3/25/2021

Back to Baseline:
Normal anatomy & physiology
of infant feeding.
Shondra Mattos, IBCLC
Bryna Sampey, IBCLC

Disclosures
Speaker disclosed they are a consultant with Doula My Soul LLC and perinatal course provider, speaker and educator for parents and
professionals in private practice.
Speaker discloses private practice, business consultant, and provider of courses through Mattos Lactation
Review of the educational activity by the planning committee concluded there is no commercial bias; there is a balance in presentation,
evidence-based content and or other indicator of integrity. There are no conflict of interests for this activity for planners nor content
reviewers.
This continuing education activity was approved by the following:

• This continuing education activity was approved by ANA-Massachusetts, an accredited approver by the American Nurses Credentialing
Center’s Commission on Accreditation until March 29, 2023
• This continuing education activity has been reviewed and is acceptable for credit by the American Academy of Family Physicians.
Physicians should claim only the credit commensurate with the extent of their participation in the activity
• GOLD is a long-term provider with the International Board of Certified Lactation Consultants
• This activity was also approved by The Midwifery Education Accreditation Council (MEAC)
• This activity was also approved by The Commission on Dietetic Registration

• Upon completion of this activity, GOLD delegates will be able to download an educational credit for this talk. Successful completion
requires that you:

• View this presentation in its entirety, under your individual GOLD login info
• For GOLD Learning Lecture Library participants, successfully complete a post-test (3 out of 3 questions correctly answered)
• Fill out the Evaluation Survey
2

1
 3/25/2021

Back to Baseline:
Normal anatomy & physiology
of infant feeding.
Shondra Mattos, IBCLC
Bryna Sampey, IBCLC

Objectives
1. Describe difficulties to other providers

2. Explain in simple terminology to parents what’s going on

3. Discuss what strategies will improve muscular movement, tone, and strength

This content will be available on the GOLD Learning Lecture Library until March 29 , 2024.

2
 3/25/2021

Meet the Speakers

Shondra Mattos
“Muscles were the first aspect of
lactation that fascinated me. The
infant face may be small, but it
impacts so much. Oral function is
exciting– I immediately knew it
was something I wanted to be
known for in this field.”

Meet the Speakers

Bryna Sampey
“I’m enamored with muscle
function in babies as it relates
to breast and chest feeding,
bottle feeding, and reflex
expression! I also spend a lot of
time and focus on the muscles
of the parent’s body, as well.”

3
 3/25/2021

Why “Back to Baseline”?

We believe that if lactation
professionals understand normal
physiology, they will better be able
to educate and help the families our
profession serves.

It is impossible to evaluate
completely without a clear
understanding of normal function.

COI & DISCLOSURES

• Shondra:
• I own a private practice in NC & an US based organization that focuses on continuing education for
lactation professionals
• I am paid for my lectures for professionals
• My views are my own and do not represent those of any other entity.
• I have cited my sources where applicable and verify the following information is true and evidence-
based, to the best of my understanding.
• Bryna:
• I own a private practice lactation and doula company in the PNW.
• I am paid for my lectures for parents & professionals.
• I own the images and video I have contributed, and I have permission to use them for educational lecture purposes.
• I benefit from white, middle-class socioeconomic privilege.
• My views are my own and do not represent those of any other entity.
• I have cited my sources where applicable and verify the following information is true and evidence-based, to the best
of my understanding.

4
 3/25/2021

bird’s
eye
view

Areas of anatomy Muscles that are recruited

controlling feeding to support multiple
functions

Introduction to muscle function

Muscle Tone Muscle Strength
• Level of reactivity to stretch • The amount of force created
by contraction of the muscle
in response to resistance
• Can be
• neutral (normal)
• hyper- (meaning over) • Can be weak or strong
• hypo- (meaning under)
• spastic (meaning inconsistent)
• flaccid (meaning nonresponsive)

10

5
 3/25/2021

What does normal feel like?

when you’re palpating muscle
• Neutral: Firm but with some bounce or give, like a trampoline.
• Contracted: Firm, with very little give, like a carpeted floor.
• Spastic: Firm and soft in turns, without external stimuli.
• Hyper-: Firm, without any relaxation over an interval.
• Hypo-: Soft, with very little contraction in response stimuli.
• Flaccid: Soft, like jelly, with no response to stimuli.

11

Embryology of muscles
(muscle development
in utero)
• Muscles are formed in
the Mesoderm layer
• By 9 weeks gestation
most core skeletal
muscles are formed
• Myofiber Activation
age: 12 weeks
• By 13 weeks: "strength
training" begins via
increased in-utero
activity

12

6
 3/25/2021

Embryology of muscles
Striated muscle is formed from
myoblasts.

Fibronectin growth factor (fgf) is

essential to help the muscle cells align
into “bundles.”

Calcium ions cause them to bond.

They’re surrounded by connective

tissue and formed into groups, making
individual muscles.

Unused muscle precursor cells are

stored in the connective tissue as
“satellite cells” which are essential for
muscle strengthening & repair.

13

Neighborhood: NECK
Function: Composed of:
Extension & • Obliquus Capitis
Flexion Superior muscle
• Scalenes
• Traps
Primarily
posterior neck • Semispinalis
muscles
muscles • s. Capitis
responsible for • s. Cervicis
movement of
extension.

14

7
 3/25/2021

Video

15

Neighborhood: NECK
Function: Composed of:
Extension & • Obliquus Capitis
Flexion Superior muscle
• Scalenes
• Traps
Primarily
posterior neck • Semispinalis
muscles
muscles • s. Capitis
responsible for • s. Cervicis
movement of
extension.

16

8
 3/25/2021

Obliquus Capitis Superior muscle

• Attachment:
Transverse process
(lateral mass) of the
atlas & external aspect
of Occipital bone

• Bilateral contraction
extends the neck.
Unilateral contraction
flexes head to
ipsilateral side

17

Scalenes
• Set of 3 muscles

• Anterior: A. tubercles of
the transverse processes of
C3-C6, first rib
• Medius: P. tubercles of the
transverse processes of C2-
C7,first rib
• Posterior: P. tubercles of
the transverse processes of
C5-C7, second rib

• Bilateral contraction of
anterior scalene causes anterior
flexion of the neck. Unilateral
contraction flexes head to
ipsilateral side (all three)

18

9
 3/25/2021

Trapezius

• Attachment: External aspect

of occiput to spinous process of
T12

• Extends the head at neck &

stabilizes the shoulder blades

19

Semispinalis muscles
• Attachment: C4-t6 to
external aspect of the
Occipital bone between
superior & inferior nuchal
lines

• Bilateral contraction
extends head. Unilateral
contraction - lateral
flexion of head, head
rotation

20

10
 3/25/2021

Neighborhood: Lips & Cheeks

• Varied in function

• Orbicularis Oris acts as an anchor

• Orbicularis Oris
• Zygomaticus
• Risorius
• Mentalis
• Depressor anguli oris
• Levator Labii Superioris
• Buccinator

21

Video

22

11
 3/25/2021

Neighborhood: Lips & Cheeks

• Varied in function

• Orbicularis Oris acts as an anchor

• Orbicularis Oris
• Zygomaticus
• Risorius
• Mentalis
• Depressor anguli oris
• Levator Labii Superioris
• Buccinator

23

Orbicularis Oris
• Own Fibers & fibers from
surrounding muscles
(buccinator)

• Attachment: dermis of the

lips, modiolus

• Needs good tone, relaxed

with little to no activation
during feeding

24

12
 3/25/2021

Mentalis • Elevates, everts & protrudes

lower lip

• Attachment: Mandible,
fibers from the Orbicularis
Oris, skin of chin

• Needs good tone, engaged

(active) during feeding

25

Depressor Anguli oris

• Pulls corners of the

mouth down

• Attachment: Base of
the mandible to
modiolus
• Needs good tone,
relaxed during feeding

26

13
 3/25/2021

Buccinator
• Brings cheeks in towards gums, assists in
closing the mouth

• Attachment: Alveolar process of maxilla,

buccinator ridge of mandible to Modiolus

• Needs good tone, relaxed during feeding

27

Zygomaticus (major)
• Elevates & everts angle of
the mouth

• Attachment: Zygomatic
process to Modiolus

• Needs to be supple &

relaxed during feeds

28

14
 3/25/2021

Risorius
• Extends angle of the mouth laterally

• Attachment: Buccal skin to Modiolus

• Needs good tone, should be soft &

relaxed during feeding

29

levator labii superioris

• Elevates upper lip

• Attachment: Front of
maxilla to skin of upper lip

• Needs good tone, should

be engaged (active) during
feeding

30

15
 3/25/2021

Neighborhood: Jaws
Function:
Mandibular movement,
Tongue support

• Masseter
• Temporalis
• Lateral Pterygoid
• Medial Pterygoid

31

Video

32

16
 3/25/2021

Neighborhood: Jaws
Function:
Mandibular movement,
Tongue support

• Masseter
• Temporalis
• Lateral Pterygoid
• Medial Pterygoid

33

Masseter
• Elevates and protrudes
mandible.

• Attachment: Mandible,
zygomatic arch.

• Needs good tone, engaged

(active) during feeding. Should not
be contracted during feeding.

34

17
 3/25/2021

Temporalis
• Elevation and retraction of
mandible

• Attachment: Temporal bone,

mandible

• Needs good tone, relaxed

(not contracted) during
feeding. Observe for mild-to-
moderate engagement during
feeding.

35

Medial Pterygoid

• Protrusion, elevation, side to

side movement of the
mandible

• Attachment: Medial surface

of ramus, Sphenoid & palatine
bone

• Contracts with mouth closing

36

18
 3/25/2021

Lateral
Pterygoid
• Depresses & Protrudes the
Mandible

• Attachment: Condyle of the

TMJ, Sphenoid & pterygoid
plate

• Contracts to open Jaw

37

Neighborhood: Tongue
• Includes suprahyoid muscles

• Vacuum, Seal, Swallowing, and airway

protection/stability
• Genioglossus
• Mylohyoid
• Stylohyoid
• Styloglossus
• Digastricus
• Styloglossus
• Hyoglossus

38

19
 3/25/2021

Video

39

Neighborhood: Tongue
• Includes suprahyoid muscles

• Orbicularis Oris acts as an anchor

• Genioglossus
• Mylohyoid
• Stylohyoid
• Styloglossus
• Digastricus
• Styloglossus
• Hyoglossus

40

20
 3/25/2021

Video:
Tongue Anatomy

41

Genioglossus
• Protrudes & Depresses the tongue

• Attachment: Inner surface of

mentalis, dorsum of the tongue,
hyoid bone

42

21
 3/25/2021

Styloglossus
• Elevates & retracts the
tongue

• Attachment: Tip of the

Styloid process, fibers of
the hyoglossus & inferior
longitudinal muscles

43

Geniohyoid
• Elevation of hyoid bone,
draws hyoid anteriorly,
shortens mouth floor, Can
assist in mouth opening

• Attachment: Inner surface of

Mentalis, hyoid bone

44

22
 3/25/2021

Mylohyoid
• Elevation of hyoid bone,
depression of mandible

• Attachment: Mandible,
mylohyoid raphe, hyoid bone

45

Diagastricus
• Elevation of hyoid bone,
depression of mandible

• Attachment: Mandible,
temporal bone (mastoid notch),
hyoid bone

46

23
 3/25/2021

Stylohyoid
• Elevation of hyoid
bone, draws hyoid posteriorly

• Attachment: Styloid process,

hyoid bone

47

48

24
 3/25/2021

The Bridge
Sternocleidomastoid (SCM)
Hyoid Muscles
Genioglossus

49

Video

50

25
 3/25/2021

The Bridge
Sternocleidomastoid (SCM)
Hyoid Muscles
Genioglossus

51

Sternocleidomastoid
• Left and right head turning

• Attachment: Sternum,
clavicle, mastoid

• Should be relaxed, bilaterally

even in tone to facilitate good
feeding on both sides of
parent’s body.

52

26
 3/25/2021

Genioglossus

• Protrusion of tongue,
depression of center of tongue

• Attachment: mandible,
intrinsic muscles of tongue

• Needs good tone, engaged

(active) during feeding

53

Hyoid Muscles
• Elevation and depression of
hyoid bone, floor of mouth

• Elevation and retraction of

tongue

• Attachment: Hyoid bone,

mandible, skull

• Needs good tone, should be

engaged (active) during feeding

54

27
 3/25/2021

Key Points to remember

• tongue muscles are complex
• tension or restriction can
impact all or part of a muscle
• understanding how all the
components work together is
essential to understanding
what is and isn’t functional
• crucial to have a baseline
understanding of “normal”

55

Thank you!
Contact Shondra: Contact Bryna:
shondra@mattoslactation.com bryna@doulamysoul.com
Social: @mattoslactation Social: @doulamysoul

56

28