What to do if your newborn isn’t latching

Article by Cordelia Uys, NCT Breastfeeding Counsellor

January 2021 - updated April 2021

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It’s not uncommon for newborn babies to take a while to learn to latch, especially if they are born a bit early, or if their birth was stressful. It can be extremely distressing for a new mother if her baby isn’t latching, but please be assured that given some time and patience, the vast majority of babies will learn to latch. 

In the meantime, there are some urgent and vital actions that need to be taken:

  • Reach out to an IBCLC lactation consultant or breastfeeding counsellor for help.

  • Establish and maintain your milk supply by making sure your breasts are getting very frequent stimulation.

  • Feed your baby

  • Do lots of skin to skin with your baby

In addition, you will need to watch out for any signs of blocked ducts and mastitis, such as painful lumps, general breast pain, red patches on your breasts and feeling feverish. (For more details, please see the links at the bottom of this article).

Working with a lactation specialist

Reach out as soon as possible to an IBCLC lactation consultant or breastfeeding counsellor who can help you with positioning and latching your baby, and also investigate why your baby is struggling to latch. Sometimes babies are just a bit sleepy in the early days; sometimes it is a matter of perfecting your technique; sometimes a baby might have some tightness in their jaw, face or neck which can be loosened with some cranial osteopathy, and sometimes babies have a tongue-tie, which can make it tricky for them to latch, or to maintain their latch.

 

Establishing and maintaining your milk supply

How milk production works

For the first 2 or 3 days after a baby is born, their mother will be producing colostrum (the first milk). Colostrum production is hormonally driven, meaning it is produced whether a baby is put to the breast or not. From around day 3, breastmilk production switches to being locally controlled, meaning it works on a supply and demand basis.

 

Both your breasts need to have milk removed at least 8 to 12 times in 24 hours 

In order for a mother’s milk supply to be established and maintained in the early months, milk needs to be removed from both her breasts 8-12 times in 24 hours. In fact, 8 times is the bare minimum and UNICEF talks about an average of 10 to 14 feeds in 24 hours; many babies will want to feed more often than this.

 

Programming your breasts

When your baby is born, your breasts have no way of knowing if you have had one, two, or more, babies, or how big your baby is. The majority of mothers are capable of exclusively breastfeeding twins or even triplets as long as milk is removed from both breasts at least 8 times in 24 hours. If a baby is being breastfed responsively and nursing effectively, he or she will be programming their mother’s breasts to make exactly the right amount of milk for his or her individual needs.

It takes 6 weeks for the prolactin receptors in your breasts to work out how much milk your baby, or babies, require. Regular and reliable milk removal from both breasts programmes them to make the right amount of milk for your baby or babies.

 

The Feedback Inhibitor of Lactation (FIL)

Whenever breasts get hard and full, a negative feedback mechanism, called the Feedback Inhibitor of Lactation (FIL), kicks in, telling them to stop making milk. This means milk production slows down when breasts are full and speeds up when breasts are emptier. The more often a mother feeds her baby, or pumps, the more milk she will make.

In the early weeks, if a mother goes longer than 3 or 4 hours without breastfeeding or pumping, the FIL will kick in, giving her breasts the message to reduce milk production, and she will also be at risk of developing blocked ducts and mastitis.

 

Double pumping with a hospital grade pump as soon as your mature milk comes in

In case your baby still isn’t latching by day 3 or 4 (when your mature milk will probably start to come in), I would recommend hiring a hospital grade double pump as soon as possible, so you can start double pumping as soon as your mature milk starts coming in.

It is imperative to pump with a hospital grade double pump because regular pumps will not be powerful or gentle enough for 8 or more pumping sessions in 24 hours. Double pumping (removing milk from both breasts simultaneously) provides much more stimulation than single pumping and saves precious time.  

Hospital grade double pumps can be hired from:

Alternatively, the Spectra S1 is a Korean-made hospital grade double pump that can be bought online. It is more affordable than most hospital grade pumps and gets excellent feedback from experienced pumpers.

Make sure the breast shields (flanges) fit you properly

Please note that a correct breast shield fit is fundamental; when breast shields don’t fit, women can experience pain and damage, and pumping will be less productive. Pumping should never hurt; if it does, it is either because the breast shields don’t fit, or because the suction/vacuum is set too high.

 

How to tell if your breast pump shields (flanges) fit you properly:

During a very interesting talk for the Gold Lactation conference in May 2022, Jeanette Mesite Frem stated that many people should actually be using a flange size a lot smaller than the standard sizes provided by pump manufacturers. If used with a little lubrication from some coconut oil, apparently a smaller flange size will increase milk yield quite substantially. Jeanette said lanolin or vaseline are too sticky.

She suggested measuring the diameter of the nipple and then trying sizes of that diameter, 2mm bigger and 2mm smaller and seeing what happens. This is totally different to what is suggested currently which is to measure the nipple and add 2-5mm.

(This is what pump manufacturers currently suggest: https://www.verywellfamily.com/ways-to-tell-if-your-breast-pump-flanges-fit-2758354 )


Many pump manufacturers have 21mm as their smallest size, but the following inserts can be used with Spectra and Medela pumps and come in smaller sizes:


https://www.amazon.co.uk/s?k=maymom&crid=2YUWQJ1DVODQI&sprefix=maymom%2Caps%2C89&ref=nb_sb_noss_1

Please make sure you don’t cause any damage or hurt yourself; if it doesn't feel right, stop and try another size.  

Pumping plan

Ideally, you want to work with an IBCLC lactation consultant or breastfeeding counsellor who can help devise a personalised pumping plan for you. The following suggestions are only a rough guide.

 

Hand expressing while you are producing colostrum  

If your baby isn’t latching, if at all possible, start hand expressing within 6 hours of your baby’s birth

There is evidence that women who start hand expressing within 6 hours of their baby’s birth will have a more generous milk supply than those who aren’t able to start breastfeeding or hand expressing until more than 6 hours after the birth of their baby.

Have a look at this film from Stanford Medical School which explains how to hand express: Hand Expressing Milk | Newborn Nursery | Stanford Medicine

This video also has a good explanation of how to hand express:

https://www.instagram.com/reel/C-qMC_BN3GB/?igsh=MTgxbzU5cDE4aTQ3eQ==

If your baby isn’t latching, while you are still producing colostrum (usually until around day 3 or 4), what is really critical and time sensitive, as well as making sure your baby is getting fed, is for you to do lots of hand expressing, so that your breasts get the message that they need to start making mature milk. Colostrum comes in small volumes and therefore cannot be collected in a pump. 

How long and often to hand express?

My suggestion would be to hand express for around 10 minutes on each breast every couple of hours during the day, and roughly every 3 hours at night. Regular removal of colostrum, and then mature milk, from your breasts is essential in order to establish and maintain your milk production.

(N.B. Please note that a recent study https://pubmed.ncbi.nlm.nih.gov/34529518/ found that the volumes of colostrum new mothers are able to hand express increases in the first six hours, and after that, the volumes of colostrum decrease. The lowest volumes of colostrum occur between 12-15 hours, and volumes stay low until a sudden increase in volume at 30-33 hours postpartum.)

You can collect the drops of colostrum directly from your nipples with a syringe. Alternatively, you can hand express on to a sterilised spoon, or into a small sterilised cup, and then suck up the colostrum with the syringe. 

How to feed the syringes of colostrum to your baby is explained in the ‘Feed your baby’ section below.

Double pumping with a hospital grade pump once your mature milk comes in

Have a look at this film from Stanford Medical School which explains how to maximise your milk production with hands on double pumping: massaging your breasts while you are pumping will make a difference to the volumes you are able to produce: https://med.stanford.edu/newborns/professional-education/breastfeeding/maximizing-milk-production.html

The four minutes of hand expressing on each breast, at the end of a pumping session (as described in the film) are really good at encouraging milk production.

You might also find some helpful suggestions in my article on the let-down reflex:

https://www.cordeliauys.co.uk/the-letdown-reflex-1

 

Pumping bra for hands-on-double pumping

You can create a pumping bra using an old exercise bra that you don’t mind sacrificing. This will allow you to have your hands free to massage your breasts while double pumping. 

It is also possible to buy pumping bras online. If you decide to purchase one, you will need to allow for a considerably larger size than you usually take. If a pumping bra is too tight, it will put you at risk of developing blocked ducts.

Here is a photo of a client wearing a sports bra she turned into a pumping bra.

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Aim to double pump at least 8 times in 24 hours

In order to establish and maintain your milk supply, the recommendation is to double pump with a hospital grade double pump, at least 8 times in 24 hours, including once at night, when your prolactin (the hormone that makes milk) levels are highest.

How long to pump for?

You will need to work out how long to pump for; it depends a lot on a mother’s milk supply. Usually, the recommendation is to double pump for between 15 and 30 minutes, but if you have a very generous milk supply, 5 to 10 minutes might be sufficient.

It is not a good idea to pump non-stop for longer than 30 minutes as this can cause nipple soreness.

If you need to increase your milk supply, continuing to pump for several minutes after your milk has stopped flowing will tell your breasts to make more milk. If you stop as soon as the flow stops, your breasts will not get the message to make more milk.

 

Getting used to producing milk by pumping

Sometimes it can take a while for a mother to get used to producing milk for a pump. A baby’s suckling stimulates the let-down reflex more effectively than a pump. This is because oxytocin, the hormone that causes the let-down reflex, is stimulated most powerfully by love, and few women love their pump.

It may take a few days of regular pumping before the volumes of milk you are able to pump start to meet all your baby’s needs.

 

Time of day and milk volumes

Please be aware there will be times of the day when you make less milk. Most women produce greater volumes of milk in the morning; volumes tend to be lower later in the day. This is a clever evolutionary design, because when volumes are lower, babies tend to want to feed more often, and a period of several hours a day of frequent feeding (known as ‘cluster feeding’), albeit exhausting, is great for stimulating milk supply. (In the first couple of months, it is normal for babies to be fussy, and to cluster feed, in the evenings.)

N.B. It is not unusual for one breast to produce more milk than the other

 

Pumping intervals

It is not necessary to pump at set times and it is fine for the time intervals between pumping sessions to vary. It’s normal for the gaps between breast feeds to be irregular, therefore it is not a problem for the gaps between pumping sessions to be irregular. If you would like to have longer gaps between some pumping sessions, you can pump hourly (or every 1.5 hours, or every 2 hours) at other times in order to ensure both your breasts are having milk removed at least 8 times in 24 hours.

 

Try not to go longer than 3 hours between pumping sessions during the day

If your breasts get uncomfortably full, the Feedback Inhibitor of Lactation (FIL) will kick in, telling them to reduce milk production. You will also be at risk of getting blocked ducts and mastitis.

If you are experiencing uncomfortable fullness and cannot pump, it is a good idea to hand express enough to stop that ‘bursting’ feeling.

 

Night feeds – prolactin

Prolactin is the hormone that makes milk; your prolactin levels are highest at night, so pumping at least once at night is important for establishing and maintaining milk production.

 

How long can you go without pumping at night?

Once your mature milk has come in, it is probably okay to have one 4-hour gap between the end of one pumping session and the beginning of the next at night, as long as you are pumping more often at other times.

 

Your partner’s support at night

You could ask your partner to take charge of feeding and settling your baby during the night, so you can wake up, pump and then immediately go back to sleep. You could put the expressed milk in a cool bag by your bed rather than taking it to the fridge.

This is a very personal decision: some women get upset at the idea of being separated from their baby at night, whereas others find that a night or two of solely pumping gives them a chance to catch up on some much-needed sleep. Getting a bit more sleep tends to help with milk production.

 

Power pumping – to increase supply and/or instead of two regular pumping sessions

Some women find it convenient to replace two regular pumping sessions with one power pumping session. Power pumping can also be a very effective way of increasing milk supply.

Since power pumping involves pumping on and off for a whole hour, it is usually only possible when there is someone else around to care for your baby, or in the evening, when your baby has gone down for their first stretch of sleep.

 

To power pump: prepare yourself as you would for a normal pumping session, double pump for 10-20 minutes, rest 10 minutes, then double pump another 10 minutes, then rest for 10 minutes, then double pump again for 10 minutes. You do this for about an hour.

The aim of power pumping is to mimic a baby who is nursing frequently to stimulate a mother’s supply, as is common during a cluster feeding session, or during a growth spurt.

 

It is a good idea to keep track of the volumes you are pumping, and pumping times. 

There are some excellent Apps that can help you stay on track with pumping; many are free, for example: https://apps.apple.com/gb/app/the-best-baby-tracker/id985523028

 

Sterilising

If your baby is full-term and in good health, you only need to sterilise the pumping equipment once in 24 hours. After each usage, wash the pumping equipment and bottle carefully with hot water and washing up liquid, then rinse well and put to dry on some clean kitchen paper. 

N.B. Bottles used to give formula need to be sterilised after each usage.

 

Storing breastmilk

Breastmilk is safe at room temperature for approximately 6 hours.

Here is detailed information on storing breastmilk: https://abm.me.uk/breastfeeding-information/expressing-breast-milk/

You can add newly pumped milk to milk already stored in the fridge on the same day, but only after it has cooled down in the fridge for at least 30 minutes. Never add warm milk to cold milk, as this encourages the growth of bacteria.

 

Breastmilk storage bags

You can store breastmilk in the fridge in bottles, but when freezing it, you might want to use storage bags, as these take up less space. Many companies make breastmilk storage bags.

Make sure to allow some space at the top of bags or bottles for the expansion that happens when milk is frozen.

 

Feeding your baby

While you are producing colostrum

On days 1, 2 and 3, you can hand express your colostrum and feed it to your baby via a syringe. Colostrum comes in very small quantities, but that is fine because babies’ tummies are very small in the first few days.

 

When you are producing mature milk

  • Paced bottle feeding:

    To protect your breastfeeding journey, it is crucially important that whoever is feeding your baby uses the paced bottle feeding method.

    When a baby is held in the traditional, reclined bottle feeding position, a combination of gravity and the baby’s sucking reflex means it is easy to persuade them to drink more milk than their tummy can comfortably fit. This puts them at risk of overfeeding, and gets them used to a fast flow, which in turn means they are likely, sooner or later, to reject the breast, which usually has a much slower flow.

    This film explains paced bottle feeding: https://www.youtube.com/watch?v=OGPm5SpLxXY

 

What type of bottle?

The type of bottle and teat you use are not as important as making sure that whoever is feeding your baby always practises paced bottle feeding. However, it is easier to practise paced bottle feeding with a bottle that is not too big or too fat. Look for a bottle that has around a 150ml maximum capacity, and one that resembles Kate Moss in shape, rather than Beyoncé. Here’s an article about which bottles to use for breastfed babies: https://breastfeeding.support/best-bottle-breastfed-baby/

 

Volumes of milk

  • The first week

    In the first week, the volumes a baby needs will increase day by day. To give you a very rough idea, on day 1, a baby’s maximum stomach capacity is circa 5ml per feed, on day 2 it is circa 10ml per feed, on day 3 it is circa 20ml to 30ml per feed, and it increases by 10ml per day until plateauing at around 60ml-80ml by day 7. The volumes a baby needs will also depend on how frequently they’re feeding and will often vary from feed to feed.

  • After the first week

    Here is a page from the website kellymom.com with some guidance on how much expressed milk a baby might need after the first week: http://kellymom.com/bf/pumpingmoms/pumping/milkcalc/

    Please bear in mind that from 4 weeks to 6 months, your baby’s maximum stomach capacity per feed is around 120ml-150ml. If they drink more than this, there is a risk of stretching their stomach.

 

Responsive feeding - be guided by your baby

The beauty of paced bottle feeding is that your baby will much more easily be able to indicate when they are full. It is normal for babies to drink different amounts at each feed. It is very important not to try to coax your baby to drink more than they can comfortably fit, or their ability to self-regulate might be impacted, putting them at risk of future overweight and obesity.

 

Feeding frequency

It’s fine for your baby to feed more than 12 times in 24 hours, but you want to make sure that he or she is not feeding fewer than 8 times in 24 hours.

 

Wake your newborn baby if they are sleeping longer than (approximately) 3 hours

A newborn baby who isn’t getting enough milk can lack the energy to wake up for feeds, so you want to wake them for a feed if they are sleeping longer than (roughly) 3 hours. Once your baby has overtaken their birth weight, and is producing plenty of wet and dirty nappies, (see the article ‘What’s in a nappy?’ below), you should be able to allow them to sleep as long as they want.

 

How to tell your baby is getting enough milk

  • Nappies 

    Keep close track of your baby’s pees and poos as they will indicate whether your baby is drinking enough milk: https://www.justonenorfolk.nhs.uk/media/2447/p2p-nct-whats-in-a-nappy.pdf

    In the first week, it can be helpful to take photos of your baby’s poos to show to your midwife. 

    From day 7 up until approximately 6 weeks, you want your baby to be producing at least 6 heavy wet nappies (weighing 45g or more) and at least two good sized poos.

    After 6 weeks, some breastfed babies no longer poo on a daily basis, due to a change in the ratio of whey to casein in breastmilk at that stage. As long as poos are soft and plentiful when they arrive, your baby is still producing plenty of wet nappies, and gaining an appropriate amount of weight, it is not considered a cause for concern for a baby to go a week, or possibly even 10 days, without doing a poo.

 

  • Weight

    Your baby's weight will of course also be a good indication of whether he or she is getting enough milk.

    Weight loss in the first few days is normal 

    When they are weighed by the midwife on day 5, it is normal for babies to have lost up to 7% of their birth weight if they were born vaginally, and up to 10% if it was a caesarean birth. It can then take 2 to 3 weeks for babies to regain their birth weight: https://kellymom.com/bf/normal/weight-gain/


If your baby isn’t producing the expected amount of wet and dirty nappies, or their weight gain isn’t as expected, please contact your midwife, GP or health visitor. 

 

Concerns over your milk supply

If you are worried that you aren’t producing enough milk to meet all your baby’s needs, please read the article ‘Is my baby getting enough milk?’: https://breastfeeding.support/is-my-baby-getting-enough-milk/

It can surprise new parents that their baby will not settle after a feed unless they are being held. Many babies will refuse to sleep in their cot, especially at night. Please read this article by the psychologist Sarah Ockwell-Smith, which explains about the 4th trimester and why most babies will only settle in their parents’ arms: https://sarahockwell-smith.com/2012/11/04/the-fourth-trimester-aka-why-your-newborn-baby-is-only-happy-in-your-arms/

 

Galactagogues – if you need to increase your milk supply

Please see this article for suggestions of herbs and medications that can be taken to help increase milk supply: https://breastfeeding.support/what-is-a-galactagogue/

 

Supplementing your baby - milk options

  • Your own breastmilk: if you are not able to produce all the milk your baby needs, you could try pumping more often, or for longer, or adding a power pumping session to your usual pumping routine.  

  • Donor milk: after a mother’s own breastmilk, as a next step, the World Health Organisation recommends pasteurised donor milk.

    For more information on obtaining donor milk if you are based in the London area, please contact the Hearts Milk Bank: https://heartsmilkbank.org/ 

  • Formula milk: the next step, if donor milk is not available, is to supplement with first infant formula (whey-based). If you are giving your baby formula, first milk formula is the only formula they need from 0-12 months.

    Please see this First Steps Nutrition link on infant formula milks: https://www.firststepsnutrition.org/parents-carers

 

Nipple shields

Nipple shields can often be a useful tool to help babies learn to latch. They should always be used under the guidance of a lactation consultation or breastfeeding counsellor, who can suggest which size and brand of shield might work best in your particular circumstances.

I have a post on Instagram about how to apply nipple shields: https://www.instagram.com/tv/CEezPPqgZpj/?utm_source=ig_web_copy_link

N.B. Nipple shields should never be used while a mother is still producing colostrum, because colostrum comes in volumes that are too small to pass through to the baby via a shield. This means that even if it looks as if the baby is feeding, they are unlikely to be getting any colostrum.  

 

The importance of skin to skin

When a baby is in skin to skin contact with their mother, it calms them both, and encourages strong mothering instincts. Oxytocin, the hormone of love, labour and lactation, will flood through the mother’s body, helping enormously with bonding and breastfeeding. Skin to skin also helps with breastmilk production.


What happens to babies during skin to skin?

  • It stabilises their body temperature. A mother’s chest has the ability to warm up by 2°C if the baby is too cold, and to cool down by 2°C if the baby is too hot.

  • It stabilises their heart rate and breathing: the baby’s heart will start to synchronise with their mother’s.  

  • It stabilises their hormone levels, releasing hormones in that promote bonding and breastfeeding.

  • It stabilises their blood sugars, thereby stimulating their digestion and an interest in feeding.  

Skin to skin is incredibly valuable for all new mothers and babies, but even more so when a baby isn’t breastfeeding, as it keeps the breast a happy place for the baby and provides the physical closeness that would usually happen when a baby is breastfeeding.

It is impossible to do too much skin to skin with your baby. Aim to be spending the majority of the time, for the first couple of weeks at least, in skin to skin contact with your baby.

In addition, being in skin to skin often triggers a baby’s reflexes, which can help them to latch on to the breast.


Skin to skin with partners

Skin to skin with partners is also very valuable and will help with bonding.


Attempting to latch your baby

There is no need to try to latch your baby more than once or twice a day. The best time to try is when you are both calm and relaxed. It is helpful if your baby is not too hungry, but also not too full. Giving them about half the amount of milk they would normally consume, and then working on latching, can work well.


In conclusion

Remember that as long as you are keeping your baby fed, stimulating your breasts very frequently, and doing plenty of skin to skin, with a bit of time, patience and good support, it is very likely that your baby will, sooner or later, start latching on to the breast. 

Good luck!


Tosan and her son Tobi

Tosan and her son Tobi

Tosan describes her experience of establishing her milk supply while waiting for her baby to learn to latch:

“My son was born at 35 week and 6 days, weighing 2.18kg. No immediate skin to skin for us, as he had to go straight to the NICU. He was heavily jaundiced, had breathing difficulties and suspected sepsis.  He was put on a glucose IV and I started trying to harvest colostrum. I got a few minutes of skin to skin at a time and I always attempted to put him to the breast, and I’d get a few licks, but no latch. One nurse, on observing my attempts to latch him, advised that my nipples were very flat, making it additionally difficult for my baby to latch. She mentioned I could try nipple shields as a sort of adaptor to help achieve a latch. I purchased some but had no idea really how to use them. I continued to give my baby drops of colostrum through a syringe. The NICU had only one member of staff offering breastfeeding support, and she only worked part time. I contacted Cordelia who advised me to express at least eight times every twenty-four hours. 

I was lucky to gain more support from the NICU nurses as they saw me fighting strongly for every second of skin to skin. My hope was to promote more oxytocin and subsequently increase my milk supply. My colostrum quickly increased and got runnier, and I was able to start pumping. The nurses would wake me up and help me stay motivated to keep up with my pumping schedule. The night-time was toughest as I was so exhausted, but I aimed to pump twice between midnight and 4am as I was advised my prolactin levels were highest during those hours.  By day 3, using a hospital grade double pump, I was getting very good volumes at each pumping session, but despite that, on day 4, the doctors said that I was not producing enough milk to meet my son’s nutritional needs. They said the glucose IV had to be removed to avoid infection, and that I had to agree to formula top ups. I was devastated and nearly gave in. With the help of my doula, I was able to get some donor milk from the Hearts Milk Foundation. The plan was to use this donor milk to top up my supply while I continued to pump rigorously and build up my milk supply. At this point, my expressed milk was fed to my baby through an NG Tube, topped up with donor milk. I only used one bottle of this donor milk as my milk rapidly increased with my pumping schedule.

As I was so determined to exclusively breastfeed, we had to stay in the NICU for three weeks. The NICU breastfeeding nurse showed me how to use the nipple shields and how to latch. My baby gradually would latch successfully first for about 30 seconds at a time, but then fall asleep. The time increased as he got stronger and gained weight. The NICU team and I established a sort of feeding titration system as follows: every 2 to 3 hours, wake baby (by any means necessary), put him to the breast, time how long he latches and suckles for, top him up with expressed milk through an NG tube. Then I would pump. This was repeated every 2 to 3 hours as we continued to practice latching. Gradually, he started to latch for longer (with nipple shields), and we were needing less and less of top ups through the NGT. By 18 days, we had our first 24 hour period of latched feeds, and zero NGT top ups. We were discharged from the NICU on Day 20.”

 

Links:

 

 

Breastfeeding support lines:

  • National Breastfeeding Helpline: 0300 100 0212 (9.30am to 9.30pm daily).

  • NCT feeding line: 0300 330 0700 (option 1). The line is open from 8am to midnight, including bank holidays.

  • Association of Breastfeeding Mothers: 0300 330 5453 (9.30am to 10.30pm).

  • La Leche League: 0345 120 2918 (8am to 11pm 365 days a year).