What to do if my baby won’t latch?

You may have heard about the Golden Hour – the first hour after birth which is so important for baby’s physiological adaptation to being outside the uterus, for bonding, and for getting a kickstart at establishing breastfeeding. This hour can actually stretch to 2-3 hours. Ideally baby should be skin-to-skin on mom’s chest, and there should be minimum medical interventions. And if all goes to plan, baby should latch and get his very first feed.

Except this doesn’t always happen. Some babies can take up to 48 hours to have their first feed. They may be sleepy and just not interested, or they may get frustrated an unhappy at the breast. Occasionally a baby may refuse for longer than that, in which case you should definitely contact a lactation consultant if you have not done so already.

Most of these unwilling latchers will latch by 4-6 weeks after birth, if the situation is managed correctly.

Some reasons for babies refusing to latch

• Baby born at or earlier than 38 weeks – these little ones were still growing, and their bodies may simply need a few more days, so have patience.
• A baby born via Caesarean section or who had a very fast vaginal birth – labour helps to prepare baby for breastfeeding in various ways, and a baby who didn’t experience that may just be a bit shell-shocked by coming out so quickly. Once again patience should do the trick.
• Pain medication given during labour – if you received a Pethidine injection during labour it has crossed the placenta to baby. This can cause drowsiness and can take 2-3 days to fully work out of baby’s body.
• Any other birth interventions can influence breastfeeding, including instrument birth and induction of labour.
• A sleepy baby – babies can be sleepy for a few reasons, including low blood sugar levels, jaundice, or an infection. The nursing staff and paediatrician will also be on the lookout for these.
• Anatomical variations of baby’s mouth (like a tongue tie) or mom’s nipples (for example inverted nipples). Both these scenarios can be treated, so seek help from a lactation consultant.

Three crucial steps

If you follow the below steps you have time to sort out the latch.

1. Start expressing breast milk to stimulate your supply

Initially you can express by hand, but if the situation lasts longer than 24 hours it would be a good idea to start using a breast pump. If this is the case you will need a pump that can stimulate and maintain supply; see our guide on how to choose a breast pump. You should aim to express every 3 hours, or 8 times in 24 hours. Do not expect to get more than a few millilitres of colostrum initially (if that much). As soon as your milk comes in 3-4 days after the birth this will change.

READ MORE: Do you really need a breast pump?

2. Feed the baby

Baby needs to get milk to keep his blood sugar levels up and to prevent jaundice. If your baby has not fed within 3 hours, start expressing colostrum and give this to baby. If a mom is not able to get out colostrum after 6-8 hours, some formula milk may be given. However, firstly make sure that you are hand expressing correctly, as mostly there is colostrum and you just need to refine your technique a bit. Formula top-ups have a place, but they should not be the only step you take to solve the problem.

3. Protect the latch

Any top-ups (expressed breast milk or formula) should be given with a syringe, or with a feeding cup, NOT WITH A BOTTLE! How a baby feeds from the breast differs completely from how they feed from a bottle. This is a sure way to confuse baby even more and may contribute rather than help solve the issue. Be cautious to use a dummy or pacifier until the latching problem is sorted. 

Helping baby to get it right

• The most important thing is to hold baby skin-to-skin, a crucial step to help along latching and milk supply.
• Position baby correctly; in the correct position the reflexes that helps baby to latch works a lot better.
• Start with a calm baby. If baby is crying and hysterical the tongue is not in the right position. Let baby suck on your finger, or hold baby against your shoulder until crying stops.
• Offer the breast often; don’t just leave it because baby is not showing interest.
• At the same time, do not force the feed. Try for ten minutes or so, and then give both of you a break.
• Sometimes a nipple shield can offer a solution. But you need the right size shield, and you will need asssistance to ensure that baby is latching correctly and getting enough milk. Read our guide on choosing and using a nipple shield. A lactation consultant can also assist with this.
• Make sure baby always has access. Wear clothes that you can easily open, and do rooming-in, where baby sleeps close to you and you can immediately put baby on when he indicates the need. If it lasts beyond the first few days when you start getting up more, use a baby carrier.
• Ask a paediatrican to check baby out and make sure there is not some physical problem that needs attending.
• See a lactation consultant.

For most moms this is not something that they expected at all; if you were scared that breastfeeding was not going to work, then this may seem like your worst fears coming true. And it is simply not what you need to build confidence. But remember that you are probably not doing anything wrong. It is the baby that needs to latch, not the mom. So just be patient and follow the above steps; if you do this, you have time to sort this out.