Trouble with latching on is one of the most common breastfeeding challenges. When your baby is not latching on correctly, it can make breastfeeding painful and difficult. A poor latch, however, is usually easy to correct. If your baby is not latching on at all, you might feel that something is wrong; it might seem like breastfeeding is impossible. However, with practice and patience, most babies will eventually learn to latch correctly. Breastfeeding is instinctive for babies, and although many factors can interfere with it, most of them can eventually be overcome.
Physical Reasons in Baby's Mouth
Some babies refuse to latch on because latching is uncomfortable due to abnormalities in the baby's mouth. Some of the most common problems are cleft palate and a tight frenulum. If your baby has a cleft palate, you might be able to see it by looking in your baby's mouth, or it might be difficult to see. Ask your doctor to evaluate your baby if you suspect a cleft palate.
A tight frenulum is harder to diagnose, and since it's not considered an abnormality, many doctors don't usually treat it. A lactation consultant can help you determine if your baby's frenulum is interfering with his ability to nurse. A tight frenulum is easy to fix -- a simple outpatient procedure of clipping the frenulum will give your baby's tongue more ability to flex and improve his ability to latch on. A cleft palate must be surgically repaired, and the procedure is not usually done until your baby is 9 to 12 months old, so breastfeeding a baby with a cleft palate will require specialized help and techniques.
Physical Reasons in Nipple and Breasts
The shape of your nipples and breasts can influence how well your baby is able to latch on. If you have large, flat or inverted nipples, your baby might have a hard time latching on effectively, especially when he is a newborn. After a few unsuccessful attempts, he might begin to refuse the breast entirely out of frustration. Nipple shields can help shape your nipple and provide a surface that's easier for your baby to latch on to, especially in the first few weeks. However, pediatrician Jack Newman recommends against using a nipple shield until after your milk supply comes in, since using it earlier can lead to latch problems.
Large or engorged breasts can also make it difficult for your baby to latch on. Expressing a little bit of milk until you feel the let-down reflex can make your breasts softer and easier to latch onto. This will also mean that your baby will be able to taste milk immediately if he does latch on, which can help coax him to the breast when he's been rejecting it.
Reasons Related to Birth Experience and Interventions
Although most babies are able to nurse well immediately after a medicated labor, some babies have a difficult time latching or sucking as a result of medications given to the mother during labor. Some medicines can make your baby extremely sleepy and uninterested in anything, including latching onto your breast. In most cases, it's not necessary for your baby to eat immediately after birth -- as long as your baby is healthy, it's usually safe to wait to feed him until the medications have worn off and he's awake enough to be interested in breastfeeding. Talk to a lactation consultant about your situation before deciding to supplement your newborn.
Some interventions and procedures immediately after birth can also cause your baby to resist latching onto your breast. Occasionally, a baby whose mouth has been suctioned at birth might resist latching on at first. A baby who has been given artificial nipples, such as pacifiers, or supplemental feedings from a bottle, might also resist the breast because the flow of milk is so much slower. Giving your baby frequent skin-to-skin contact and constant access to your breast can help him become comfortable with latching on.
Reasons Related to Milk Supply
Both an oversupply and an undersupply of milk can cause your baby to resist latching onto your breast. If you have an oversupply with a forceful letdown, your baby might cough or gag when your milk lets down, and he might sometimes refuse the breast because the letdown is so forceful. Talk to a lactation consultant if you suspect you have oversupply, since treating an oversupply when you don't really have one can lead to an undersupply.
An undersupply of milk can cause your baby to refuse the breast because he isn't getting enough when he does latch on. Build your milk supply by pumping, and continue to offer your baby the breast frequently. Talk to a lactation consultant about whether you should consider supplements like fenugreek to increase your milk supply.
Reasons Related to Positioning, Environment and Technique
Sometimes your baby's refusal to latch is a simple matter of positioning, technique or environment. A very sensitive baby might have a hard time latching in a noisy or distracting environment; offering the breast in a quiet, dark room might solve the problem. He might also be unable to latch because of the way you are holding him or the angle at which you are offering the breast. Have a lactation consultant observe your position and technique as soon as possible after birth to see if you can fix the problem with a simple position adjustment.
References
- "Help--My Baby Won't Nurse!"; Kellymom; Kelly Bonyata; June 2011
- "When the Baby Refuses to Latch On"; Breastfeeding Online; Jack Newman; 2003
- "Cleft Lip and Palate"; Kids Health; Joseph A. Napoli and Linda D. Vallino; January 2011
- Ask Dr. Sears: Tongue-Tie
- "Too Much Milk?"; Breastfeeding Essentials; Becky Flora; December 2000
