Corrective Helps for Health Care Providers

The “4R” Approach©: A Self-Help Strategy
For Structural Correction and Tension Relief in Nursing Infants

Author Judy Terwilliger, RN, CMT, PBS

An Integrative, team effort approach between allied healthcare practitioners, community resource support systems and parents/caregivers is vital in the effort to resolve these hidden barriers in the shortest time possible.


– Trying to change the venue that you may be using can be critical to the relief needed in general. If there is underlying muscle tension and the associated dysfunction, a position change that reduces neck stress should be tried.  Always strive for “neck neutral.”

Example of positions: side sitting upright, front latch reclined, side-lying


– the process of repositioning the infant’s body in a clearly relaxed and anatomically uncompromised position in an effort to straighten the body for ease of securing a good bond and relaxed position. This can be useful prior to repositioning with a change of venue.  Again, remember “neck neutral.”

Example: side-lying for a few seconds on each side or to the side of preferred comfort.


– The process of applied gentle stretches of the infant’s extremities to tolerance (not pressing any areas of resistance) as in the case of the arms up to the ears (using cupped arms at the elbows) and bicycling of the legs with thumb support at the knees.  This is to be done with fullest possible extensions in both circumstances.

Applied moist warmth to areas of restriction noted as in a warm compress to the upper shoulders and neck prior to re-alignment as above or before re-trying latching. Moist warmth for no more than 10 minutes out of every hour can be helpful in relaxing the musculature and effecting more positive outcomes.

Examples: warm bath, warm compress


– The process of encouraging both parents and infant in the process of patient, consistent applications of the above techniques.

Activities can be done with each diaper change to remind parents to apply these in a repetitive fashion to remind the musculature to be less tense and produce relaxation.

A calm quiet voice in the midst of the storm is always best in any circumstance. Restoring the calm to both parents and infant is essential to success. Control depends on it.

Examples: soft music, low fan, bio-feedback exercises, reassuring voices

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