Difficulty with Latching On or Sucking

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.


Illustration of breastfeeding, massage technique

  • 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
    include:

    • 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.


Illustration demonstrating the use of a breast pump

  • 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.