A breast-fed baby must be able to remove milk from the breast well. They must get enough milk to gain weight and receive proper nutrition. A baby’s sucking also “tells” the breasts to increase or maintain milk production. Poor milk removal can cause problems with weight gain and nutrition because the baby is not getting enough milk. Poor milk removal will cause a decrease in mom’s milk supply.

Conditions that Can Cause Suck or Latch-On Problems

There are many things that affect how well a baby can suck and remove milk from the breast. Some babies have problems staying awake. Other babies have problems coordinating suck, swallow and breathe patterns. A few babies have conditions that affect the structure of the mouth that makes feeding difficult. Some causes of suck or latch-on problems include:

• Prematurity
• Labor and delivery medication
• Down syndrome
• Jaundice
• Infection
• Cardiac defects
• Tongue-tie
• Cleft lip or palate

Signs of Problems

It is important to know the signs that a baby is not removing milk from the breast well. Steps can be taken to correct the problem.

Signs of ineffective sucking in the baby:

• Does not wake on their own for feedings eight or more times in 24 hours or at least every three hours
• Latches on and then slips off of the breast often during the feeding
• Falls asleep within five minutes of latch-on or after sucking two or three minutes
• Does not suck regularly for the first seven to 10 minutes of a feeding
• Feeds for more than 30 minutes without acting full
• Produces less than two stools in 24 hours by the end of the first week (for the first four to eight weeks)
• Produces fewer than six soaking wet diapers in 24 hours by the end of the first week
• Rapid or excessive weight loss (more than 7-10%) for the first 10-14 days, or slow weight gain (less than 1/2 - 1 ounce per day)

Signs in the mother:

• Has persistent sore or bruised nipples or areola
• Develops red, raw or cracked nipples
• Has creased or flattened nipples after feedings
• Does not have breast fullness before feedings and does not have softened breasts after feedings
• Has engorgement, more than one episode of narrowed ducts (plugged ducts) or breast infections, such as mastitis

Help With Breastfeeding

Feeding problems can be upsetting, but most babies will learn to breastfeed if given time. It is important to work with the baby’s doctor and your lactation consultant (IBCLC) for latch or sucking problems. There are things you can do to help the breastfeeding process. You also need to make sure your baby is getting enough to eat. Always ask your baby’s doctor if you have questions.

• Wake the baby to breastfeed every three hours. Feed sooner if the baby is giving you feeding signs or cues.
• Know that your baby will do better at some feedings than others.
• Massage your breast toward the nipple during the feeding. This will help the milk flow into the baby’s mouth and encourage the baby to stay awake and continue to suck.
• Keep a chart of the number of wet diapers and stools per day. Write down the amount and color of the stools.
• If your baby is not feeding well at the breast, use a hospital-grade, double electric breast pump to develop and maintain a good milk supply. Pump your breasts after breastfeeding.
• Offer supplements of expressed breast milk as directed. Talk to your baby’s doctor about using donor milk from a milk bank or formula if you do not have enough milk to feed your baby.
• Some babies need some help with learning to suck. Ask your doctor for advice or referrals if you have concerns.
• Certain feeding devices and methods may help the baby to learn to breastfeed. A lactation consultant (IBCLC) or healthcare provider can help you decide if a device or method is right for your baby.

Get support; consult your lactation consultant (IBCLC) or your baby’s healthcare provider for any concerns or questions. Your support network can help provide information and the moral support you need.

Contact Us

For additional information, call the Center for Breastfeeding Medicine at 513-636-2326.