The Connection Between Oral Tension, Neck Restrictions, and Head Shape

As a therapist and mom, I am always looking for the “why” behind the occurrence of events. One puzzling topic is the connection of oral ties, neck tension, and head shape changes among infants. When asking a parent of a child with torticollis if their baby has (or had) latching issues, they will likely respond yes. The baby favored a side when turning their head and therefore exhibited a preference on that same side when turning the head to latch.

But, why does this occur!? And why, if a baby has oral tension or oral ties, do they often have a strong head turn preference or even develop torticollis?

There are a few reasons, so I am here to help you understand this interaction between oral ties, neck tension, and head shape changes.

So, first, what is an oral tension?

Oral tension is any restriction in the oral movement that affects functional movements. These functional movements may be sucking and swallowing early in infancy and language and speech in childhood. In early infancy, there can be oral tension present that may result in inability to move the tongue efficiently for feeding. This can result in air in-take during feeding, difficulty nursing, or breast pain when the baby nurses. In later infancy, tension may inhibit the child’s ability to make certain sounds. In this article, we will be focusing on the infancy stage when considering the affects of oral tension. Oral tension can be caused by an oral tie, but oral tension does not always indicate a tie.

In the oral cavity, there are strands of connective tissue, called frenulums. These frenula connect one area to another. There are frenulums that connect the tongue to the bottom of the mouth. These frenulums also connect the lips (top and bottom) to the gums. There are also cheek frenula. If these frenulums are tight, a frenulectomy may be needed to release the connective tissue tightness. This, in common terms, is called an oral tie release. This release will reduce the restriction and support proper oral motor movement.

There are several types of oral ties, but I will not go into the specifics because I am no oral tie expert. For the purpose of this article, we will focus on oral TENSION and it’s affect on neck mobility. It’s important to note, as stated above, that oral tension can be causes by a tie but a tie is not required for oral tension to be present.

This article will focus on the restriction in movement of the tongue due to muscle tension. We will focus specifically on where the tongue originates and inserts.

The tongue is a large muscle that inserts to the hyoid bone. This hyoid bone is a bone that is just below the chin and at the top of the neck. This hyoid bone has many muscles attached and moves upward and downward to control the movements required for sucking and swallowing. The mobility of this bone is very important in these sucking and swallowing movements.

The other muscles that attach to the hyoid bone, in addition to the tongue, are above and below. The muscles above the hyoid are called the suprahyoids and the muscles below the hyoid is called the infrahyoid. The suprahyoids control the upward movement of the hyoid bone, particularly sucking movements. The infrahyoids control downward movement of the hyoid particularly when opening your mouth. All of these muscles work together in oral motor patterns due to the movement of the hyoid bone and the engagement of the attached muscles. These muscle movements and mobility are crucial in sucking patterns in early infancy feeding.

The important part to note is that the infrahyoid bone inserts at the same level as a neck muscle that is very important in neck and head rotation. This connection is VERY IMPORTANT and we will revisit this topic below ⬇️

So, now let’s talk about neck tension.

Neck tension can manifest in multiple ways, but the common definition is usually classified as torticollis. Neck tension is often due to in-uterine crowding, multiple births, premature delivery, breeched position and many other factors not listed.

There can be neck tension present without the diagnosis of torticollis. This can present as a strong turn preference or an overactive side of the neck which causes the baby to prefer a side when sleeping, lying, and/or traveling in a car seat. This tension usually is spherical and affects many muscles, but a main muscle affected is the sternocleidomastoid (or SCM). This muscle is a long sheet that runs from the level below the ear (or mastoid process) to the front of the neck. This area of insertion is called the manubrium or, in common terms, the breastbone.

This SCM controls rotation of the neck, so when a baby has stiffness in this muscle they are not able to move their head freely to the non-preferred side. The SCM controls opposite turn of the neck, so if your baby has a right side preference or turn preference, then they have tightness in the left SCM muscle.

And what about head shape?

Head shape is huge topic today with the Safe to Sleep campaign as 1 in 10 babies deal with abnormal head shape changes. This is so important in relation to oral tension and neck tightness because head shape is directly related to these topics. Head shape is usually due to tension in the neck which limits a baby’s ability to change and alternate the positions of their head. This difficulty with moving their head leads to long amounts of pressure spent on one side of the head which shifts mass and effects the shape of the baby’s soft skull. There are many types of head shape changes, like plagiocephaly and brachycephaly. I discuss these types of head shape more in depth in my Head Shape and Helmets article here. Head shape can be corrected through repositioning, but the main focus should be addressing any neck or body tension present. Tension is often times the primary reason the head shape changes have occurred. If the tension of the neck and oral cavity is not addressed, head shape can be affect. We will explore this further below!

So what’s the connection between all of this?

This SCM is very important in the connection of oral tension, particularly tension of the tongue muscle and the muscles that control the hyoid bone. The infrahyoid and the SCM both attach at the manubrium on the breastbone (see photo). This means that when the hyoid bone mobility is hindered, or oral tension is present in the muscles attaching to the hyoid, the neck mobility can be affected. This causes the tension in the oral cavity to move downward and cause issues in head and neck mobility. So, if your baby has a tongue limitation or tie, their neck movement can become affected by the limits in oral motor movement. The important thing to note is stretching your baby’s oral cavity and neck can encourage the proper release of this oral and neck tension. A great stretch to address oral and neck tension is the guppy stretch. When completing this guppy stretch, have your baby bring their neck back into full extension on the side of your leg. This encourages your baby to open the front of their neck, which elongates the muscles of the neck and lower oral cavity. Check out my Neck Stretches for “Flat Head” freebie here for more information on this guppy stretch!

Now, if your baby has torticollis or a side preference, then this neck tension can move upward due to limits in the neck movement. These limits in neck movement, as mentioned above, are due to tightness in the SCM. This SCM can lead to limitation in the infrahyoid muscle due to the closeness of insertion. This abnormal turn preference places increased contraction on the muscles on the sides and front of the neck, including the SCM and infrahyoids. This tension can result in poor movement of the hyoid bone which can affect sucking and latching. This can lead to increase tension in the suprahyoid which further affects the oral cavity. This can also affect tongue movement and mobility if the hyoid bone is not easily mobile. We discussed stretches that encourage oral and neck tension release, but there are several more stretches for specifically the neck. Find them also included in the Neck Stretches freebie!

This tension can affect positioning comfort and strength of the neck and face which can affect the babies ability to turn head and/or feed. If the infant has a preference to one side or an oral tension restricting movement, they will be uncomfortable in a position that places the muscles in a less desirable position. For example, if your baby prefers the right side, then they may not latch or feed well when the head is turned left due to discomfort in the non-preferred position. Your baby also may exhibit weakness on one side of the neck or face due to overactive muscle engagement on the opposite side. To explain this further, if your baby has a right turn preference then the left side of their neck is overworking due to the muscle engagement. This leads to the right side of the neck being weak due to underwork and lack of muscle engagement.

With all this being said, oral or neck tension is not addressed, then head shape can become affected. The oral tension can cause the neck to become tight which can affect the head shape because the baby does not change the position of the head easily. Then, if neck tension is present head shape can automatically become affected due to the baby’s lack of head repositioning ability. See!? Oral tension and neck tension are directly related to head shape! And it’s all related to the muscles and their interaction with one another. Remember that song, “The Skeleton Dance!?” It’s so true! Everything in our body is indeed CONNECTED.

So how can all of this be addressed!?

As stated above, if an oral tie is present, then a procedure may be indicated if functional difficulties are present. If only oral tension is present, then stretching can be completed to elongate the muscles and tissues. This allow for optimal tissue elongation and proper healing and mobility. Neck tension can be resolved in a variety of ways, but therapy (OT or PT), chiropractic care, massage, and stretching are my top recommendations. Head shape can also be corrected many ways, but I am a firm believer in repositioning to correct when dealing with mild to moderate shape changes. If the head shape is severe, then helmet therapy may be indicated.

Oral and neck tension and head shape need to be addressed so your baby is as successful as possible in feeding, movement, and head shape symmetry. If your baby has difficulty with latching or feeding, be sure to reach out to your pediatrician, pediatric speech therapist (SLP), or pediatric dentist. This may be due to an oral tie and this is important to address if functional difficulties are present. If your baby has a side preference, reach out to a licensed therapist, like myself, so you can have the tools you need! Email me at [email protected] if you have any concerns and want more specific advice. You want to address these issues ASAP before they lead to other more complex issues. If head shape is a concern, complete this FREE Head Shape Assessment here, so you can also have the tools and information to help your baby best!

Thanks for reading!