27 AprSuck Training: A Tool For The Breastfed Baby

One of the most common reasons I see new mothers and their babies in the first few days after birth is because a baby simply will not latch onto the breast. Mom will state, that after several minutes and multiple attempts, the baby either “falls asleep” (which really means baby is shutting his world out, known as a neurological shut down…aka “playing opossum” ),or becomes extremely fussy. The term neurological shut down sounds scary, but it is a normal response that the baby does when he is over stimulated or frustrated. He goes “Zen” if you will, shutting out all distractions. Baby has to reboot in order to try again. Sometimes mothers state that if the baby does latch on, it becomes excruciating for the mother resulting in sore nipples due to improper position and latching techniques. After several minutes of sucking, baby comes off frustrated and fussy, and mom’s nipple looks like a brand new stick of lipstick because the baby has compressed the nipple into a unnatural shape.

As natural as breastfeeding is, some babies, for various reason, do not have the ability to latch onto the breast correctly. In order for a baby to breastfeed, the tongue must be positioned properly in the mouth. The baby needs to be able to have a wide open mouth, rest his/her tongue on the floor of the mouth and be able to extend the tongue over the lower gum line. Basically, the tongue must be down and roll forward in order to latch on properly to the mother’s breast.  If a baby has not learned how to position the tongue correctly, or has what we call a “disorganized sucking pattern” the baby can’t transfer milk appropriately resulting in poor weight gain, increased fussiness, and super sore nipples.

If I see a baby who is having difficulty latching, the first step is to determine if it is a mom issue or a baby issue. If it is a mom issue, usually by just fixing the position of the baby, the baby is able to grasp the nipple and latch on correctly. We have a saying in the lactation world, “Nose to chin and hug them in”. What this means is, that in order for the baby to latch, the mother must make sure that the baby is tummy to tummy, mom should “ridge” her breast like a sandwich (I know referring to your breast as a sandwich may sound weird), sweep her nipple in a downward motion from nose to chin, and when the baby opens his mouth wide she is to “Hug” her baby in to her breast. By doing this, it allows more of the breast tissue into the baby’s mouth to get a deeper more comfortable latch.

However, some babies have smaller mouths, or a tight frenulum, (The frenulum is the “stringy” ligament underneath the tongue that helps the tongue to extend or stretch beyond the gum line). Or simply, the baby hasn’t learned how to move the tongue in a good pattern. Reasons for this may be due to the oral anatomy of the baby’s mouth or the gestational age of the baby.  If the baby is less than 39 weeks gestation when born, it can often effect how the baby sucks.  This is why your caregiver will stress the importance of staying pregnant until 39 weeks. One of the first things that may be done is to provide a nipple shield to allow the baby to latch deeper onto the breast. There are however certain guidelines to follow when using the nipple shield to make sure that it doesn’t affect your milk supply. When used correctly a nipple shield can often be a versuck training1   Suck Training: A Tool For The Breastfed Babyy beneficial tool.

However, one very good strategy for getting a baby to latch well, is teaching the infant how to suck using a method known as suck training. In extreme cases, an occupational therapist should be consulted to ensure that all aspects of the suck are being evaluated and corrected. In mild cases however, the following steps can often correct a disorganized suck allowing a better latch, decreasing sore nipples, thus creating a better breastfeeding experience for both mom and baby.

  1. As soon as your baby is beginning to exhibit feeding cues, such as bringing the hands to the mouth, showing signs of waking, sticking his tongue out, and licking his lips, prepares to feed him. Do not wait till the baby is crying to try and latch. Crying is a late feeding cue, and a baby will have a more difficult time latching to the breast when he/she is overly hungry.
  2. Hold your baby in your lap in a sitting position, supporting the head in the palm of your hand
  3. With clean hands, insert your free index finger, palm side up, into your baby’s mouth resting comfortably in the soft curved palate on the top part of the mouth. Be careful not to insert your finger to far into the baby’s mouth as this can cause him/her to choke. Simply go as far as the first knuckle joint. The tip of your finger should be touching the palate which feels “Squishy” on the roof of the mouth.
  4. Gently stroke the roof of your baby’s mouth to encourage the infant to begin sucking. Once you feel your baby sucking on your finger extend your finger straight.
  5. Your baby should be wrapping the sides of his/her tongue around your finger. With your finger straight (applying gentle pressure onto the back of the tongue) pull down on the baby’s lower lip. The baby’s tongue should be on the floor of his mouth with the sides of his tongue curled against your finger.
  6. After you have checked the position of the tongue, make sure that the lips are rolled out around the finger as well. If the baby’s lips appear to be tucked in, and not flanged like a fish, he will not be able to suck well.
  7. Allow the baby to suck on your finger for 1-2 minutes while pulling down on the chin to help the tongue extend out further. Gently push down and forward with your finger while the baby is sucking.
  8. Once you feel that the baby’s tongue has relaxed into a down and forward position, and has a good sucking rhythm, you and your baby should be ready to latch onto the breast. Be sure to have good pillow support, bring the baby to your breast, and lean back when latching.

*Remember “Nose to chin, hug him in” while latching!!!  When the baby has latched deeply, flip the lower lip out.

Try not to be discouraged if the baby doesn’t latch right away. It may take several attempts of suck training to get him/her use to the new tongue placement. Just like with all exercise, the more you do it, the easier it gets!

Copyright© 2012 Danielle Gauss,IBCLC,ICCE/ JustBreastFeeding.com. All Rights Reserved

 

14 Responses to “Suck Training: A Tool For The Breastfed Baby”

  1. Cindy says:

    Thank you for the training method… I will try it with my son in the days to come. He had a lip and tongue tie which was discovered (finally!!!) by a consultant 4 days ago… However, as he is 3 months and a half old, he was developed a nursing technique which allows him to get enough milk to grow, but not enough to empty my breasts properly.. hence they are always full and hurting! I tried having my son suck on my finger several times, but he does not seem to want to latch onto it. I will try with your technique. With a little luck, it will work!

  2. Annie VerSteeg IBCLC says:

    Hi Danielle,
    Thanks for the great description. When I am teaching suck training, I encourage my finger further back to the juncture of the hard and soft palate. The place where, in a Breastfeed baby, the tip of the nipple would be. I find it takes some babies, a little time to get comfy with it and these are the moms who are experiencing nipple pain and the baby has a bit of a ‘bubble’ palate where she/he likes to put everything; our fingers or the tip of the nipple or the bottle. When the babies learn to bypass the closer area and get comfy with the ‘proper’ spot the Breastfeeding goes much better…
    I’d appreciate your thoughts on this.
    Annie

  3. Sarit says:

    Please help! My son is damaging my nipples- he is 5 weeks old. I thought he was latching properly because I’d always adjust his upper lip to the “fish-pose”. However, now I notice that his lower lip is completely being sucked in under my breast. I’ve tried to flip it out 100 times (which is difficult as it is), but as soon as I do, he adjusts right back to flipping it back in! I also noticed that his upper lip is much bigger than his lower- his lower lip is smaller and naturally “goes in and under” the upper lip. I really could use any advice I can get. I’m in so much pain, that I’m utterly scared each time i have to nurse him. I hear him sucking and drinking, but when he comes off (or I take him off), my nipple is completely pulled and pointed- I try soaking it in lanolin for the pain but it hurts and burns 24/7

    • Admin says:

      Make sure you are leaning back, and bringing the baby to you. Use good pillow support and make sure that his tummy is touching your tummy. If he is latched correctly you should not see your areola at all when latched and his cheek should be touching your cheek. If you are still have discomfort it may be a good idea for you to schedule an appointment with a local lactation consultant who could observe his latch and give you some hands on techniques. Maybe visiting an Occupational therapist for some suck training or using a nipple shield to help protect your nipple (must be a 24mm, and must be stretched on first) to help your son grasp hold of the nipple deeper may be helpful. Hope this helps. If you have trouble finding a lactation consultant in your area, please contact me and I will help you locate one.

  4. Nikola Nikolov says:

    That totally helped our 5-day old son to start latching properly.
    He was a bit weak in his first 2-3 days while we were at the hospital and he was only getting his food from a bottle and when we came back home he wouldn’t latch properly, so my wife had to pump and we would supplement him with extra formula until he was no longer hungry.

    My wife was scared to try that technique so I did it and after realizing that he has a pretty strong suck and stimulating him for 1-2 minutes we put him on the nipple(which my wife had to harden a bit) and he latched on pretty well(way better than before).

    We had to do the suck training on the next feeding as well, but I’m assuming that after some time he won’t need any reminders on how to latch properly.

    His tongue is either too small yet, or he hasn’t learned to take it out, but that doesn’t seem to affect his feeding too much.

    Thank you for the helpful article – we were getting a bit worried that he’d always prefer the easier feeding from a bottle over breastfeeding :)

    • Erika Blanchard says:

      Nikola Nikolov~

      Thank you for your reply! It was so helpful and it gave me hope. My husband and I just had our identical twin sons last Monday, 2/17/2013, via c-section. Our sons were 3 weeks early (37 gestation) and on a feeding tube for the first couple of days. Once they were ok’d to leave the intermediate unit, I tried to breastfeed. However, neither one could latch on properly nor was I producing any colostrum or milk. I was told because they are “premies” and a caesarean. It would take some time to latch and make milk. :( Felt like the cards are stacked against me.

      My beautiful baby boys are now 7 days old. Yay! But I too have had to tongue train them- which they are still having difficulty with- and supplement with formula in a bottle. I am really afraid that I will lose or not make enough milk, due to them not being on the breast.

      How long did it take your baby to finally latch and was your wife able to provide enough milk?

      Thank you in advance for your time. I hope everything continue to go well with your baby and may you & your have continued success in the wonderful journey of breastfeeding.

      Cheers,
      Erika and Twins

      • Erika Blanchard says:

        They were born last week 2/17/2014~ lack of sleep makes you forget what year you’re in. Lol

      • Nikola Nikolov says:

        Hi Erika,

        Our son latched very well right after the first attempt at suck training. He’s still fussy sometimes and we have to do it about half or a little bit more of the times. We also found that feeding him expressed milk from a bottle can also make him latch better – that’s because he’s either too upset to latch correctly or too tired.

        My wife started pumping on the second day we got back from the hospital. While in the hospital she had very little(almost no) colostrum – it was a rather difficult birth so her milk didn’t come in right away(we were supplementing with formula as well), but between pumping and the baby latching on, she’s now producing enough milk.

        So if they are still not latching, make sure to pump every 2 to 3 hours to stimulate your milk production – bottle feed them the expressed milk since it’s better than formula. They say it is normal for your milk to take some time to come in. In the mean time, you can drink breast-feeding tea(I’m pretty sure you can find it in a pharmacy) – it’s a mix of things like anise, lemon balm, cumin, rue, dill, etc. and is designed to stimulate the production of breast milk. In the hospital they also suggested eating more berry fruits(red berries, black berries, raspberries, etc.), or drinking juices made from them.

        If all else fails, try contacting a latching consultant(La Leche League – http://www.llli.org/ seems like a good place to start).

        I’m pretty sure that your milk will come in and that your sons will start latching(my wife had a very emotional relief once our son latched for the first time). If possible try to get your husband to help as much as he can – for instance let him feed your sons with formula during the nights so that you can get a good sleep.

        PS: Sorry for the late reply – there is no notification by email on replies here :)

  5. Gina says:

    I saw so many lactation consultants at the hospital but no one showed me the suck training technique. My baby would get very frustrated and fall asleep at every feeding. He’s now 3 months and I have a very low milk supply. Is it possible to train him now and build up supply?

    • Admin says:

      It is possible to help him suck better with suck training, but that may not be the reason of your low supply. Your breasts work by supply and demand, the more they are stimulated, the more milk you are going to make. So it is true that if a baby is able to latch deeper and stimulate better, your milk should increase. But you also would need to begin pumping after feeding as well. It is not uncommon at 3 months to start notice a temporary drop in your supply as that often is a time when your estrogen surges and you ovulate. Does not mean you will necessarily get your period back, but that surge of estrogen can absolutely result in a temporary drop in supply. I would venture to look however in other reasons for low supply. Are you taking any medications such as birth control (even the mini-pill) antihistamines, decongestants, eating or drinking peppermint or sage anything, etc… All those things drop supply. I would also recommend starting some herbal supplement like More Milk Plus capsules, provided you are not a diabetic or allergic to peanuts. If none of this sounds like it could be the culprit, then it could be something more physical such as a hormone imbalance, thyroid or prolactin hormone is off, or testosterone levels. Having your hormones checked by your care giver may provide some great answers. Hope this helps.

  6. Karen says:

    Any exercises you Can recommend for a 6 week old who just had an upper lip tie and posterior tongue tie released last week? Her suck is still pretty weak after 7 days. Plus she has stopped taking bottles all together.

    • Admin says:

      I would recommend taking her to an occupational therapist at this point for physical therapy and suck training. Without seeing the baby’s suck it would be very hard for me to determine what would work best. Best of luck to you.

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