It is a newborn’s instinct to search for his mother’s breast. Most babies will latch and begin to feed within a few hours after birth. Occasionally, a baby will not latch to the breast. This can be very frustrating and discouraging for a new mother!
Babies who do not breastfeed initially can still learn to breastfeed. It may take a lot of patience and persistence but it definitely is possible. The first step in helping your baby to latch is identifying the problem.
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. She will work with you to identify the cause and make a plan to help your baby learn to breastfeed.
- Your 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 your 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 in this post.
- Your nipples may be difficult to grasp.
Women’s nipples come in all shapes and sizes. If your nipples are quite flat, it can be difficult for your baby to latch. Squishing the breast to flatten it can help (like you would do to a sandwich before taking a big bite).
Be sure to flatten it parallel to your baby’s lips. If you compress your breast with your thumb opposite your baby’s nose and your fingers on the other side, you will be shaping it in the correct way. This post uses graphics to further explain how to “sandwich” the breast.
If latching continues to be a problem and your breasts have filled with milk, a nipple shield may be an option. Ask your lactation consultant if it is advisable in your situation.
Although it is rare, some nipples are too large for a newborn to grasp. If this is the case, it will be necessary to pump and use a bottle temporarily. When your baby grows a little bigger, he will be able to latch more easily to your nipple.
- Baby may have a tongue tie.
A tongue-tie restricts the tongue’s range of motion. This makes it difficult for your baby to grasp and draw your nipple into his mouth. Releasing the tongue-tie will allow your baby’s tongue to move more freely. (Read this post to learn more about tongue ties.)
- Baby’s first feeds may have been by a 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 a bottle nipple, acting like he cannot find your nipple. It can be frustrating for a baby to relearn how to breastfeed.
Skin to skin snuggling between feeds can help. You could also drip some milk on your nipple to entice your baby to suck. If the difficulty persists, your lactation consultant may suggest a nipple shield to help your baby transition from the bottle to the breast.
- Your 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.
If you suspect your baby has an anatomical challenge, please consult with a Lactation Consultant. She can help you to determine the cause of your baby’s difficulty and recommend solutions for your baby’s particular difficulty.
- 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 breastfeed, diligent pumping will help you to develop a full milk supply. This is the best way to ensure your 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 well but is suddenly unable to latch, it may be due to overly full breasts. If the brown area around the nipple (areola) is quite firm, it may be difficult for your baby to grasp. This post describes a technique that may be helpful.
There are many possible reasons your baby won’t latch to the breast. The following general principles apply, regardless of the underlying issue.
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If your baby won’t 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 both for you and your baby to enjoy these sessions. If it is frustrating for either mom or baby, it is time to take a break.
- A baby whose body is well supported is more likely to breastfeed. In the laid back position, your baby’s entire body is supported against your own (read more and see a photo here). If you are more comfortable feeding in a cradle or football hold, ensure that pillows support your baby’s entire body. (There are photos of these holds in the link above.)
- Try allowing your baby to self attach while you are in the laid back position. (There is a video showing self-attachment in this post.)
- Do some hand expression. This will tell your breasts that it is time to begin producing more milk. (Learn how to hand express by watching this video.) Recent research shows that beginning hand expression in the first hour after birth brings your milk in faster and dramatically increases milk supply at 3 weeks.
- Feed drops of your hand expressed colostrum to your baby with a spoon. Babies are incredible; they will “sip” milk from the spoon.
If your 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 your 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 to establish your milk supply. You may not express a single drop at first. That’s okay. Please do not give up. Pumping tells your body that your baby is here and will need milk. Developing a good supply of milk will be key in coaxing your baby to the breast.
- You will, of course, need to feed your baby. The first choice is to feed your own expressed breast milk. Sometimes, however, your baby may need more milk than you are able to produce. Banked donor breast milk is available in some areas. If this is not the case for you, your healthcare provider will recommend a type of formula. Feeding your baby will help ensure he has the energy to continue to learn to breastfeed.
- 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. Some babies are quickly frustrated and 20 minutes of trying will be too long.)
- Sometimes it is helpful to give your baby a little milk prior to a breastfeeding attempt, especially if your baby is quite hungry. Taking the edge off the baby’s hunger may help him to be more relaxed and ready to try breastfeeding.
- Your healthcare provider may suggest you feed your baby by spoon, cup or finger feeding when he is not latching. These methods become more difficult once he is taking larger volumes. Your healthcare provider may then suggest beginning to use a bottle. This does NOT mean you must give up on breastfeeding! Again, it is important to feed your baby so that he will have the energy to learn to feed. If you choose to bottle, use a rounded nipple rather than one with a flattened cross-section. For most babies, a slow flow nipple and paced bottle feeding are best. Entice your baby to gape widely when taking the bottle to mimic latching at the breast.
- A nipple shield can be useful in some instances once your milk supply is established. It is not recommended to use a nipple shield in the early days of breastfeeding before your milk comes in.
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 your baby skin to skin are the most important things you can do.