Latching fundamentals

Your baby was literally born to feed!

But it's necessary to understand the basics of infant feeding, starting with how babies attach (latch) onto the breast, to better assist our pain-free latching efforts.

All babies have a set of steps they need to do for effective feeding. These set of steps also called a neurobehavioural program, is similar among all baby mammals and ensure that they are competent in finding the nipple and feeding without much help from their parents.

Getting to the nipple

Let's outline all the steps babies do to self attach to the breast. These predictable, sequential steps are seen in nearly all babies who are born without medication (such as epidural) and without birth trauma. Each step serves a purpose (YES even hands in front of their face!) and an interruption in any of these steps can confuse them.

• Hand to mouth movements

• Tongue movements

• Mouth Opening

• Focusing on the nipple

• Crawling to the nipple

• Massaging the breast to evert the nipple

• Licking

• Attach to the breast

These steps are sequential, meaning babies follow these steps in order. Older babies may be able to skip over one or more of these steps without issue, but younger babies use each step to orient to the breast before moving on.

I often find that parents, in an attempt to speed up the attachment process unintentionally hurry along this process which creates stress and confusion for their babies, making latching stressful for both parties!

For example, Parents often swaddle babies or move their hands out of the way because they feel their baby gets distracted or frustrated by the hand placement. Moving a baby's hands away from their face may make latching easier for parents, but it disrupts their natural orientation process and the bit of stability the hand by face posture offers.

Attachment

Similar to the orientation process, babies have a set sequence of steps they need to accomplish to attach to the breast. Regardless of the position your nurse in, your young baby will:

• Orient themselves to the nipple using the rooting reflex

• Extend their neck and lead with their chin

• Open their mouth wide using the gaping reflex when the nipple stimulates their philtrum

• Bring their tongue down to the floor of their mouth and extend their tongue over the lower gum and lip

• As they close their mouth, the front part of their tongue (anterior tongue or tongue tip) will cup the breast, and the rest of their tongue will form a groove to conform and hold it

• Begin to suck

It's not uncommon to try to speed up (parent-sped latching) or lead (parent -led latching) your baby's latching efforts. There is nothing wrong with these approaches, and many babies may need to have guidance. But it is critical to ensure that you're working with your baby's reflexes and not against them and this is especially true during the first few weeks as you both are learning this new process!

Some ways that parents often interrupt the ATTACHMENT phase include:

Not providing postural stability that allows for secure attachment: Babies need to be tummy to tummy and held firmly and securely into your body. None of baby’s weight should be resting on their back and your baby’s belly button should be directly facing & touching your body. Ears, shoulders & hips must be aligned.

These minor changes in posture has a major impact on how easily and how comfortably your baby can latch & nurse.

Accidentally stroking the cheeks, face or mouth while attempting to latch on. Babies will root towards any stimulation, including away from the breast. A baby initially heading toward the breast may get off course if their rooting reflex is stimulated.

Trying to latch a crying baby. It's better to calm your baby down and then attempt to relatching than to keep trying to latch them while they're upset.

Stuffing the breast into baby's mouth before they have had time to lower their tongue: This is admittedly very tricky because babies open their mouths wide for 0.002 seconds. But during a wide gape, babies should lower their tongue and that’s the time you want to bring your baby onto the breast.

Pressing on the back of their babies head causing the chin to tuck towards the chest. Flexion is the enemy of easy and pain-free latching. Also touching the back of a baby's head can elicit a reflex that results in them throwing their heads backward and popping off the breast.

Latching is a stressful aspect of feeding at the breast in the early weeks. It is not always possible to allow babies to self attach at every feeding, and as I mentioned above, some baby's need a more parent involved approached.

I've created a complete latching guide available for download, which will provide you with the information needed to understand latching and help you work WITH baby's natural abilities, which will result in less frustrating and more comfortable latching.

Trouble shooting painful latching

If you’ve followed all the steps of latching, read my Free 23 page latching guide, and yet breastfeeding is painful, you are not alone.

Discomfort during the first few weeks is not uncommon, though it may be hard to differentiate between “normal” discomfort and abnormal pain.

I tell parents that if they curl their toes, hold their breath, feel like they want to throw their baby, or have the thought that they would rather not breastfeed than deal with the level of discomfort all the time to seek lactation help.

But I see this often: A parent will contact me complaining of pain with nursing, confused because the previous help they received said the latch looked perfect! Yet, for some reason the pain persists, their nipples continue to be damaged, and baby continues to struggle with weight gain, despite the *perfect* looking latch.

What gives?

A possible reason your baby's latch is painful is that you're taking the lead

It may not always be easy to tell in what way you’re leading or speeding the process. I have provided two images below from handouts I’ve made that will hopefully highlight a few of the differences.

Note that laid back positions may not be easy or achievable for some parents due to anatomy.

Pain with breastfeeding is often due to an issue with oral function

Proper oral function and mobility are essential for effective and painless breastfeeding. There are many reasons that feeding may be painful including pain due to compression or rubbing of your nipple in your baby's mouth and/or excessive sucking strength. In most cases, where pain is present despite proper latching technique, there's an underlying issue with function.

For example:

Typically, with painless nursing, your nipple should be drawn back into your baby's mouth to reach the area where their hard and soft palate meet. If your nipple is too far forward in their mouth, your nipple will get smashed between their tongue and hard palate causing you pain and misshaped nipples.

Another possible outcome is that your nipples become abraded, or damaged by friction, caused by the tongue rubbing the face of your nipple.

Additionally, unrelieved excessive sucking pressure during feedings can cause a decrease in blood flow in your nipple causing pain and vasospasms.

In any of these cases, it's what's going on inside of baby's mouth that's causing pain, regardless of how wide and perfect the latch looks to the outside observer.

So in which situation would we see these types of events occurring?

Here's a short list of the possibilities. Your baby may have:

• A restriction in tongue mobility (such as extension, elevation, cupping, lateralization) due to tongue tie

• An excessively recessed or small jaw

• A tongue that is overly large

• Small or absent sucking pads

• A high or arched Palate

• Dis-coordination managing the suck-swallow-breath process

• Low or high tone

All of these things can have an impact on how your baby uses their mouths and tongue to feed, and most of these can't be assessed by looking at latch alone. A proper evaluation of pain with nursing must include a full assessment consisting of watching a feeding session and investigating all causes of feeding pain.

Another benefit of getting professional lactation help to resolve your pain with feeding is we can provide you with guidance regarding the best feeding positions for your specific situation.

You may not be using the right feeding position for your baby's feeding abilities

Latching refers to what occurs with baby’s mouth but positioning refers to your’s and your baby’s position in space. Latching fundamentals don’t change BUT the position in which you latch and feed may vary.

It may seem that there are only a handful of positions to use and that they are all created equal, but this is absolutely not the case.

I briefly covered this in 6 positions you may not know about, where I introduced six therapeutic breastfeeding positions and holds and quickly discuss in what situations these positions may be effective.

But just as it's impossible to cover all the possibilities of positions and holds in an easily digestible post for parents, it's impossible to give blanket statements about which holds will be perfect for every situation.

Another way to look at it is that just because two babies have tongue ties, the positions they need to nurse comfortably and without causing pain may differ. Parents too have different abilities and not every nursing position that may be beneficial for one family will be physically achievable by another.

The fantastic thing about breastfeeding though, is that there is no right or wrong way to do it. I encourage you to play around with finding a position that works for you and your baby. You may be surprised to discover a position that you make up on your own completely resolves your pain with nursing!

Here’s a parting secret

The perfect latch is one that is not painful and one where baby can nurse without difficulties and can transfer well.

How it looks on the outside is not as important as to what’s actually happening between your baby and the breast. My daughter had an awfully shallow looking latch, probably due in part to the elasticity of my breast tissue and how our parts came together. This situation may be the same for you if nursing is painless and your baby is transferring well to maintain your supply and grow well.

If this is not the case for you, if it’s painful or transfer is an issue, book an appointment with me asap. We will trouble shoot together and get you on your way to pain-free nursing.