Breastfeeding Difficulties - Baby 

Breastfeeding Difficulties - Baby

As with some mothers, some babies may have difficulty with breastfeeding. Listed in the directory below, you will find additional information regarding breastfeeding difficulties for babies, for which we have provided a brief overview.

Ineffective Latch-On or Sucking

A baby must be able to effectively remove milk from the breast during breastfeeding if he/she is to obtain enough milk to gain weight and "tell" the breasts to increase or maintain milk production. Therefore, ineffective milk removal can result in poor weight gain due to inadequate intake of milk by the baby, which is then followed by a drop in the amount of milk being produced for the baby.

A baby's ability to suck and remove milk may be affected in different ways. Prematurity, labor and delivery medication, and conditions such as Down syndrome, may initially make it difficult for a baby's central nervous system to remain alert or coordinate suck-swallow-breathe actions. Acute health conditions, such as jaundice or infection and chronic conditions, such as cardiac defects may also influence a baby's level of alertness or the ability to suck. A "mechanical" issue, such as tongue-tie or a cleft lip or palate might directly interfere with a baby's ability to use the structures in the mouth for effective sucking.

Sometimes, the cause is obvious, but often it is not. However, it is important to recognize the signs that a baby is unable to effectively remove milk during breastfeeding so that steps can be taken to remedy any problem. Signs of ineffective sucking may include the following: The baby who consistently:

• does not wake on his/her own to cue for feedings eight or more times in 24 hours.
• cues to feed 14 or more times in 24 hours.
• latches on and then lets go of the breast repeatedly.
• pushes away or resists latch-on.
• falls asleep within five minutes of latch-on or after sucking for only two or three minutes.
• does not suck almost continuously for the first seven to 10 minutes of a feeding.
• continues to feed without self-detaching at the first breast after 30 to 40 minutes.
• feeds for more than 45 minutes without acting satisfied or full after a meal.
• produces fewer than three stools in 24 hours by the end of the first week (for the first four to eight weeks).
• seems "gassy" and produces green, frothy stools after the first week.
• produces fewer than six soaking wet diapers in 24 hours by the end of the first week.
• has difficulty taking milk by other alternative feeding methods.

The mother who:

• has persistent sore or bruised nipples or areola.
• develops red, scraped or cracked nipples.
• frequently observes misshapen nipples after feedings (i.e., creasing or flattening).
• rarely or never notices fullness prior to, and a softening of the breasts after, a feeding, especially if there are several hours between feedings.
• experiences more than one episode of plugged ducts or mastitis.

How you can help with the breastfeeding process:

When a difficulty with latch-on or sucking persists beyond the first several days after birth, it can be discouraging. Although most babies will learn to breastfeed effectively if given time, it is important to work with the baby's physician and a certified lactation consultant (IBCLC) if a baby has difficulty sucking. Until the issue resolves there are several things you can do to help breastfeeding progress while you make sure your baby is getting enough to eat. Always consult your baby's physician for more information.

• Wake the baby to breastfeed every two to three hours if he/she is "sleepy" and still has not mastered feeding cues.
• Your baby probably will do better for some feedings. Do not be discouraged if he/she is too sleepy or seems to "forget" from feeding to feeding.
• Some feedings will last longer than others, and your baby may need time to "get going" at the breast for some feeds.
• Massage your breast with downward and inward strokes to deliver milk into the baby's mouth when he/she begins to fall asleep at the breast too soon after starting to feed.

• Chart the number, amount, and color of urine and stools for wet and dirty diapers on a daily record.
• Use a hospital-grade, electric breast pump to ensure milk removal. Express milk for several minutes after breastfeeding. How long you will need to continue to pump depends on how quickly your baby learns to breastfeed effectively.
• Weigh the baby regularly or record a test-weight before and after one or more daily feedings.
• Offer additional calories by giving baby any expressed breast milk available first or a prescribed infant formula based on his/her progress at breast. The amount used and the alternative feeding method used should change as your baby's sucking ability improves.
• Certain breastfeeding devices or alternative feeding methods may encourage effective sucking or provide your baby with additional nutrition during the "learning to breastfeed" process. Although a specific device may have advantages for your situation, every device also has disadvantages. To avoid pitfalls, any breastfeeding device should be used with the guidance of a certified lactation consultant (IBCLC). Devices that may be helpful in certain situations include the following:
  • nipple shield
    A thin silicone or latex nipple shield, which is centered over the nipple and areola, has been shown to encourage a better latch, more effective sucking pattern, and better milk intake during breastfeeding for certain babies.
  • feeding tube system
    A feeding-tube system may be taped to the breast or your finger so that a baby receives additional milk through the tube when the baby sucks. When a thin feeding tube is attached to a syringe and taped it to the breast or your finger (finger-feeding), you or a helper can gently press the plunger to deliver a few drops of milk in the baby's mouth if the baby "forgets" to suck. Commercial feeding-tube systems are also available.
  • alternative feeding methods
    In addition to a feeding-tube system, there are other alternative feeding methods that will ensure that your baby gets enough food, yet are less likely to interfere with long-term breastfeeding. These include cup-feeding, syringe-feeding, spoon-feeding, or (eye) dropper-feeding. If using a bottle, bottle nipples (teats) with a slower rate of flow usually are preferred.
• If any structural variation in the baby's mouth is found, work with the proper healthcare professionals to correct or treat it. Depending on the type of variation, this may involve anything from oral exercises taught by occupational therapist to some type of surgical treatment.

Other ways to help the baby with ineffective sucking:

Other hints for the baby include the following:

• Skin-to-skin contact seems to help babies get to the breast more effectively, sooner, and it helps you maintain milk production.
• When a baby has the basic idea of effective sucking but cannot seem to do it consistently, try pumping one breast while breastfeeding your baby on the other.

• You may want to limit a breastfeeding if you or your baby gets too frustrated or if the feedings take more than 40 to 45 minutes. By stopping when frustrated or limiting the time of feedings, you will have more time to pump and remove milk effectively, and you may find it is easier to remain patient through the learning process.
• You may want to let the baby's father or other family members and friends handle alternative feedings, so you do not become overwhelmed. This frees you to concentrate on breastfeeding, maintain pumping sessions, and enjoy periods of cuddling skin to skin with your baby.
• Do not throw away any breastfeeding device or an alternative feeding method because you did not like it or it did not work when first suggested. The device or method that did not help one day may work great the next and vice versa.
• Once your baby is growing and developing properly and his/her nutritive sucking ability is improving, ask your baby's physician when you might eliminate test-weighing. Ask when you can stop waking him/her for feedings and begin to wait to see if he/she will demonstrate feeding cues. You will also want to know when it is safe to start decreasing supplementary breast milk or formula.
• Keep thinking positive. It is normal to get frustrated and think your baby will never learn to breastfeed effectively. It is normal if some days seem an eternity of breastfeeding practice, alternative feedings, and breast pumping sessions. It is normal for your confidence to rise and fall. Try to maintain perspective by having a sense of humor. Think about how far your baby and you have come since his/her birth rather than how far you still may have to go.
• Get support. In addition to staying in touch with a certified lactation consultant (IBCLC), contact a representative of a breastfeeding support organization, who will have lots of information and will provide you with moral support whenever you need it.

Slow or Poor Infant Weight Gain

Determining slow or poor infant weight gain:

Weight gain is one of many signs of good health in the breastfeeding baby. Sometimes, a perfectly healthy baby simply gains weight slowly because it is just his/her own unique growth pattern. In other situations, there is a problem that can be pinpointed. If a baby is not gaining weight according to certain patterns, the baby and the mother should be checked by the physician and a certified lactation consultant (IBCLC). To determine whether slow weight gain is a baby's natural growth pattern or the result of something else, you should be asked a lot of questions about both you and your baby.

Do not panic if your baby's weight gain is ever a concern. Whether slow weight gain is related to a baby's natural pattern or some other factor, receiving your breast milk via continued breastfeeding or an alternative feeding method is almost always in the best interest of the baby. Also, most weight gain issues can be resolved and the mother-baby breastfeeding relationship can continue with proper intervention.

Distinguishing the "natural" slow gainer from a slow-weight-gain problem:

A baby that is a "natural" slow-gainer still gains weight steadily, albeit slowly:

• maintains a particular growth curve.
• increases in length and head circumference increase according to typical rates of growth.
• wakes on his/her own and is alert and cues to breastfeed about eight to 12 times in 24 hours.
• produces wet and dirty diaper counts similar to a faster-growing baby.

Other factors should be considered when a baby:

• does not gain at least one-half an ounce (15 g) a day by the fourth or fifth day after birth.
• does not regain birthweight by two to three weeks after birth.
• does not gain at least one pound (454 g) a month for the first four months (from lowest weight after birth versus birthweight).
• exhibits a dramatic drop in rate of growth (weight, length, or head circumference) from her/his previous curve.

Always consult your baby's physician for more information.

Mismanaged Breastfeeding

Managing mismanaged breastfeeding:

Perhaps the most common cause of slow weight gain is related to mismanaged breastfeeding. The following are some ways to help your baby gain weight if breastfeeding management is the reason for the slow weight-gain pattern.

• Watch for signs from your baby that he/she wants to feed. Your baby should wake and "cue" to breastfeed about eight to 12 times in 24 hours by rooting, making licking or sucking motions, bobbing his/her head against the mattress, your neck or a shoulder, or bringing his/her hand to the face or mouth. Put him/her to your breast right then. Crying is a late feeding cue. Usually a baby latches and breastfeeds better if he/she does not have to wait until he/she is crying, frustrated, or too tired to feed. Putting a baby off to try to get the baby to go longer between feedings and frequently offering a pacifier instead of the breast when a baby demonstrates feeding cues are often linked to poor weight gain.
• Many mothers find milk production increases and babies' weight gains improve if they and their babies let chores and activities go for two or three days, so they can breastfeed, more or less, around the clock. When a baby is not breastfeeding, the mother holds him/her skin-to-skin on her chest, which often helps her become more sensitive to the baby's feeding cues.
• If your baby is a "sleepy" baby who does not cue to feed at least eight times in 24 hours, you will have to wake the baby to feed frequently - about every two hours during the daytime and evening hours and at least every three to four hours at night until weight gain improves.
• Be sure your baby is mainly uncovered during breastfeeding. A baby that is bundled papoose-style seems to get much too warm and comfy, and he/she is more likely to doze off too quickly during feedings. If there is a chill in the air, drape a sheet or light blanket over you and the baby, as needed.
• If your baby falls asleep within minutes of latching on, massage your breast as you breastfeed to re-trigger sucking by stroking downward and inward on the breast.

• Make sure your baby is latching on correctly and sucking effectively.
• In general, avoid "switch nursing." That is, breastfeeding at one breast for a few minutes, then the other, and then back again. This may interfere with your baby getting enough of the calorie-rich hindmilk, which your baby gets more of as a feeding continues on one breast. However, the "switch" strategy sometimes stimulates the "sleepy" baby so he/she wakes up and begins sucking again.
• Offer a supplement during, or after, breastfeeding (when prescribed) to provide additional calories. Use your own expressed milk first for any alternative feedings if any supplementary feedings are recommended.
  
  
• Use an alternative feeding method recommended by a certified lactation consultant (IBCLC). There are many alternative feeding options, so let her know if a recommendation does not "feel right" for you. Alternative feeding methods include:
  • cup feeding
  • a tube system with a special feeding tube taped to the breast or a finger
  • syringe feeding
  • an eyedropper
  • spoon feeding
  • bottle-feeding

  Several methods require assistance from a professional, such as a certified lactation consultant (IBCLC) so you can use them correctly. Depending on your baby and the cause of the problem, some methods may work better than others. Also, discuss bottle nipple type with the IBCLC if you bottle-feed any supplement. Some types of bottle nipples are less likely to interfere with breastfeeding than others.

• Pump your breasts after as many daily breastfeedings as possible, especially if you are uncertain whether your baby is effectively removing milk during breastfeeding. Pumping will remove milk effectively, so your breasts will know to produce more milk. Ideally, you would use a hospital-grade, electric pump with the appropriate collection kit to obtain milk.
• Your baby should be weighed on a frequent and regular basis until he/she is gaining weight at a satisfactory rate. Digital scales are available that allow a healthcare provider or a certified lactation consultant (IBCLC) to get precise pre- and post-feeding weights in order to measure how much milk a baby takes in during a particular breastfeeding. Although this can be helpful, babies take in different amounts at different feedings throughout a 24-hour period. Therefore, a professional may recommend that parents rent this type of scale so a baby can be weighed before and after different feedings. They also may suggest recording only a daily or weekly weight, depending on the situation.

If breastfeeding is properly managed, yet the baby still is not gaining adequate weight, it is likely that some other factor is affecting milk production or the baby's ability to breastfeed effectively. Always consult your physician in this case.

Over-Active Let-Down

Although most babies with breastfeeding difficulties have problems related to getting enough milk, a few have the opposite problem - handling too much milk. Some mothers have such a strong let-down that the baby cannot handle the volume of milk.

If your baby chokes, gags, pushes off of the breast a minute or two after beginning to feed, an over-active let-down may be the cause.

Most babies do learn to handle let-down as they mature, but until then you might take the baby off the breast until the milk flow slows. Try using only one breast each feeding. Some mothers find it helps to position the baby so that the back of her throat is higher than the nipple, so that the milk has to "travel" uphill during a let-down, which slows the flow. Another option is to try pumping through the let-down immediately before a feeding.