When Baby Does Not Yet Latch

by Jack Newman, MD, FRCPC

Why Would A Baby Not Latch?

There are many reasons a baby might refuse to take the breast. Often there is a combination of reasons. For example, a baby might latch on even with a tight frenulum if no other factors come into play, but if, for example, he is also given bottles early on, or if the mother's nipples and areolas are swollen from fluid from the fluids she received during the labour and birth, this may very well change the situation from "good enough," to "not working at all."

  1. Some babies are unwilling to nurse, or suck poorly as a result of medication they received during the labour. Narcotics are responsible for many such situations, and meperidine (Demerol) is particularly bad as it stays in the baby's blood for a long time and affects the way he sucks for several days. Even morphine given in an epidural (Epimorph) may cause the baby to be unwilling to nurse or latch on, since medication from an epidural definitely does get into the mother's blood, and thus into the baby before he is born. Other interventions during labor and birth (e.g. intravenous fluids in large amounts, vigorous suctioning of the baby at birth which is simply not necessary for a healthy full term baby) can also cause difficulties with the baby latching on. For more information see the book The Latch and other keys to successful breastfeeding, chapter 4, Causes of Latch Problems, and/or see theL-Eat Latch ad Transfer Tool, Step #8, N-eat.
  2. Abnormalities of the baby’s mouth may result in the baby’s not latching on. Cleft palate, but not usually cleft lip alone, causes severe difficulties in latching on. Sometimes the cleft palate is not obvious, affecting only the soft palate, the part inside the baby’s mouth.
  3. A baby learns to breastfeed by breastfeeding. Artificial nipples interfere with how the baby takes the breast. Babies are not stupid. If they get slow flow from the breast (as is expected in the first few days of life) and rapid flow from the bottle, they will not be confused—many will figure it out quite quickly, and prefer the faster flow.
  4. If the mother's nipples are particularly large, or inverted, or flat, these nipple variations may make latching on more difficult, not usually impossible. However most women said to have flat or inverted nipples actually do not. In fact, nipples that look flat are almost always normal, but we live in a society where bottle feeding is still the norm, so if a mother doesn’t have nipples that look like the end of a feeding bottle may be told that their nipples are flat.
  5. A tight frenulum (the whitish tissue under the tongue) may result in a baby having difficulty latching on. This is not, strictly speaking, considered an abnormality, and thus, many practitioners do not believe that it can interfere with breastfeeding; many studies indicate that it can indeed interfere.

    However, one of the most common causes of babies' refusing to latch on arises from the misguided belief that babies in the first few days must breastfeed every 2 hours, or 3, or on some other aberrant sort of schedule. Babies were not meant to feed by the clock even during the first days. Belief in the schedule and trying to stick to a schedule results in anxiety on the part of the staff when a baby has not fed, for example, for three hours after birth, which then results, frequently, in babies being forced to the breast when they are not yet ready to feed. When the baby is forced into the breast, and kept there by force, especially when the baby is not interested or ready, we should not be surprised that some babies develop an aversion to the breast. If this misguided approach then results in panic, and "the baby must be fed," alternative feeding methods (the worst of which is the bottle) are then used, resulting in worsening of the situation and the beginning of a vicious circle.