Solutions for latching problems

What do I do if my baby cannot latch?

To help a baby learn to latch, mothers should try to identify and eliminate any barriers. They should offer the breast regularly, choose an appropriate breastfeeding hold and position, and use good latching technique. Nipple shields are the easiest solution for a latching problem, but many babies cannot use them. They are unlikely to work if the nipples are fully inverted. If a baby cannot breastfeed effectively even with a nipple shield, the next option is to express every time the baby feeds and supplement with replacement feeds until the baby learns to breastfeed. Babies should not be upset during the process and mothers should keep the time for one feeding and expressing session under one hour.

A) Summarizing how to approach latching problems

If your baby cannot latch or stay latched:

B) Latching and positioning techniques

Our clinic regularly sees mothers who say their babies can’t latch. With the following approaches, these babies have no problems breastfeeding.

1) Use proper positioning and latching techniques

If you find it hard to latch your baby, ensure that you are using proper techniques.

  1. Place the baby in an appropriate breastfeeding
  2. Choose a hold that gives the baby good support, such as the:
    1. Cross-cradle hold.
    2. Under-arm hold.
  3. Use the breast sandwich technique if it is helpful.
  4. Latch the baby.
  5. Consider the laid-back hold if other holds are not effective.

If you use a breastfeeding pillow, make sure it does not add to the problem. The pillow must not position the baby too low or too high relative to the nipple.

Some mothers will unnecessarily worry about blocking the baby's nose while breastfeeding and may deliberately keep the baby’s mouth and nose too far away from the breast. This can cause a poor position and even prevent latching. 

2) Firm up your nipple

Some mothers have very soft nipples and their babies sometimes don’t feel the nipple when trying to latch. These mothers can use nipple root massage for a few seconds to firm up the nipple right before trying to latch the baby.

Soft nipples are also more prone to becoming painful.

3) Offer a dry nipple

Other babies have trouble recognizing a nipple when it is wet. It may be wet from the baby’s saliva after the mother has tried to latch the baby a few times. Quickly drying the nipple with a soft, clean cloth may make it easier for the baby to latch.

4) Ensure the nipple root is soft 

Use the pinch test to ensure that your nipple root is soft and not firm before trying to latch the baby.  

C) Offer the breast at all or most feeds

We encourage mothers to offer the breast at each feeding to maximize the baby’s exposure to the breast.

Do not let the baby get too upset or tired at any point during the feeding. Ideally, the whole process of attempting to breastfeed, giving the baby extra milk, and expressing takes one hour at most and preferably less time. Find shortcuts to make this happen. One option is to have someone else supplement the baby while you express. A long process is tiring for you and your baby.

1) A baby who cannot latch or stay latched

If the baby cannot latch or stay latched, consider the following approach:

  1. Offer the breast when the baby shows early hunger signs.
  2. If the baby can breastfeed, ensure that the baby has a normal feed.
  3. Optional:
    1. If the baby does not breastfeed well within a few minutes, try a nipple shield.
    2. If the baby can breastfeed effectively with the nipple shield, ensure that the baby has a normal feed.
  4. If the baby does not latch and breastfeed well within a few minutes, supplement the baby with around 30 to 60 millilitres (1 to 2 U.S. fluid ounces) of milk to calm the baby.
  5. Once the baby shows early hunger signs, repeat steps 1 to 3 on the other breast.
  6. If the baby does not latch and breastfeed well within a few minutes on the second breast or if the baby has had a normal feed but remains hungry, supplement the baby with enough milk so that the baby is no longer hungry.
  7. As soon as the baby is fed, no longer hungry, and settled, express and store your milk.

If the baby is not very effective in using a nipple shield every time you try it, you should not use it regularly. Rather offer it once or twice a day, just to see if the baby has learned to use it.

If the baby cannot latch at all, it is reasonable to minimize the time that you and your baby are awake at night and just give the baby a replacement feed and then express without offering the breast.

2) Breastfeeding if the baby can breastfeed a little

Babies who are learning to latch may be able to breastfeed a little. Consider the following approach:

  1. Offer the breast when the baby shows early hunger signs.
  2. Stop breastfeeding if:
    1. The baby keeps popping off and on the breast.
    2. The baby is no longer actively sucking.
    3. The baby is frustrated.
    4. Twenty minutes have passed.
  3. If the baby:
    1. Is calm, offer the second side or,
    2. Is hungry, supplement the baby with around 30 to 60 ml (1 to 2 U.S. fl oz) of milk to calm the baby.
  4. When the baby shows early hunger signs, repeat steps 1 and 2
  5. If the baby:
    1. Is calm or asleep, ensure that the baby has had a normal feed.
    2. Is still hungry, supplement the baby with enough milk so that the baby is no longer hungry.
  6. As soon as the baby is fed, no longer hungry, and settled, express and store your milk.

As babies learn to latch and stay latched, they may feed better at some feeds than others. Mothers will find they express less milk if the baby has breastfed normally. The above approach will ensure that the baby is fed and the milk supply is maintained. 

Mothers can simply breastfeed and stop supplementing and expressing once the baby is growing well and the baby no longer needs supplements.

D) Try a nipple shield

A nipple shield is often the easiest and most effective solution for a latching problem. If effective, it allows mothers to breastfeed without supplementing or expressing.

We found that 30 to 40% of the babies in our clinic cannot use a nipple shield and will never learn to do so. For example, a nipple shield is unlikely to work if your nipples are very inverted. If it is not effective, do not use it. 

Shields are used for as long as needed. For some babies, this is until they have weaned. To help a baby learn to breastfeed without a shield, you can offer the breast without the shield at the start of a feed and when offering the second breast. The breast should only be offered for a minute or so and stopped before the baby gets frustrated. It is also reasonable to limit this to daytime.

E) Keep the baby calm and keep feeding activities reasonable

Babies who are very hungry, frustrated, or angry will cry and will not latch. This is stressful for the baby and the mother. Understand the baby’s limitations and avoid approaches that don’t work.

To keep the baby calm:

  • Avoid repeated use of a tool or approach that is not working.
  • Stop trying to latch the baby once the baby is starting to get frustrated.
  • If the baby is hungry and angry, offer a bit of milk to calm the baby down before trying to latch the baby.
  • Hold the baby skin-to-skin, which can also help the baby learn to latch more quickly (Svensson 2013).
  • Speak to the baby while offering the breast using a slightly high-pitched, loving voice to reassure the baby.
  • Ensure that the baby is getting enough milk at each feed and growing well.

F) Express

If your baby cannot effectively breastfeed without or with a nipple shield, expressing will provide milk for the baby and maintain your milk supply until the baby can latch.

1) Establish your milk supply

It is important to establish your milk supply by expressing as soon as the problem appears.

If your baby cannot breastfeed effectively right after birth, you should express within the first hour and then regularly after each of the baby’s feeds.

If the newborn baby can latch and suck on a nipple shield, we encourage mothers to express after all feeds until the milk has come in, it is clear the baby does not require supplementing, and the nipple shield is working.

The expressed colostrum is given to the baby if supplements are required or it can be stored for later use.

2) Maintain your milk supply

If your baby is unable to breastfeed effectively with or without a nipple shield, you need to express after each of the baby’s feeds to maintain your milk supply. Expressing will also provide milk for the baby's supplements.

G) Feed the baby

Many mothers use bottles to give their baby milk. Bottles are useful because they save time and effort. You may consider other feeding devices, such as finger or cup feeds, but some mothers find them time-consuming. Most mothers already find expressing and supplementing to be a lot of work. See what works for you and your family.

Tube-at-the-breast systems do not work in this situation because the baby cannot suck consistently at the breast. 

Follow your baby’s hunger signs to determine the amount of milk the baby needs.

References

Svensson KE, Velandia MI, Matthiesen AS, et al. Effects of mother-infant skin-to-skin contact on severe latch-on problems in older infants: a randomized trial. Int Breastfeed J. 2013 Mar 11;8(1):1