Breastfeeding Troubles Dallas TX

by Jack Newman, MD, FRCPC

Why would a baby refuse to take the breast?

There are many reasons a baby might refuse to latch on. Often there is a combination of reasons. For example, a baby might latch on even with a tight frenulum if no other factors come into play, but if, for example, he is also given bottles early on, this may very well change the situation from "good enough", to "not working at all".

• If the mother's nipples are particularly large, or inverted, or flat, these nipple variations make latching on more difficult, not usually impossible.

• Some babies are unwilling to nurse, or suck poorly as a result of medication they received during the labor. Narcotics are responsible for many such situations, and meperidine (Demerol) is particularly bad as it stays in the baby's blood for a long time and affects the way he sucks for several days. Even morphine given in an epidural may cause the baby to be unwilling to nurse or latch on, since medication from an epidural definitely does get into the mother's blood, and thus into the baby before he is born.

• Vigorous suctioning at birth may result in babies not sucking properly and not wanting to latch on. There is no need to suction a healthy, full term baby at birth.

• Abnormalities of the baby's mouth may result in the baby's not latching on. Cleft palate, but not cleft lip, causes severe difficulties in latching on. Sometimes the cleft palate is not obvious, affecting only the part inside the baby's mouth.

• A tight frenulum (the whitish tissue under the tongue) may result in a baby having difficulty latching on. This is not, strictly speaking, considered an abnormality, and thus, many physicians do not believe that it can interfere with breastfeeding, but they are misinformed.

My baby doesn’t know how to latch yet because...

My baby is too sleepy to latch

My baby is too frantic to latch

My baby is refusing to latch

My baby latches but it really hurts!

I’m too engorged for baby to latch on.

OR

I’m afraid my baby isn’t getting enough because...

My baby isn’t nursing often enough

My baby seems hungry all the time

I don’t seem to have any milk yet

I can’t get my milk to letdown

I’m engorged but I can’t get milk out

9 Ways to prevent and treat these early breastfeeding problems:

1.HOLD YOUR BABY A LOT. Think about where your baby was just a few short days ago...tightly bound up inside your uterus, likely head down. It was dark - and LOUD, and warm and your movements constantly rocked him gently in the amniotic fluid. This was her home. Try to replicate this as best as you can and you will find your baby magically calmed. (I don’t suggest putting him back inside you however!)

2.SKIN-TO-SKIN. A breastfeeding mom’s best position. Take it all off, baby in diaper, you bare chested (save that nursing bra for work). Partners have a good chest for this also - even if it IS hairy! Place baby, lean back, close eyes, get rest. Heavenly.

3.TAKE NAPS TOGETHER. Your baby CAN sleep on your chest, up between your breasts.

4.LOOK FOR THE EARLY HUNGER CUES. If your baby isn’t already skin-to-skin, place the baby there.

5.ALLOW BABY-LED LATCHING. Place your baby skin-to-skin between your breasts. Follow the baby’s lead, bringing his rear up as he moves head down. Keep face, cheek, lips, chin toughing breast so he knows where it is. Line up nose to nipple, chin and lower lip touching the breast. Baby can now reach with his upper lip up and over the nipple to form an “off-center” comfortable latch.

6.FORGET THE CLOCK. Let your baby nurse as often and as long as she wants to, as long as it is mutually comfortable. A “full baby” will go to sleep happily between the breasts, a “hungry baby” will continue to root and self-latch.

7.HELP A FRANTIC BABY BY CALMING BABY FIRST.Move baby away from the nipple if she is too frantic to latch - keep the breast a happy place to be! Place back between breasts, upright, stroke his back, make eye contact, talk to her say “shhhhhhh”. Let the baby suck on your finger with the soft side up to the palate. Hand baby off to another person. If these don’t work, feed a little expressed breastmilk or formulat 1/2 -1 ounce or so, as soon as the baby has calmed down, put back skin-to-skin and let baby look for breast again as above.

8.DO NOT PUT UP WITH PAIN! If the latch hurts alot break suction by gently pulling back on baby’s cheek at the corner of her mouth. Relatch again until it doesn’t hurt. If baby is sucking well, sometimes pulling down on the chin or on the lower lip will adjust the latch enough to make a little painful latch feel better. Breastfeeding should not hurt, if it does, something is wrong - GET HELP!

9.TRUST YOUR INSTINCTS. TRUST YOUR BABY’S INSTINCTS

Attribution: Nightingales Breastfeeding Support Center. Help for all things breastfeeding from a Pediatrician who specializes in Breastfeeding Medicine.