How can I get my newborn to latch on and nurse?

Ask Anne…

Question: My 4 day old refuses to latch on and nurse. When she was born she was jaundiced and very sleepy. She slept for 7 hours her first night home.  Now she is more lively, but she cries and pulls off my breast and won’t latch on at all. While waiting for my milk to come in, we are giving her expressed milk via a syringe plus formula as a last resort. We know she sucks well because now she is sucking on the syringe hard enough to bring down the plunger by herself, but we still have to wake her up to eat.  Now that my milk has come in,  how can I teach her that my breasts contain milk so that she will latch on and nurse ?

Answer: Having a baby who won’t latch on is one of the most frustrating things that new mothers have to deal with.  I can assure you that it is a very common problem, and there are lots of things you can do to help her get the idea.

Mothers are usually back at home before their milk comes in. Most babies are  not really hungry the first day or so, because they are born with  extra fluid in their tissues and until they excrete it, they are usually not very interested in eating.  This works out pretty well in most cases, because by the time they decide they are hungry on day 2 or 3,  your milk is starting to come in. However, sometimes you and your baby aren’t completely in sync in the beginning, and that can cause some breastfeeding ‘bumps in the road’.

Your situation is very typical: the baby is a bit jaundiced and sleepy and not very interested in nursing during the 24 hour hospital stay. Once you get home, the excess fluids have worn off, the baby is hungry, your milk is in, and yet when you try to put her on the breast, she either pulls off and acts like you are trying to poison her, or she falls into a coma-like sleep and you can’t wake her up. Does this sound familiar?

The good news is that none of this is abnormal, and she will get the hang of it. Even though she is born with a strong sucking reflex, she has to learn how to attach to the breast and suckle properly so that the milk will let down and she will feel full. At the same time, you have to get the hang of how to hold and position her correctly and comfortably. Once you both accomplish this, she will make the connection between going on the breast and getting her tummy full, and she will LOVE to nurse.

It’s normal for babies to become agitated and fussy on the third or fourth day, because they are feeling hunger pangs for the first time.  Their little tummies rumble and growl, and they don’t like this new feeling one bit.  They have no way of knowing that if they go on the breast, they will get  milk and feel good again. They will soon figure it out, but it is a learning process.  Be patient and hang in there.

While you are both learning this new skill, it is important to make sure that she gets enough to eat. If she is frantically hungry and crying,  she isn’t going to be in the mood to learn anything new.  During these initial attempts at nursing, you may need to stop and give her some milk periodically if she becomes upset. It takes a great deal of patience, but she will figure it out soon and then you’ll be fine.

There are several things you can do to help:

• Don’t wait until she is starving before you feed her. Try to catch her when she is showing you early hunger cues (wriggling around, putting her fingers in her mouth, rapid eye movements, etc.)
• Crying is a late hunger cue, and if you wait till she is crying, she may be too upset to nurse
• Express some milk before you put her on the breast so that the milk is already let-down and flowing immediately and she won’t have to wait for it. Newborns are not known for their patience. This can also help pull the nipple out and make it easier to grasp.  Sometimes babies have trouble latching on to  the nipple once the milk comes in and the breast tissue becomes swollen and more difficult to compress.
• Use the syringe to dribble some milk down the side of your nipple while you are trying to get her to latch on.  If she gets upset, take her off and give her enough milk in the syringe to take the edge off her hunger and then try again.
• Most newborns tend to be sleepy for the first week or so, and often need encouragement to stay awake for feedings.
• Keep track of her urine and stool output. If she is losing weight, she may respond by becoming even sleepier and will not nurse well. Since you can’t  measure how much she is taking at the breast, you need to keep track of her output carefully until you are sure that she has started to gain weight.
• Use a pump if she doesn’t go on the breast well. It can sometimes take a while for babies to begin nursing effectively, and your breasts need adequate stimulation during the early supply building days of milk production. You can use any milk you express to help with your attempts at latch on, and also to help ensure that she is getting enough fluids.
• Feed her frequently – try to nurse/feed her at least 8 times in 24 hours. Once she starts taking the breast, she will want to nurse frequently: 10-12 times or more in 24 hours
•  Try lots of skin-to-skin contact. Use a sling or baby carrier to keep her close between feedings. Try getting in the tub together. Nurse without a bra, and undress her down to her diaper. Even if she just sleeps against the breast, or nuzzles or licks it a little, it’s a step in the right direction.
•  If nothing else works, try a nipple shield.  Sometimes babies who absolutely refuse to latch on will nurse if they have a shield to grab hold of, especially if your nipples tend to be large or flat.

Above all, don’t get discouraged. She will get the hang of it.  Days three and four are usually the roughest, and the time when most mothers are likely to give up and switch to formula. There are many reasons for this: the physical stress your body has been through (you often just don’t feed good – even with a natural childbirth with no complications, you are still physically drained, and you may be dealing with additional stresses like constipation, hemorrhoids, episiotomy stitches, or recovering from a c-section), the hormonal upheavals, sleep deprivation, and the sometimes overwhelming pressure of being the one person totally responsible for the nourishment of this new little person in your life.

Do whatever you have to do to survive the first two weeks. If you have to use slings, swings, bottles, pacifiers, a glass of wine,  pain medicine, or even formula, use them and don’t feel guilty about it. The most important thing is that you make sure your baby gets enough to eat while lowering your stress level, enjoying your baby, getting your strength back, and continuing nursing. It really won’t matter down the road, and sometimes using these things can make the difference between continuing to nurse or giving up in the early days, depriving you and your baby of the many benefits of breast milk.

Anne Smith, IBCLC
Breastfeeding Basics