Latch-on: Simple solutions to common breastfeeding problems

Any mom who says breastfeeding is easy just doesn’t remember the first few weeks!

At some point every new mother has difficulty breastfeeding. If you have been advised to supplement with formula, don’t give up on breastfeeding entirely. Every ounce of breast milk a baby gets will help them grow and thrive in ways that formula manufacturers will never be able to match. Fortunately, the two most common breastfeeding problems, insufficient milk supply and pain, are relatively easy to address:

Check baby’s latch and suck

Making a good milk supply almost entirely depends on baby latching on well.  All other factors combined like maternal age, breast shape and mom’s health status don’t add up to the effect that a proper latch has on both milk production and prevention of nipple pain. If baby doesn’t latch well, mom’s hormonal system won’t receive the proper signals to increase milk production – and nursing will be far more painful.

The nipple needs to go deeper into the baby’s mouth than you would ever guess. When you first learn to help baby latch you basically have to shove their head on at just the right moment when their mouth is wide open. This takes practice. Then listen for the rhythmic train-like sound of suck-swallow. If you aren’t absolutely sure you are doing it right, have your pediatrician or lactation consultant observe you feeding the baby.

What are signs of a good latch?

Good latch:

  • An angle of about 120 degrees between the top and bottom lip
  • The lower lip (and, to a lesser extent, the upper lip) turned outward against the breast
  • The chin and nose in close proximity to the breast
  • Full cheeks
  • Tongue extended over the lower dental ridge and in visible contact with the breast if the lower lip is pulled away

Bad latch:

  • Contact between the upper and lower lip at the corners of the mouth
  • Tongue not visible below the nipple when the lower lip is pulled down
  • Creased nipple following nursing

 

What about supplements to increase milk supply?

Galactagogues are medications or herbal substances that are thought to increase milk production. No medications or supplements have been shown to be effective in research studies. Fenugreek is the most common herbal supplement used and there is no evidence that it works. There is some evidence that it causes diarrhea and flatulence. It’s tempting to think that taking fenugreek is worth a try, however, it isn’t known whether it crosses into the milk and is probably not worth the minuscule risk to the baby. Plus, who needs more gas? Even the most commonly prescribed galactagogue, metoclopramide, was not more effective than placebo in research trials. Honestly, a relaxing cup of herbal tea may be more helpful.

 

Put baby to the breast A LOT

The honest truth is that not making enough milk is expected. Every baby will have days when they act like they are starving which leads any caring mom to assume she isn’t making enough milk – and she’s probably correct. Babies have growth spurts and need more calories. These spurts often occur around 2-3 weeks, 6 weeks and 3 months. But they can happen anytime.

The solution is for the baby to spend more time breastfeeding. Like all high-end luxury goods, breast milk is manufactured exclusively on a supply and demand schedule. When baby has a growth spurt he needs more calories, so he’ll nurse more often and for a longer time to stimulate an increase in milk production. So there is a bit of a delivery delay while mom’s breast milk factory revs up production.

Is baby getting enough?

If only breasts were marked off in ounces so breastfeeding moms knew how much milk baby was drinking! Since breasts aren’t see-through you can reassure yourself that baby is getting enough milk if she seems satisfied at the end of a feed or if she has a wet diaper after each feed. If you need more tangible evidence, most lactation consultants can weigh your baby before and after a feed to see precisely how much volume they drank. That way you know she drank 4 ounces even though it seemed like she got nothing or spit most of it up.

 

Ease the pain

Breastfeeding pain is inevitable, but will resolve after about the first week. You should only have pain during the first minute or so. Interestingly, one of the most common (and unavoidable) causes of pain is thought to be the negative pressure on the milk ductules that have not yet filled with milk after baby’s first few suckles. Some mother’s can also feel the “pins and needles” sensation of milk letdown. Both sources of discomfort should go away after the first weeks.

If you have pain that increases during a feed or still have pain after the first few weeks, this is likely due to nipple trauma or infection and you will need to seek medical help.

The best treatment for nipple pain is prevention – so that means ensuring a good latch and avoiding excessive moisture or irritating cleansers. Treat traumatized nipples with a topical antibiotic like bacitracin and cover with a non-stick pad to prevent infection and protect irritated or cracked nipples from sticking to the breast pad or bra.

What about biting?

Babies start teething around 3 months and may start biting then too. Babies can’t bite at the beginning of a feed because their teeth are completely covered by their tongue when they are actively sucking and swallowing. Keep the baby close to the breast with their mouth wide open to avoid letting their latch become too shallow on the nipple. Once swallowing is over and the baby is nursing for comfort, take the baby off the nipple to prevent biting. If baby bites you, firmly say “no”, break the suction and briefly put her away from you on a safe surface. Don’t show too much emotion or she might think it’s a fun game called “Bite Scream Laugh Repeat.”

 

There are about a million problems that can happen when you’re new at breastfeeding, like breast infections and engorgement. That’s why there are experts called lactation consultants and volumes of books on the subject. Studies have shown that with accurate advice and treatment, the majority of these difficulties can be overcome. The benefits of breastfeeding are just too great to give up. If you want to lose the baby weight, prevent breast cancer and wash fewer bottles all while providing baby with the best nutrition, do everything you can to maintain your status as a Breastfeeder.

Do you know the secret breast milk ingredient we all need?

 

TODAY.com Parenting Team Contributor

Author: Wendy Hunter, MD

Associate Clinical Professor of Pediatrics, UC San Diego and pediatrician at Rady Children's Hospital, Department of Emergency Medicine.

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