MommaMatch

One of the most common reasons I see new mothers and their babies in the first few days after birth is because a baby simply will not latch onto the breast. Mom will state, that after several minutes and multiple attempts, the baby either 'falls asleep' (which really means baby is shutting his world out, known as a neurological shut down aka 'playing opossum' ),or becomes extremely fussy. The term neurological shut down sounds scary, but it is a normal response that the baby does when he is over stimulated or frustrated. He goes 'Zen' if you will, shutting out all distractions. Baby has to reboot in order to try again. Sometimes mothers state that if the baby does latch on, it becomes excruciating for the mother resulting in sore nipples due to improper position and latching techniques. After several minutes of sucking, baby comes off frustrated and fussy, and mom's nipple looks like a brand new stick of lipstick because the baby has compressed the nipple into a unnatural shape.

As natural as breastfeeding is, some babies, for various reason, do not have the ability to latch onto the breast correctly. In order for a baby to breastfeed, the tongue must be positioned properly in the mouth. The baby needs to be able to have a wide open mouth, rest his/her tongue on the floor of the mouth and be able to extend the tongue over the lower gum line. Basically, the tongue must be down and roll forward in order to latch on properly to the mother's breast. If a baby has not learned how to position the tongue correctly, or has what we call a 'disorganized sucking pattern' the baby can't transfer milk appropriately resulting in poor weight gain, increased fussiness, and super sore nipples.

If I see a baby who is having difficulty latching, the first step is to determine if it is a mom issue or a baby issue. If it is a mom issue, usually by just fixing the position of the baby, the baby is able to grasp the nipple and latch on correctly. We have a saying in the lactation world, 'Nose to chin and hug them in'. What this means is, that in order for the baby to latch, the mother must make sure that the baby is tummy to tummy, mom should 'ridge' her breast like a sandwich (I know referring to your breast as a sandwich may sound weird), sweep her nipple in a downward motion from nose to chin, and when the baby opens his mouth wide she is to 'Hug' her baby in to her breast. By doing this, it allows more of the breast tissue into the baby's mouth to get a deeper more comfortable latch.

However, some babies have smaller mouths, or a tight frenulum, (The frenulum is the 'stringy' ligament underneath the tongue that helps the tongue to extend or stretch beyond the gum line). Or simply, the baby hasn't learned how to move the tongue in a good pattern. Reasons for this may be due to the oral anatomy of the baby's mouth or the gestational age of the baby. If the baby is less than 39 weeks gestation when born, it can often effect how the baby sucks. This is why your caregiver will stress the importance of staying pregnant until 39 weeks. One of the first things that may be done is to provide a nipple shield to allow the baby to latch deeper onto the breast. There are however certain guidelines to follow when using the nipple shield to make sure that it doesn't affect your milk supply. When used correctly a nipple shield can often be a very beneficial tool.




However, one very good strategy for getting a baby to latch well, is teaching the infant how to suck using a method known as suck training. In extreme cases, an occupational therapist should be consulted to ensure that all aspects of the suck are being evaluated and corrected. In mild cases however, the following steps can often correct a disorganized suck allowing a better latch, decreasing sore nipples, thus creating a better breastfeeding experience for both mom and baby.

1. As soon as your baby is beginning to exhibit feeding cues, such as bringing the hands to the mouth, showing signs of waking, sticking his tongue out, and licking his lips, prepares to feed him. Do not wait till the baby is crying to try and latch. Crying is a late feeding cue, and a baby will have a more difficult time latching to the breast when he/she is overly hungry.


2. Hold your baby in your lap in a sitting position, supporting the head in the palm of your hand


3. With clean hands, insert your free index finger, palm side up, into your baby's mouth resting comfortably in the soft curved palate on the top part of the mouth. Be careful not to insert your finger to far into the baby's mouth as this can cause him/her to choke. Simply go as far as the first knuckle joint. The tip of your finger should be touching the palate which feels 'Squishy' on the roof of the mouth.


4. Gently stroke the roof of your baby's mouth to encourage the infant to begin sucking. Once you feel your baby sucking on your finger extend your finger straight.


5. Your baby should be wrapping the sides of his/her tongue around your finger. With your finger straight (applying gentle pressure onto the back of the tongue) pull down on the baby's lower lip. The baby's tongue should be on the floor of his mouth with the sides of his tongue curled against your finger.


6. After you have checked the position of the tongue, make sure that the lips are rolled out around the finger as well. If the baby's lips appear to be tucked in, and not flanged like a fish, he will not be able to suck well.


7. Allow the baby to suck on your finger for 1-2 minutes while pulling down on the chin to help the tongue extend out further. Gently push down and forward with your finger while the baby is sucking.


8. Once you feel that the baby's tongue has relaxed into a down and forward position, and has a good sucking rhythm, you and your baby should be ready to latch onto the breast. Be sure to have good pillow support, bring the baby to your breast, and lean back when latching.

*Remember 'Nose to chin, hug him in' while latching!!! When the baby has latched deeply, flip the lower lip out.

Try not to be discouraged if the baby doesn't latch right away. It may take several attempts of suck training to get him/her use to the new tongue placement. Just like with all exercise, the more you do it, the easier it gets!

Copyright 2012 Danielle Gauss, IBCLC, ICCE JustBreastFeeding.com. All Rights Reserved