — checking how the baby's mouth is actually functioning, not just how it looks — and where a restriction is present, providing targeted stretches and exercises to support it.
Why this piece often gets missed
This isn't a criticism of the care families are already getting — it's a gap in how the system is set up, and it's worth understanding:
• Lactation consultants (IBCLCs) are experts in feeding mechanics — latch, positioning, supply. A structural assessment of the baby's neck, body, or oral movement sits outside that scope.
• Child health nurses are often the first free support families see, and they do a genuinely great job — but they hold a child health nursing qualification, not an IBCLC credential, and because they work within Queensland Health, they aren't able to point families toward private services. So a family can go through this entire pathway and simply never hear that a physio or speech pathology assessment is an option — not because it wouldn't help, but because it's not something that pathway can refer to.
What a physio or speech pathology feeding assessment actually involves
It's a hands-on, low-pressure look at the baby themselves — checking movement and tension through the neck and body, and function through the mouth — followed by practical stretches or exercises where they'd help. It's not about redoing the feeding support you've already had; it's about checking the one part that usually hasn't been looked at yet.
If any of this sounds familiar, our baby drop-in and screening sessions are a simple, no-pressure way to get that piece checked. [Book a screening session →]
FAQs
Is this instead of seeing my IBCLC or lactation consultant?
No — it's a complement to that support, not a replacement. Lactation support looks at feeding mechanics; a physio or speech pathology assessment looks at the baby's own body and mouth function. Many families see both.
What age can a baby be assessed from?
From birth. In fact, the earlier a restriction is picked up, the simpler it usually is to help resolve.
Does this mean my baby has a tongue tie?
Not necessarily. A restriction can be present with or without an obvious tongue tie, and a tongue tie can also be present without significantly restricting movement. That's exactly why a functional assessment — not just a visual check — matters.
My baby's feeding is only "a bit" difficult, not severe — is it still worth checking?
Yes. Tension and restriction sit on a spectrum, and smaller issues are often easier to help early, before they've had time to affect feeding, sleep, or comfort more broadly.