When Baby Won’t Latch to the Breast
It is instinctual for a new baby to search for his mother’s breast. Most babies will latch and begin to feed within a first few hours of birth. Other babies will struggle to latch. There is nothing more frustrating and discouraging for a new mother!
Babies who do not breastfeed initially can learn to breastfeed. It may take a lot of patience and persistence but it definitely is possible!
Why won’t baby latch to the breast?
A baby who does not latch to the breast isn’t “choosing” not to breastfeed. He is not latching because there is a problem. Ask for help from an International Board Certified Lactation Consultant to help you determine the cause and to establish a plan to get baby to the breast.
- Baby may be recovering from a difficult birth.
If forceps or vacuum were used at birth, your newborn may be sore and in need of some recovery time. Handle baby gently with lots of skin-to-skin snuggling. Pay attention to his cues and offer the breast in positions that seem most comfortable. (You can see some possible positions here: Positions for Breastfeeding.)
- Mom’s nipples may be difficult to grasp.
Women’s nipples come in many shapes and sizes. If nipples are quite flat, it can be difficult for the baby to latch. Try to gently “sandwich” the breast, aligning it with the shape of baby’s mouth. This creates a firm spot for baby to latch. (Imagine eating a large sandwich; it is easier to get your mouth around it if you flattened it first.)
Once the breasts have filled with milk, trying a nipple shield is an option.
Although it is rare, some nipples are too large for baby to grasp. Diligent pumping and feeding the baby in another way may be temporarily needed until baby grows a little bigger.
- Baby may have a tongue tie.
A tongue tie restricts the tongue’s range of motion. It can be difficult for baby to grasp and draw the nipple into his mouth. A tongue tie release allows the tongue to move more freely. (Check out this KellyMom page for links to tongue tie information.)
- Baby’s first feeds may have been by bottle; baby is unsure how to suck at the breast.
Sometimes, for medical reasons, a baby will be given a bottle soon after birth. As a result, he may search for something long and firm like the bottle nipple and act like he cannot find your nipple. It can be frustrating for a baby to relearn how to breastfeed. Try skin to skin snuggling between feeds. Dripping milk from the nipple via a feeding tube can entice baby to begin to suck. A nipple shield may also be useful.
- Baby may have an anatomical challenge (e.g. a cleft lip or palate) or the shape of the mouth or jaw may make latching challenging.
Your Lactation Consultant can help you to determine the cause and help you develop a plan to work towards establishing breastfeeding.
- Baby is a preemie and is not yet strong enough to maintain a latch.
If your baby was born prematurely and is not yet able to feed at the breast, diligent pumping will help you to develop a full milk supply. This is the best way to ensure baby will eventually transition to the breast. Do skin to skin snuggling as much as medically possible. A nipple shield, special positioning or supporting baby’s cheeks during the feed may be suggested.
- Overly full breasts.
If your baby had been breastfeeding but is suddenly unable to latch, it may be due to overly full breasts. Feel the areola, the brown area around the nipple. If it is quite firm, it may be difficult for baby the grasp. This post (Too full? Baby can’t Latch) describes a technique that may be helpful.
**Identifying the problem can help to direct the solution.**
No matter what the underlying issue may be, these principles may help.
If baby will not latch in the first 24 hours after birth:
- Keep your baby skin to skin as much as possible.
- “Practice” breastfeeding; express a drop of milk on your nipple and let baby lick and nuzzle. The goal is for mom and baby to enjoy these sessions. If it is frustrating for either mom or baby, it is time to take a break.
- A baby who is well supported is more likely to breastfeed. In the laidback position, mom leans back and baby’s entire body is supported against her own (read more and see a photo here). If you are more comfortable feeding in a cradle or football hold, use pillows to support baby’s body. (There are photos of these holds in the link above.)
- Self attachment in the laidback position can be quite effective (There is a video of self attachment in this post.)
- Do some hand expression to stimulate your breasts to begin producing milk. (Learn how to hand express by watching this video.)
- Feed drops of your hand expressed colostrum to baby with a spoon. Babies are incredible; they will “sip” milk from the spoon.
If baby continues not to latch after the first 24 hours:
- Try massage and hand expression before attempting at the breast. A drop of milk on your nipple can entice baby to latch.
- Even if baby won’t latch, continue with “practice sessions”. Remember if either you or the baby becomes frustrated, take a break. Calm your baby by snuggling and talking in low, gentle tones. When baby is ready, try again. If you need more of a break, pass your baby to a support person while you care for yourself.
- Begin pumping with a hospital grade electric pump, approximately every 2 to 3 hours during the day and at least once at night (a minimum of 8-12 times in 24 hours). Pumping for 15 – 20 minutes on each side will help your milk to come in. You may not express a single drop at first. That’s okay. Please do not give up. Pumping tells your body that baby is here and will need milk. Developing a good supply of milk will be key in coaxing baby to the breast. After a full supply is established, you can adjust the time spent pumping as needed to obtain the required milk.
- You will, of course, need to feed your baby. The first choice is to feed your own expressed breast milk. Sometimes, for medical reasons, your healthcare provider may recommend feeding more milk than you are able to produce. If banked human milk is available in your area, that is ideal. If donor milk is not available, infant formula may be used. Feeding your baby will help ensure he has the energy to continue to learn to breastfeed. Your healthcare provider may suggest you feed baby by spoon, cup or finger feeding.
- Some women find using a 20-20-20 principle helpful. “Practice” at the breast for up to 20 minutes; feed the baby in an alternate way if needed (approximately 20 minutes) and pump/hand express for 20 minutes. (Please note: the times are suggestions only. Please modify according to your baby’s cues. Sometimes babies are quickly frustrated and 20 minutes of trying will be too long.)
- Sometimes, giving baby a little milk prior to a breastfeeding attempt may be helpful, especially if the baby is quite hungry. Taking the edge off the baby’s hunger may help baby to be more relaxed with the latching attempts.
- Once baby is taking larger volumes, your healthcare provider may suggest beginning to use a bottle to feed your baby. This does NOT mean we have given up on breastfeeding! Again, it is important to feed your baby so that he will have energy to learn to feed. When baby is taking larger volumes, some babies will tire before they have been able to complete the feed. If you choose to bottle, use a rounded nipple rather than one with a flattened cross-section. reference?Choose a slow flow nipple. Entice the baby to gape widely when talking the bottle to simulate latching at the breast.
- A nipple shield may be useful in some instances once milk supply is established. Using a nipple shield before the milk supply is established is not recommended.
- Search out a mother-to-mother support group such as La Leche League.
In our experience, with time and patience, most babies will eventually learn to breastfeed. Consult an International Board Certified Lactation Consultant for assistance. In the meantime, stimulating your milk supply and snuggling skin to skin with your baby are the most important things you can do.
References and More Information:
- Bonyata, Kelly. “Establishing and maintaining milk supply when baby is not breastfeeding.” KellyMom.com. 23 Feb. 2016. Web.
- Newman, Jack, MD, FRCPC, and Edith Kernerman, IBCLC. “When Baby Does Not Yet Latch.” nbci.ca International Breastfeeding Centre, 2009. Web.
Cindy and Jana are Registered Nurses and International Board Certified Lactation Consultants who have assisted over 20,000 families.