Suspect ineffective sucking if the newborn frequently (one or more): · Does not wake for 8+ feedings or wants 14+ in 24 hours · Keeps latching on and letting go of the breast · Can`t seem to latch on or pushes away · Falls asleep 2-5 minutes after latch-on or starting to suck · Feeds for more than 30-40 minutes without self-detaching at the first breast · Feeds for more than 45 minutes but doesn`t seem satisfied · Soaks fewer than 6 diapers in 24 hours by day 6-7 · Has fewer than 3 stools in 24 hours by 6-7 days after birth through the first 4-8 weeks) · Seems “gassy” and produces green, frothy stools after the first week · Seems to have difficulty feeding no matter what feeding method is tried. (* Any baby may demonstrate one or more of these signs occasionally.) When a baby breastfeeds ineffectively, the mother is more likely to develop sore, red, bruised, raw, blistered, or cracked nipples. Her nipples may appear creased, flattened, misshapen or white at the end of a feeding. She also may experience a plugged duct or mastitis due to poor milk removal.
The baby’s gums should completely bypass the nipple and cover approximately one inch of the areola behind the nipple. Make sure the baby’s lips are everted. Some baby’s will tighten or purse their lips, especially the lower one. If the lower lip is inverted (turned in), try simply pressing down on baby’s chin to evert the inwardly turned lip.
How can I get my baby to latch on properly?
First, position yourself correctly. Milk flows better from a relaxed mother, and it’s easier to breastfeed your baby if your arms, back, and shoulders are well-supported. Prepare a nursing station in your favorite room with a comfortable chair, plenty of pillows for support, and peace and quiet or soothing music. After you’ve prepared your body to breastfeed, prepare your mind. Take a few relaxing breaths and imagine your nourishing milk flowing from your breasts into your baby. Help your infant to relax, too. If she’s crying, rock and sing to her until she quiets down. If she’s sleepy, gently bring her body into a sitting position while saying her name. Babies latch on best when they are in a quiet, yet alert, state.
Next, position your baby correctly. Whether you use the cradle hold (baby cradled in your arms lying on a pillow on your lap), the clutch or football hold (baby’s body tucked to the side, under your arm, near your breast, neck supported by your cupped hand), or the side-lying position (nursing in bed), be sure that Baby’s head and body are turned to face your breast with her mouth at the level of your nipple. Pull her in close¿ — she should not have to turn her head or strain her neck to reach your nipple.
Cup your breast in your hand, with your fingers and palm underneath and thumb on top, well behind the areola. Avoid the “cigarette hold” (when the nipple is between your two fingers) because your fingers would be right where baby needs to latch on. Express a few drops of milk. Using your milk-moistened nipple, gently massage your baby’s lips, encouraging her to open her mouth wide, like yawning. As she opens wide, direct your nipple slightly upward and toward the center of her mouth, and with a rapid arm movement, pull her close to you, so that her mouth will close down over your areola. We call this technique “RAM,” an abbreviation of “rapid arm movement.” It may sound startling at first to say “RAM Baby on,” but it really helps mothers remember two important components of latching on: that they need to move their arm to draw their infant in closer (rather than leaning forward, which can make their backs sore), and that they must move quickly before the baby’s mouth closes again.
While a bit of initial discomfort is to be expected in the first two to four days of breastfeeding, persistent pain usually means your baby is not latching on properly. To improve Baby’s latch-on, be sure his mouth is wide open as he takes the breast; both of his lips should be turned out (everted). When your baby takes the breast with mouth open wide, he’ll have a “fish mouth” look as he nurses, and you should not be able to see your nipple. Be sure your baby’s tongue is between his lower gum and your breast. (If you pull down gently on Baby’s lower lip, you should be able to see his tongue.) If his bottom lip is pulled inward instead of outward, use the index finger of the hand that is supporting your breast to pull out that lower lip. (You may need a helper to take a peek under the breast and do this for you while Baby is latched on.) This “lower lip flip,” as we call it, may be all that’s needed to keep your infant from tight-mouthing your nipple.
If your baby doesn’t get onto the breast well at the first try, take him off (break the suction with your little finger inserted into his mouth) and try again, waiting for that wide-open mouth. Don’t settle for a less-than-great latch-on: Be patient, keep trying, and soon your baby will learn exactly what to do.
What if I need to supplement with formula?
“Combo feeding” (breastfeeding and supplemental formula) can work, but it’s important to get breastfeeding off to a good start for a few weeks before introducing commercial nipples. Otherwise, babies can become “nipple confused,” which means they try to suck at the breast the way they get milk out of a bottle. This is not very effective, and it can be painful! If formula supplementation is medically necessary within the first month, a lactation consultant can help you try supplementing with a syringe or a nursing supplementer, a handy device that delivers breast milk or formula through a flexible tube attached to your nipple, while baby breastfeeds. Supplementers help babies learn to suck from a mother’s nipple. As an added perk, mother gets the milk-making hormonal stimulation as Baby sucks at her breast.
Breastfed babies sometimes refuse to take bottles offered by Mom because it just doesn’t feel right. Dad or a substitute caregiver may be more successful at persuading a baby that food can come from other sources. Choose a nipple with a wide base so that baby has to open his mouth wide as he does at the breast. This will minimize problems with lazy latch-on when baby is fed at the breast.
Don’t take it personally if your baby appears to prefer pumped breast milk or formula from a bottle. It usually doesn’t take as much effort to get milk from a commercial nipple. (This is a good reason to avoid them in the early weeks.) If you are planning to combine breastfeeding with formula supplements, or if you find yourself doing this, try to give breastfeeding priority. The more you substitute formula feedings for feedings at the breast, the less milk your breasts will make, and it’s possible that your baby’s interest in breastfeeding will also wane. Combo feeding works for many mothers, but use some caution or your baby may stop breastfeeding before you had planned on weaning.
As a general guide, a baby getting sufficient milk should gain four to seven ounces a week, or a minimum of a pound a month.