Q: My baby is 4 weeks old (born 2 days late weighing 7 pounds 4 ounce) but is not gaining enough weight (he now weighs 8 pounds). He only really sucks at the start of each feeding and then falls asleep. I’ve tried to keep him feeding by tickling him and putting a cold washcloth on his face. I put him down asleep and he wakes right up, sucks his fists and cries. I can pump out 4 ounces of milk after every feeding, so I know he is not getting anything! He has no medical problems and neither of us is on medication. Our lactation consultant said that he has a shallow latch so she taught me how to put firm support under him and flange out his lips, but it is not helping. How can I help him get more milk and start gaining?
A: This is really hard! I’m so glad you asked for help. You have been doing a wonderful job! Despite that your baby is not feeding well, you have established a good milk supply.
A lot of babies don’t suck strongly enough at first, but there are ways you can teach him to suck more effectively.
What do you feel when you put your finger (with the soft pad down) in his mouth? With a good suck pattern, your baby will pull your finger deep into his mouth and cup his tongue around your finger – like a hot dog in a bun.
If your baby doesn’t actively accept your finger, try gently placing it on his lips and rubbing his front lower gums. Talking encouragingly, singing quietly or bouncing gently while you do this may help. If he grimaces or gags, stop or slow down. Your baby may need time to feel comfortable with your finger in his mouth. Once your baby does accept your finger, try gently pulling your finger away to see if he will try to pull it back. Practicing this will help increase his suck strength and may help him pull your nipple deeper for a better latch.
If your baby easily accepts your finger and sucks, try to gently and rhythmically massage his tongue down and forward. It is really important to work slowly and to watch your baby’s reaction to be sure your baby is comfortable during this exercise.
Here are ways to help your baby develop a stronger suck during feeding:
Be sure you are sitting in a comfortable position so you can bring the baby to you. DO NOT lean over and give the breast to the baby. Many babies feed better when their mothers put their feet up.
Hold your baby with your hand on his back between his shoulder blades and just your thumb and forefinger supporting his head. Do not push on his head and bend his neck – it’s hard to eat that way! Use your other hand to support your breast (put a rolled up washcloth under your breast if your hand gets tired.)
Hold your baby tummy-to-tummy with the baby’s body in straight alignment. (You can draw a straight line from your baby’s ear, to the shoulder and the hip.) Put a little pressure on your baby’s thoracic spine (where a bra closure would be) to support his suck swallow breathe patterns.
It is very important not to settle for a shallow latch. Make sure your baby’s neck is extended and aim your nipple towards his top lip or nose. Tease your baby’s lips with your nipple and when his mouth is open wide - quickly hug your baby to you. Look to be sure both of his lips are flanged out and that he is sucking at least 8 -10 suck swallow breathe in a burst before pausing and catching his breath.
If he doesn’t keep sucking, try supporting his suck by gently holding under the boney part of the jaw. If that doesn’t help, try letting the baby’s head fall back a tiny bit to see if he will suck harder to draw the nipple back into correct position.
Sometimes massaging the breast while the baby is nursing will help because it increases milk flow and keeps the baby stimulated to suck more.
Remember, you and your baby are both learning a new skill which takes time and practice.
If you are still having problems after trying these ideas, you may want to have a professional breastfeeding evaluation from a speech pathologist specializing in pediatric dysphagia. Ask your pediatrician for a referral.
Joan Dietrich Comrie of Carolina Pediatric Dysphagia (919-877-9800) specializes in the treatment of pediatric dysphagia.