NURSING
MOTHERS, INC.
Nursing the Newborn Who Has
Difficulty Grasping the Nipple
or Shows Nipple Preference
Factsheet 8
Nursing your baby can be as simple and as uncomplicated as picking up your baby and placing him to your breast. However, some newborns have difficulty grasping the nipple, and take longer to learn breastfeeding. Should this happen, look at the more common reasons for this problem. Overfull breasts, tight bras, or nursing pads can flatten nipples, making them difficult for the baby to grasp. Flat or inverted nipples may also contribute to the problem. Even the way you offer the breast to the baby affects his ability to nurse. And in some cases, feeding the baby with rubber bottle nipples or indiscriminately using a pacifier can discourage a baby's interest in breastfeeding.
Flattened Nipples
Look at the fit of your bra. If it is too tight, your nipples will be pressed in, making it difficult for the baby to latch on to them. Wearing nursing pads makes your bra fit more snugly and may have the same effect. If this is the case, contact Nursing Mothers and ask about the loan of a nursing bra from the bra bank until you have determined what size you will need. Or, if it feels comfortable to you, don't wear a bra. Another option is to lower your bra flaps one half hour before feeding the baby.
Breasts that have become overfull, feeling firm may cause the nipple to be less prominent. You may remove some milk from your breasts either with a breast pump or simple hand expression. This softens the areola, or darker area of the breast, so the baby is better able to grasp the nipple.
Some women have flat nipples without these conditions. If this is the case with you, you can help your nipple stand out for the baby using one or two of these suggestions. These hints will also help inverted nipples. Try to pull your nipple out with the thumb and index finger, turning gently to the left, then to the right (this is called a nipple roll). Doing this immediately before positioning the baby at the breast will make it easier for the baby to grasp the nipple. Or, drop catchers can be worn inside the bra 20-30 minutes before feeding to draw out the nipple. Sometimes pumping with a breast pump to achieve a milk ejection reflex (let-down) is all that is needed to pull the nipple out enough for the baby to grasp it.
Positioning the Baby for Breastfeeding
The position you use for feeding your baby can affect his ability to grasp the nipple. There are several ways to hold your baby. No matter which position you choose, it is important to offer the breast so the baby is able to latch on to the nipple and maintain his grasp.
First, hold the baby facing your breast. The baby should not have to turn his head to feed: position him so that his belly is facing directly flat against your body. Use pillows, if necessary, to help raise the baby so his mouth is at the level of your nipple. Next, support your breast with your fingers beneath and your thumb on top. Take care that your fingers do not cover any of the areola. The baby needs to be able to take as much of the colored part of your breast in his mouth as possible. Gently touch the baby's lips with your nipple several times and wait for the baby to open his mouth wide, like a yawn. As soon as you see the baby's mouth open wide, hug the baby close into the breast.
The baby should have taken an inch or more of the breast into his mouth. Sometimes it helps to gently compress your breast, as if you were holding a hoagie, while latching on your baby: this helps more of the breast into his mouth. Let go once he is latched on, as to not restrict the milk-flow. His lips will be relaxed and flanged out. His chin and nose will be touching the breast and he will not readily let go. These are indications that your baby has a good grasp of the nipple. Though some pain is common in the first few weeks of getting the hang of nursing, you should not feel continuous pain when the baby is correctly latched on. If you do, break suction with your little finger and try again. It only takes a few nursing sessions with an incorrect latch to cause many days of pain with each nursing. But with correct latching, the pain and soreness will eventually subside after a few days for some moms, a few weeks for others. See Factsheet #4 on Sore Nipples for more information.
Artificial Nipple Preference
Babies may develop a preference for bottle nipples when they have gotten these before breastfeeding is well established. Pacifiers and nipple shields can also discourage a baby from taking the breast. An infant with preference problems may cry and refuse to latch on when the breast is offered. OR she may latch on briefly and immediately drop off the nipple. This situation is upsetting and stressful for both you and your baby. It is usually a good idea to avoid any artificial nipple for at least the first 3-4 weeks. Sucking on a breast differs from sucking on a bottle in lip and jaw positions, as well as tongue and jaw movements. In addition, if the baby has sucking difficulties, an artificial nipple can reinforce these and make breastfeeding more of a challenge.
Ideally, a baby learning to breastfeed will never use an artificial nipple or a pacifier. It is much easier to prevent nipple preference problems than to correct them, and it may take just one artificial nipple to confuse some babies. If your baby requires a breastfeeding substitute in the first weeks, or if your doctor recommends a supplement for your baby, using an alternative feeding method that avoids artificial nipples may better preserve the breastfeeding relationship. Such methods include droppers, cups, spoons, or a Supplemental Nursing System. A lactation consultant or a Nursing Mothers counselor can help you work with these methods. You should always consult your doctor for help choosing the alternative feeding method that is medically appropriate for your baby while breastfeeding is interrupted.
If you suspect your baby has a preference for artificial nipples, Nursing Mothers recommends that you not offer your baby any other nipples or pacifiers while you are trying to reestablish breastfeeding. You can use you finger, well-cleaned and nail side toward the baby's tongue, as a pacifier or to help with suck training. Concentrate on increasing skin-to-skin contact between you and your baby. Undress your baby, leaving on his diaper, and remove your shirt and bra. Hold the baby next to your skin. If it is cool, you can put a robe or blanket over both of you. Even if you use an alternative feeding method, you can position your baby as if you were going to breastfeed.
Stimulating the milk ejection reflex (let-down) before attempting latch on may help encourage newborns with preference problems -- the baby will not have to wait as long or work as hard to establish a flow of milk. When the baby shows signs of wanting to feed, express a few drops of breastmilk onto your nipples as you offer your breast to the baby. Alternatively, you may use a medicine dropper to drip breastmilk onto your nipple. Be sure to follow carefully the steps for good positioning and latch on. If the baby becomes upset, stop your attempts and calm the baby. Then, when the baby is settled, try again. If you are unable to get the baby to nurse after several tries, feed your baby with another method. Occasionally, you may find it helpful to feed the baby 1/2 ounce of breastmilk before attempting to latch on. This can help relieve his desperate hunger and may reduce his level of frustration.
Newborns should nurse 8-12 times (once every 2-3 hours on average) in a 24 hour period. When attempting to reestablish breastfeeding, you should offer your breast frequently to the baby. You may find it helpful to offer your breast to a sleepy baby before he fully awakes. Whenever your baby does not nurse, it is important that you express your milk, either manually or with an efficient breast pump. This ensures an ongoing milk supply for your baby.
Keep in touch with your Nursing Mothers counselor during this
time. She will help you decide what is best for you and your baby.
While you and your baby are learning to breastfeed, it is a good idea to
curtail your activities for a few days. The time you spend with your baby
now will more than pay off. Before long, you and your baby will be
enjoying all the benefits breastfeeding offers.
Revised 9/94; 1/03 Megan Allen
Patty Alfieri, RN, IBCLC
Cynthia Stecca-Sweeney
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Nursing Mothers, Inc. is a
non-profit organization. We never charge for our
services, we would gladly accept your tax-deductible donations.
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