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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 labour.
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.
- A baby learns to breastfeed
by breastfeeding. Artificial nipples interfere
with how the baby takes the breast. Babies
are not stupid. If they get slow flow
from the breast (as is expected in the
first few days of life) and rapid flow
from the bottle, they will not be confused—many
will figure it out quite quickly.
However, one of the most
common causes of babies’ refusing to
latch on arises from the misguided belief
that babies in the first few days must breastfeed
every 3 hours, or on some other insane sort
of schedule. This results in anxiety on
the part of the staff when a baby has not
fed, for example, for three hours after
birth, which results, frequently, in babies
being forced to the breast when they are
not ready yet to feed. When the baby is
forced into the breast, and kept there by
force, when the baby is not interested or
ready, we should not be surprised that some
babies develop an aversion to the breast.
If this misguided approach then results
in panic, and “the baby must be fed”,
alternative feeding methods (the worst of
which is the bottle) are then used, resulting
in worsening of the situation and the beginning
of a vicious circle.
There is no evidence
that a healthy full term newborn must feed
every three hours during the first few days.
There is no evidence that they will develop
low blood sugars if they don’t feed
every three hours (the whole issue of low
blood sugars has become a mass hysteria
in newborn nurseries which, like all hysterias,
results from a grain of truth, perhaps,
but actually causes more problems than it
prevents, including the problem of many
babies getting formula when they don’t
need it, and being separated from their
mothers when they don’t need to be,
and not latching on). Babies should be together,
skin to skin with their mothers, 24 hours
a day (See handout 1a The
importance of Skin to Skin Contact).
When they are ready, most will start looking
for the breast. Having the baby with the
mother skin to skin immediately after birth,
and allowing the baby and the mother the
time to “find” each other, will
prevent most situations of the baby not
latching on. Mother and baby skin to skin
will also keep the baby as warm as being
under a heating lamp. Having the baby and
mother together for 5 minutes though, is
not the answer. The mother and baby should
be together until the baby latches on, without
pressure, without time limits (“we’ve
got to weigh the baby”, “we’ve
got to give the baby vitamin K,” etc—these
procedures can wait!). This might take 1-2
hours or more.
But the baby is not
latching on!
Okay, so how long can
we wait? There is no obvious answer to that.
Certainly, if the baby has shown no interest
in nursing or feeding by 12 to 24 hours
after birth, it may be worthwhile to do
something, mostly because hospital policies
usually require the mother to be discharged
by 24 to 48 hours. What can be done?
- The mother should start
expressing her milk, and that milk (colostrum),
either alone, or mixed with sugar water,
should be fed to the baby, preferably
by finger feeding. If it is difficult
to get colostrum (often hand expression
works better than a pump in the first
few days), then sugar water alone is fine
for the first few days. With finger feeding,
most babies will start sucking, and many
will wake up enough to attempt going to
the breast. As soon as the baby is sucking
well, finger feeding should be stopped
and the baby tried at the breast. Finger
feeding is essentially a procedure to
prepare the baby to take the breast, not
primarily a method to avoid the bottle,
though it will do that too. Therefore
it is done before attempting the baby
at the breast, to prepare him to take
the breast. See handout #8 Finger
Feeding.
- Before discharge, early,
competent help needs to be arranged so
that the mother and baby are getting help
by day four or five at the latest. Many
babies not able to latch on in the first
few days will latch on beautifully once
the mother’s milk supply has increased
substantially as it usually does around
day 3 or 4. Getting help at this time
avoids the negative associations with
the breast that many babies develop as
time goes on.
- A nipple shield started
before the mother’s milk becomes
abundant (day 4 to 5) is bad practice.
Starting a nipple shield before the mother’s
milk “comes in” is not giving
time a chance to work. Furthermore, used
improperly (as I see it often being used),
a nipple shield may result in severe depletion
of the milk supply.
I’m home from hospital.
The baby won’t latch on. What do I
do?
The single most important
factor influencing whether or not the baby
latches on is the mother’s developing
a good milk supply. If the mother’s
supply is abundant, the baby will latch
on by 4 to 8 weeks of life no matter what.
What we try to do at the clinic is get the
baby latching on earlier, so that you won’t
have to wait that long. So, it is more important
you keep up your supply, than avoid a bottle.
The bottle interferes, and it is better
you use other methods (such as a cup) if
you can, but if you feel you have no choice,
you should do what you need to do.
- Learn how to get
the best position and latch from an experienced
lactation specialist (see also handout
When Latching
and see our videos).
As the baby comes onto the breast, compress
the breast so that the baby gets a gush
of milk. Try the baby on the breast he
seems to prefer, or the breast that has
more milk, not the breast he resists more.
- If the baby latches
on, he will start sucking and start
drinking (get information on how to
know a baby is actually getting milk
at the breast—see handout #4
Is My Baby
Getting Enough Milk? and see our
videos).
- If the baby doesn’t
latch on, don’t try to force
him to stay on the breast; it won’t
work. He will either get hysterical
or “go limp”. Move him away
from the breast and start again. It
is better to go on-off, on-off several
times than to push him into the breast
when he hasn’t latched on.
- If the baby goes
to the breast and sucks once or twice,
he hasn’t latched on a little;
he hasn’t latched on at all.
- If the baby refuses
the breast, don’t keep at it until
he’s angry. Try finger feeding a
few seconds to a minute or two, and try
again, perhaps on the other side. Finger
feeding is to prepare the baby to take
the breast, not primarily to avoid a bottle.
- If the baby doesn’t
latch on, finish the feeding with whatever
method you find easiest.
- Using a lactation aid
at the breast may be helpful, but often
requires an extra hand.
- At about two weeks after
birth, a change in what you have been
doing often seems to send a message to
the baby that “there’s more
than one way to do this”. If you
have been finger feeding only, a change
to a cup or bottle will sometimes work,
or using a nipple shield will often work.
If you have been bottle feeding only,
switching to finger feeding may work (only
before attempting the baby at the breast
is good enough if finger feeding is too
slow, and finishing the feeding with cup
or bottle).
How to maintain and
increase milk supply
- Express your milk as
often as is practical, at least 8 times
a day, using a reliable pump that expresses
both breasts at the same time. Using compression
while pumping increases the efficiency
of pumping and increases the milk supply
(another hand is helpful, but mothers
have rigged up the pump so that they don’t
have to hold onto the tubing or flanges
while pumping and thus can compress without
help).
- If the baby hasn’t
latched on by day 4 or 5, start fenugreek
and blessed thistle to increase milk flow.
See handout #24. Miscellaneous
Treatments. Domperidone may also be
useful. See handouts 19a
and 19b
on Domperidone.
- If you must use a nipple
shield, do not use one at least until
the milk supply is well established (at
least 2 weeks after the baby is born).
Get good hands on help first.
Do not get discouraged.
Even if your milk supply is not up to the
needs of your baby, many babies will still
latch on. Get good help. Do not do this
on your own.
Questions? (416) 813-5757
(option 3) or drjacknewman@sympatico.ca
or my book Dr. Jack Newman’s Guide
to Breastfeeding (called The Ultimate Breastfeeding
Book of Answers in the USA)
Handout #26. When The Baby
Refuses to Latch On. January 2005
Written by Jack Newman, MD, FRCPC. ©
2005
This handout may be copied
and distributed without further permission,
on the condition that it is not used in
any context in which the WHO code on the
marketing of breastmilk substitutes is violated
1. Breastfeeding:
Starting out right
a) The
importance of Skin-to-Skin contact
2. Colic in the Breastfed Baby
3. a) Sore Nipples
b) Treatments
for Sore Nipple and Sore Breasts
4. Is my baby getting enough?
5. Using a Lactation Aid
6. Using Gentian Violet
7. Breastfeeding and Jaundice
8. Finger Feeding
9. a) You should continue breastfeeding
(Medications and breastfeeding)
b) You
should continue breastfeeding (Illness in the mother or baby)
10. Breastfeeding and other foods
11. Some breastfeeding myths
12. More breastfeeding myths
13. Still more breastfeeding
myths
14. More and more breastfeeding
myths
15. Breast compression
16. Starting solid foods
17. What to feed the baby when
the mother is working outside the home
18. How to know a health professional
is not supportive of breastfeeding
19. a) Domperidone 1
b) Domperidone
2
20. Fluconazole
21. Breastfeed a toddler –
Why on earth?
22. Blocked ducts and
mastitis
23. Breastfeeding your adopted baby
24. Miscellaneous treatments for problems
25. Slow weight gain after
the first few months
26. When the Baby refuses to
latch on
27. Expressing Milk
28. Toxins and Infant Feeding
How breastmilk protects Newborns
Risks of formula feeding
Breastfeeding and guilt
Candida protocol
Protocol to increase the intake
of Breastmilk by the Baby ("Not enough milk")
When latching
Protocols for Induced Lactation
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