The Baby Who Has Yet to Latch

on January 03, 2014 in Breastfeeding

So you looked forward to greeting your newborn and begin breastfeeding, and your baby doesn’t latch onto the breast.  Or maybe your baby can latch on to one side, but not the other.  You may begin wondering if your baby simply doesn’t want to nurse!

 

Nothing could be further from the truth.  While your newborn may fuss and you may become frustrated at your attempts to get the baby latched on, rest assured that he is simply upset with not getting the right signals that he needs to get breastfeeding going.

 

While in the hospital or birth center, you may or may not get the help you need from experienced hands.  Lucky are you if a nurse or lactation consultant can identify what is going wrong and assist your attempts at getting a good latch. Unfortunately, many mothers don’t get the help they need or despite getting help, continue to struggle.

 

If after several unsuccessful sessions at getting the baby to take the breast, it is time to start expressing your

colostrum in order to begin feeding the baby. Instead of turning to infant formula, you may be offered (or you can request) an electric breast pump to get the precious early drops of this early milk that has high levels of antibodies that protect your vulnerable newborn.  Some mothers may find that they actually get more colostrum using hand expression. You can learn more about the technique of manual expression at this great video from Stanford University. Visit http://newborns.stanford.edu/Breastfeeding/FifteenMinuteHelper.html on line.

Good latch techniques are shown there as well.

 

Be sure to express your milk every 2-3 hours around the clock to signal your breast to begin making mature milk and bring in a full supply to satisfy your baby.  A one-day-old baby needs just drops of colostrum. On Day 2, the baby needs a ½ ounce and on Day 3, the baby needs an ounce at each feed.  On Day 4, the baby will require about 1 ½ ounces and on Day 5 the amount needed is anywhere between 2-3 ounces depending on the baby’s weight, with smaller babies (6 to 6 ½ pounds) needing about 2 to 2 ½ ounces) and larger babies (8 to 9 ½ pounds) needing closer to 3 ounces at most feedings. This amount stays about the same for the next several days and increases slowly as the baby grows.

 

There are many possible reasons that a baby may have difficulty. Some may be a problem with the nipple or some babies may struggle because of a problem they have.  Some mothers have flat or inverted nipples.  Other mothers may have nipples that are simply too large for their young infants, nipple that are as large or larger than a quarter.

 

Some newborns may have a tongue-tie, a short frenulum, and the thin string-like piece of tissue that limits the baby from getting his tongue forward enough to attach to the breast. This is usually easy to remedy by having the Pediatrician or a Pediatric dentist do a quick snip of this tissue, which is relatively painless for the baby.

 

Some babies have a retracted jaw, which makes it difficult for him to latch onto the breast.  Seeing the baby’s face in profile can often identify this; the lower jaw is much further back than the upper lip.

 

For some babies, the use of a nipple shield can be a temporary cure.  I recommend trying a nipple shield once your milk is in, and you can work with a lactation consultant who can help find the right size shield and ensure that the baby is able to transfer enough milk using a shield.  Shields come in 3 sizes and the size must be able to fit both the size of the nipple as well as the baby’s mouth.  Weighing the baby on an electronic scale before and after the feeding can determine whether the baby is getting enough milk when evaluating the usefulness of a nipple shield. Some lactation consultants will still recommend that mothers, who use a shield, continue to pump after nurslings to ensure that the milk supply stays high.

 

The two most important things during the period before the baby eventually latches successfully is getting great support, especially from an experienced lactation consultant, and bringing in and maintaining high milk production.  Some hospitals have outpatient breastfeeding services.  Most communities have lactation consultants who either work with a Pediatric group or are in private practice. Insurances typically cover the cost of lactation services. If you have government insurance, they are also required to cover lactation services. If you qualify for WIC (The Special Supplemental Nutrition Program for Women, Infants, and Children), there may be a lactation consultant on staff that can offer you help.

 

It is also very important that your partner and family support your efforts.  It is very common that your partner and/or family encourage you to give up trying to nurse.  I believe that this is because they hate to see you upset and struggling. Be sure to ask for their help as well as their support.  Others can certainly help with household duties, cooking meals, caring for other children and feeding your baby by bottle if you like. Let others know what you need in these early days, especially their understanding and encouragement.

 

When your baby finally is able to latch, you will want to have an abundant milk supply. This means that expressing your milk at least 8 times each 24 hours, until your baby is nursing well, is crucial. I suggest that mothers, who are exclusively pumping, use a rental grade pump over a personal use pump.  Personal use pumps are intended for mothers who are separated from their babies for a few feedings a day and are not designed for full-time pumping. Renting a pump is still less expensive that feeding infant formula and if you qualify for WIC they may be able to loan you a high quality pump.

 

Staying positive can be the hardest part of having a non-latching infant, but I rarely see infants who do not eventually reward their mothers and eventually latch.  My experience is that the majority of non-latching infants do so by around 4-6 weeks, although I know of a few infants that did latch later than this.  My own son was unable to latch and swallow milk for the first few weeks until we visited our Pediatric dentist who snipped his very tight frenulum.

 

Perhaps the non-latching baby is teaching one of the most important parenting lessons to mothers; your patience and persistence will pay off!