Breastfeeding Difficulties for Babies

Some of the most common difficulties infants may experience while breastfeeding include:

• Ineffective latch-on or sucking
• Overactive let-down
• Slow weight gain

Do not wait to get help if you’re having troubles breastfeeding. The sooner you intervene, the better. Missouri Baptist offers breastfeeding support groups and breastfeeding classes for new mothers. Some expectant mothers may desire, or benefit, from a private, individualized lactation evaluation and consultation with a lactation consultant. These private consultations are available for a nominal fee. For more information, please call our Lactation Services at (314) 996-5747.

A baby must be able to effectively remove milk from the breast during breastfeeding if he or she is to obtain enough milk to gain weight and give cues to 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 medications 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 cleft 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. A baby who consistently does any of the following may be showing signs of ineffective sucking:

• Does not wake on his or her own for feedings.
• Cues to be fed fewer than eight times in a 24-hour period.
• Cues to be fed 14 or more times in a 24-hour period.
• 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.
• Nurses on one breast for longer than 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 (three stools per day is normal for a baby who is more than one week old and younger than one month).
• Seems gassy or produces green, frothy stools after the first week.
• Produces fewer than six wet diapers in 24 hours (a baby produces six wet diapers a day by the end of the first week).
• Has difficulty taking milk by other alternative feeding methods.

If you are experiencing any of the following, your baby may be having difficulty latching on:

• Persistently sore or bruised nipples or areola.
• Red, scraped or cracked nipples.
• Misshapen nipples after feedings (for example, creasing or flattening).
• Rarely or never notices breast fullness prior to nursing and breast softening after nursing, especially if there are several hours between feedings.
• More than one episode of plugged milk ducts or mastitis.

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 doctor or a certified lactation consultant 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.

• Wake the baby to breastfeed every two to three hours if he or she is sleepy and still has not mastered feeding cues.
• Expect for some feedings to last longer than others. Your baby may need time to get going at the breast for some feeds.
• Massage your breast with downward and inward strokes (or use one hand to gently squeeze the breast) to deliver milk into the baby's mouth when he or she is nursing. This is also helpful when your baby begins to fall asleep at the breast too soon after starting to feed.
• Use the MoBap Baby Feeding Log to keep track of the number, amount and color of urine and stools for wet and dirty diapers on a daily record.
• Use a hospital-grade breast pump to ensure complete milk removal. Many women will express milk by pumping for several minutes after breastfeeding.
• 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 or her progress at the 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. Devices that may be helpful in certain situations include:
  • 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 and better milk intake during breastfeeding for some 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 to the breast or your finger, 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 with a slower rate of flow are usually preferred.
• If any structural variation in the baby's mouth is found, work with your baby’s doctor to correct or treat it. Depending on the type of variation, this may involve anything from oral exercises to some type of surgical treatment.

Other ways to help your baby breastfeed more effectively include:

• Increase the amount of skin-to-skin contact you share with your baby. Skin-to-skin contact seems to help a lot of babies with nursing. This also 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 at the same time you are breastfeeding your baby on the other.
• You may want to limit breastfeeding duration if you or your baby get 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 can always use a breast pump to express milk and give it by an alternative feeding method.
• 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 or her nutritive sucking ability is improving, ask your baby's doctor when you might eliminate test-weighing and when you can stop waking him or her for feedings to see if he or 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 positively. It is normal to get frustrated and think your baby will never learn to breastfeed effectively. 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 or 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, join a breastfeeding support group that will have lots of information and will provide you with moral support whenever you need it.

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 or pushes off of the breast a minute or two after beginning to feed, an overactive let-down may be the cause.

Most babies will learn to handle let-down as they mature, but until then you might take the baby off the breast until the your milk flow slows. Try using only one breast at each feeding or other feeding positions. Some mothers find it helps to position the baby so that the back of the baby's 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.

Do not wait to get help if you’re having troubles breastfeeding. The sooner you intervene, the better. Missouri Baptist offers breastfeeding support groups and breastfeeding classes for new mothers. Some expectant mothers may desire, or benefit, from a private, individualized lactation evaluation and consultation with a lactation consultant. These private consultations are available for a nominal fee. For more information, please call our Lactation Services at (314) 996-5747.

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's just his or her own unique growth pattern. In other situations, there's a problem that may or may not be easy to identify. If your baby isn't gaining weight according to certain patterns, you and your baby should be checked by your doctor or a certified lactation consultant.

Don't panic if your baby's weight gain is ever a concern. Whether slow weight gain is related to your baby's natural pattern or some other factor, it's almost always best for your baby to continue to breastfeed. Most weight gain issues can be resolved without having to stop breastfeeding your child.

A Naturally Slow Gainer vs. a Slow-weight-gain Problem

A baby who is a naturally slow gainer will gain weight steadily, though slowly and will:

• Stay on a particular growth curve.
• Grow in length and head circumference according to typical rates of growth.
• Wake on his or her own and is alert and wants to breastfeed about 8 to 12 times in 24 hours. As infants get a little older, they may breastfeed less often.
• Has about the same number of wet and dirty diapers as a faster-growing baby.

Your baby’s weight gain may be an issue if he or she:

• Doesn't gain approximately an ounce per day (30g/day) until 3 months of age
• Doesn't gain approximately 0.67 ounces per day (20g/day) between 3 and 6 months of age
• Doesn't regain birth weight within 10 to 14 days after birth
• Has a dramatic drop in rate of growth (weight, length or head circumference) from his or her previous curve

If you are concerned about your baby’s weight gain, consult with his or her doctor.