Why the “Guppy” is Not Helpful for Babies Struggling to Breastfeed

As a pediatric physical therapist, I often see babies in my office who are struggling with feeding - both breast and bottle. Families frequently seek information online for specific stretches or exercises to help their baby feed and move better. However, what these families may not consider is the order and effectiveness of these exercises.

One popular, or trendy, stretch is known as the “guppy” or “head hangs.” This exercise involves allowing the infant’s head to fall backwards into cervical extension with the goal of stretching the front of the neck. This stretch brings about many concerns leading me to my choice not to use it in my practice. 

First of all, babies' necks are fragile, as they have not yet developed full head control until about 4 months of age (in typical development). When parents or other providers perform the “guppy” or “head hangs,” it is often without careful consideration of safety. The head MUST BE supported by either the parent’s hands or the floor. It is not safe for an infant’s head to hang in an end-range extension without support. Furthermore, the front of the neck contains numerous muscles and fascia. For the stretch to be effective, the infant’s mandible must be elevated and the cervical spine positioned in a specific rotation. Without this precise positioning, the stretch is ineffective at best.

Babies are born with a startle reflex, which is triggered by backward movements of the head, as in the “guppy” or “head hangs.” When this reflex happens, babies extend their arms and legs, and often follow up with crying. Continuously triggering the startle reflex can be very dysregulating for the baby. Tighter, more tense babies often have an exaggerated startle reflex and are extra sensitive to movement, which can cause nervous system dysregulation and do more harm than good.

A whole-body assessment and treatment approach is necessary for these babies as a tight neck is rarely an isolated issue. There are typically other areas in the baby’s body that need attention as well. If the pelvis, ribcage, thoracic spine, and shoulder girdle are not moving well, then stretching the neck alone will not yield the desired results. Once the other areas of the body are moving better, the neck naturally loosens up, reducing the need for isolated cervical spine treatment.

In my practice, I take the whole body into consideration to help infants feed better. If your baby is struggling with feeding, milestones, or feeling comfortable in their body, reach out to a provider who assesses and treats the entire body from head to toe. One exercise alone is unlikely to provide the progress you're looking for. Providers who prescribe (yes, if you’re giving exercises to a family, you are prescribing them) the “guppy” or “head hangs” without a full-body assessment may be well-intentioned, but they are missing critical pieces of your munchkin’s movement puzzle. Therefore, they should refer these babies to someone capable of providing whole-body treatment with the credentials to support it.

If you have concerns about your baby’s feeding or development, seek out a pediatric physical therapist who can provide a comprehensive assessment and tailored treatment plan. Your baby deserves the best, most effective care possible.

For more information on bodywork, see this blog post HERE.