Problems with Latching On or Sucking
It's common in the first days of life for a baby to have trouble latching on or maintaining
sucking at the breast. If this problem doesn't go away, more help is needed. A baby
must be able to remove enough milk from the breast through correct latch and sucking
to gain weight. This milk removal then tells the breasts to increase or maintain milk
production. If the baby doesn't get enough milk, he or she will have poor weight gain.
Poor milk removal from the breast can also affect milk supply.
Many things can affect a baby's ability to suck and remove milk. Factors such as prematurity,
jaundice, infection, heart disease, a mother's medicines and many others can affect
a baby's ability to stay alert or coordinate the suck-swallow-breathe actions. Other
mechanical issues that may play a role include tongue-tie or a cleft lip or cleft
palate. These might directly interfere with a baby's ability to use the structures
in the mouth for effective sucking.
Sometimes the cause is obvious. Often it's not. But it's important to recognize the
signs that a baby can't effectively remove milk during breastfeeding. Then the baby's
healthcare provider can ensure there are no health or mechanical issues affecting
feeding. And steps can be taken to fix the problem.
Below are some signs of ineffective sucking.
The baby who normally:
Doesn't wake on his or her own to cue for feedings.
Cues to feed fewer than 8 times in a 24-hour period.
Cues to feed 14 or more times in a 24-hour period.
Latches on and then lets go of the breast repeatedly.
Pushes away or resists latch-on.
Falls asleep within 5 minutes of latch-on or after sucking for only 2 or 3 minutes.
Doesn't suck almost continuously for the first 7 to 10 minutes of a feeding.
Nurses on one side for longer than 30 to 40 minutes.
Feeds for more than 45 minutes without acting satisfied or full after a meal.
Produces fewer than 3 to 4 stools in 24 hours. (Three to 4 stools per day is normal
for a baby who is more than 1 week old and younger than 1 month).
Seems gassy or produces green, frothy stools after the first week.
Produces fewer than 6 wet diapers in 24 hours (a baby produces 6 wet diapers a day by
the end of the first week).
Has trouble taking milk by other feeding methods.
The mother who:
Always has sore or bruised nipples or areola.
Gets red, scraped, or cracked nipples.
Often has misshapen nipples after feedings (such as creased or flattened).
Rarely or never notices breast fullness before nursing and breast softening after
nursing. This is even more likely if there are several hours between feedings.
Has more than 1 episode of plugged milk ducts or mastitis.
How you can help with the breastfeeding process
When a problem with latch-on or sucking continues beyond the first few days after
birth, it can be discouraging. Most babies will learn to breastfeed effectively if
they are given time. But it's important to work with the baby's healthcare provider
and a certified lactation consultant (IBCLC) if a baby has trouble latching or sucking.
Until the issue is fixed there are a few things you can do. These will help breastfeeding
progress while you make sure your baby is getting enough to eat. Always talk with
your baby's healthcare provider for more information:
Wake the baby to breastfeed every 2 to 3 hours if he or she is sleepy and still has
not mastered feeding cues.
Your baby likely will do better for some feedings. Don't be discouraged if he or she
is too sleepy. Or if he orshe seems to forget from feeding to feeding.
Some feedings will last longer than others. Your baby may need time to get going at
the breast for some feeds.
Massage your breast toward the nipple (or use one hand to gently squeeze the breast) to
send milk into the baby's mouth when he or she is nursing. This is also helpful when
your baby begins to fall asleep at the breast too soon after starting to feed.
Chart the number, amount, and color of urine and stools for wet and dirty diapers
on a daily record until latching and sucking is better.
Use a correctly-fitted hospital-grade, electric breast pump to be sure all milk is
removed. Many women will express milk by pumping for a few minutes after breastfeeding.
How long you will need to keep pumping depends on how quickly your baby learns to
breastfeed effectively. It also depends on how much milk your baby needs to grow beyond
what you are providing with breastfeeding.
Weigh the baby often. Or record a test-weight before and after a feeding. This is
best done at the office of a lactation consultant or the baby's healthcare provider
with a medical-grade breastfeeding scale.
Offer more calories as instructed by your baby's healthcare provider.
Certain breastfeeding devices or alternative feeding methods may encourage effective
sucking. Or they may give your baby added nutrition while he or she is learning to
breastfeed. A certain device may be good for your situation. But every device also
has disadvantages. To prevent problems, any breastfeeding device should be used with
the guidance of a certified lactation consultant (IBCLC) or healthcare provider with
advanced knowledge of breastfeeding. Devices that may be helpful in certain situations
Nipple shield. This thin silicone device is centered over the nipple and areola. It encourages a
better latch, more effective sucking pattern, and better milk intake during breastfeeding
for certain babies.
Feeding tube system. A feeding-tube system may be taped to the breast or your finger. It lets the baby
get additional milk through the tube when he or she sucks. To do this, a thin feeding
tube is attached to a syringe and taped to your breast or your finger (finger-feeding).
Then you or a helper can gently press the plunger. This sends a few drops of milk
into the baby's mouth if he or she forgets to suck. Commercial feeding-tube systems
are also available.
Alternative feeding methods. There are also other alternative feeding methods. These will make sure that your baby
gets enough food. But they are less likely to interfere with long-term breastfeeding.
These include cup-feeding, syringe-feeding, spoon-feeding, or (eye) dropper-feeding.
If using a bottle, bottle nipples with a slower flow rate are often preferred.
If any structural change in your baby's mouth is found, work with the healthcare provider
to correct or treat it. Depending on the type of variation, this may include anything
from mouth exercises to surgical treatment.
Other ways to help a baby with ineffective sucking
Other hints for the baby include:
Skin-to-skin contact seems to help a lot of babies with nursing. This also helps you
maintain milk production.
When a baby has the basic idea of effective sucking but can't seem to do it consistently,
try pumping one breast while breastfeeding your baby on the other.
You may want to limit the time of each breastfeeding session if you or your baby get
too frustrated. Or if the feedings take more than 40 to 45 minutes. This will give
you more time to pump and remove milk effectively. You may also find it's easier to
be patient through the learning process. You can always express milk and give it by
an alternative feeding method.
You may want to let the baby's father or other family members and friends handle alternative
feedings. That way you won't get overwhelmed. This frees you to focus on breastfeeding,
maintain pumping sessions, and enjoy cuddling skin-to-skin with your baby.
Don't throw away any breastfeeding device or an alternative feeding method because
you did not like it or it did not work when first suggested. The device or method
that did not help one day may work great the next.
Once your baby is growing and developing correctly and his or her nutritive sucking
ability is improving, ask your baby's healthcare provider when you can stop waking
him or her for feedings and begin to wait to see if he or she will demonstrate feeding
cues. You will also want to know when it's safe to start decreasing supplementary
feedings, if they are needed.
Keep thinking positively. It's normal to get frustrated and think your baby will never
learn to breastfeed effectively. It's normal if some days seem an eternity of breastfeeding
practice, alternative feedings, and breast pumping sessions. It's normal for your
confidence to rise and fall. Try to keep perspective by having a sense of humor. Think
about how far your baby and you have come since his or her birth, not how far you
still may have to go.
Get support. Stay in touch with the baby's healthcare provider and a certified lactation
consultant. But also contact a breastfeeding support organization. They will have
lots of information. And they'll give you moral support whenever you need it.