The pause in the chin as the baby opens his mouth to the maximum, just before closing his mouth, indicates his mouth is filling up with milk; the longer the pause, the more milk the baby is taking in. Thus, it is obvious that the advice to feed the baby 20 minutes (10 minutes, 30 minutes, whatever) on each makes no sense. A baby who drinks as this baby drinks for 20 minutes on the first side could easily refuse to take the second side since he would be full. Even a shorter period of time drinking as he does could easily fill him up.
Compare this baby to the baby in the “nibbling” video. The baby in the “nibbling” video could easily spend hours on the breast and not get enough. The whole notion of feeding a baby by the clock makes no sense at all. The pause can also be seen in the first few days of life. See the videos of the 2 day old, 28 hour old and 10 hour old babies
Note the position of the baby at the breast. Chin in the breast, nose not touching, baby’s lower lip covering more of the areola with the lower lip than the upper. An asymmetric latch.
The pause in the chin as the baby sucks means the baby just got a mouth full of milk. The longer the pause, the more milk he got.
A baby who drinks like this for 20 minutes straight (for example, we are not recommending feeding by the clock), might not take the other side, he would be full.
Timing feedings makes no sense.
This baby is eight weeks old and is doing almost no drinking, though very occasionally one sees a short pause in the baby’s chin. A baby who breastfeeds only with this type of sucking could stay on the breast for hours and still not get enough milk. Something needs to be done here and if achieving a better latch, using compression doesn’t help, the baby almost certainly needs to be supplemented. The best way to supplement the baby is with a lactation aid at the breast. Why?
1. Babies learn to breastfeed by breastfeeding
2. Mothers learn to breastfeed by breastfeeding
3. The baby continues breastfeeding and thus continues getting milk from the breast and thus increases the mother’s milk production
4. The baby is not likely to refuse to latch on
5. There is much more to breastfeeding than breastmilk, as important as the breastmilk is
See the video clip “Inserting a Lactation Aid”
The baby in this video is only 40 hours old.
Baby has a pretty good latch. Notice his chin is in the breast, his nose is away from the breast and he covers more of the areola with his lower lip than the upper lip.
During the first part of the video, the baby has an occasional pause in the chin, but is mostly “nibbling” without drinking.
Mother is using compressions, but not always as we recommend. She should compress while the baby sucks, but does not drink and not while he’s not sucking at all.
Compressions at this age (before milk “comes in”), often work only after several series of compressions, unlike later, when the milk supply is greater, when compression usually works immediately.
Around 1 minute into the video, the baby starts pulling a little at the breast, becoming impatient with the slow flow.
Then, about 1 minute and 14 seconds, the baby starts to drink vigorously, and you can see several pausing type sucks in a row.
The mother maintains compression until baby no longer drinks, then releases (at 1 minute 30 seconds).
The baby starts sucking again at about 1 minute 37 seconds. Babies who are latched on and hungry will start sucking on their own. No need to tickle their feet or put cold cloths on their foreheads.
Babies do not fall asleep at breast because they are tired, but rather because the flow is slow. How to maintain the flow?
1. A good latch
2. Compressions when the baby is sucking but not drinking
See the how the baby in the video clip Introducing a lactation aid wakes up and drinks vigorously when the flow of milk increases again. Notice around two minute mark, the compression once again works well.
Finger feeding is to be used primarily to prepare a baby who does not latch on to take the breast.
Note that finger feeding is done only long enough to calm the baby and to get the baby sucking well. This rarely takes more than 60 seconds.
It should not be used as a method of supplementation when the baby does take the breast. In such a case supplementation, if necessary, should be given at the breast with a lactation aid.
We filmed this baby because he had already latched on after being finger fed.
Why did he not latch on to the right side in this video?
• Because he already had fed on the right side, the flow of milk from the breast was slower: babies like fast flow and even if the lactation aid would provide him with more flow, it wasn’t enough
Why did he latch on to the left side?
• Because he hadn’t yet fed on the left side, the breast was “fuller” and the flow was rapid: babies like fast flow
Note that we do not try to force a baby to stay at the breast. If the baby struggles, allows the breast into his mouth but doesn’t suck, or cries, then we let him come away from the breast and try again.
• If the baby latches on, there is no need to try to force him to stay, he’s latched on
• If the baby does not latch on, trying to force him to stay at the breast is futile and likely to make him angrier or “go limp”
This baby needs to receive supplementation. It is best that the baby receive this via lactation aid because:
1. The baby is still on the breast and breastfeeding.
2. Babies learn to breastfeed by breastfeeding.
3. Mothers learn to breastfeed by breastfeeding.
4. The baby is still getting milk from the breast thus helping increase the mother’s milk production.
5. The baby is not likely to reject the breast as he would if he were supplemented by bottle or by any method not on the breast.
6. There is more to breastfeeding than breastmilk; the baby and mother are in close physical contact.
One way to introduce the tube is to insert it while the baby is at the breast as in this video clip. The other is to line up the tube with the nipple and latch the baby on the breast and lactation aid tube at the same time.
Note the position of the baby:
1. The baby’s chin touches the breast but nose does not touch.
2. The baby covers more of the areola with his lower lip than his upper lip.
3. The baby is slightly tilted up towards the mother.
The baby has now fed from both breasts and is not getting much milk flow (mostly nibbling at the breast—see video clips of babies drinking or not drinking). It is time to supplement.
Note the following:
1. The breast tissue is eased out of the way so that the corner of the baby’s mouth is visible.
2. The fact that the baby is tilted slightly upwards makes it easier to find the corner of the baby’s mouth and insert the tube.
3. The tube is inserted in the corner of the baby’s mouth.
4. The tube is pushed almost straight back towards the back of the baby’s throat but also slightly upward toward the roof of the baby’s mouth.
5. The milk moves down the tube to the baby’s mouth, but the baby does not drink (see video clips of babies drinking or not drinking). Something is not working.
6. The mother is attempting compression, but compression should be done when the baby is sucking and not drinking, not when the baby is not sucking at all. Moreover, compression while the baby is being supplemented at the breast with a lactation aid is not necessary.
7. At 21 seconds into the video, I fiddle with the tube placement, and now it starts working. The baby is drinking.
8. Notice the baby pops his eyes open when he starts getting milk again. Babies are not “lazy”; they respond to milk flow. Young babies such as this one tend to fall asleep when the flow of milk is slow, not necessarily if they have had enough.
9. More fiddling with the tube at about 35 seconds. If the baby is well latched on and tube is well placed, supplementing using the lactation aid takes no more time than giving the baby the bottle or finger feeding. Using finger feeding to supplement when the baby takes the breast is not the best approach either.
10. At about 1 minute into the video, I pull the baby’s chin down a bit. Remember, good latch and good placement of the tube make this system work best. Pulling down the chin gets more of the breast into the baby’s mouth.
11. At about 1 minute and 18 seconds, we bring the baby around even more asymmetrically by having the mother push the baby’s bottom in with her forearm.
12. At about 1 minute and 55 seconds, milk comes out of the baby’s mouth means something is not right. Baby has slipped off the breast or the tube has moved. Fiddling with the tube again makes it work properly again.
This baby is only 10 hours old. Notice the asymmetric latch: chin touches the breast, but not the nose and the baby covers more of the areola with his lower lip than his upper lip. He is also tilted up somewhat towards the mother.
He is drinking milk from the breast. You can tell because of the pause in the chin just as he opens his mouth to its widest before closing again. The pause is subtle here because the baby is getting only small amounts of colostrum—as nature intended! If necessary, compression can help the baby get more milk (see the video clip of the 2 day old baby at this site). The very large amounts of formula an artificially fed baby gets in the first few days is not physiologic or natural or normal or ever been proved to be safe.
Shows latching on. Not perfect, but good enough. The mother had no pain. It did take two tries to get the baby to latch on, but that’s okay; there’s no point in trying to force a baby who does not take the breast to stay on the breast. It won’t work. Note the baby has an “asymmetric” latch, with the chin touching the breast, the nose not touching the breast, and he covers more of the areola with his lower lip than the upper.
Compressions help the baby get more milk.
The baby starts searching for the breast. The mother guides him towards the nipple. The baby opens up fairly wide, but the mother does not bring the baby on as well as she could and the baby has a shallow latch. He should have more of the breast in his mouth.
The baby is mostly nibbling at first though there is an occasional pause in the movement of the chin (see other videos showing good drinking).
The mother starts compressing around 1 minute and 10 seconds, and the baby responds by starting to have pausing-types of sucks that indicate he is getting milk well.
When the baby does not yet take the breast or refuses it completely, this technique can help to put the baby in a state where he can accept the breast. The baby is skin to skin with the mother and indicates when he is ready to search for the breast. When he starts searching, the mother helps him, guiding him toward the breast, supporting his back and neck. The mother is careful not to hold his head. Babies need to have their necks supported but not their heads. See the information sheets The Importance of Skin to Skin Contact and When the Baby Does Not Yet Latch.
The baby just had a tongue tie release.
The mother is doing compressions appropriately. She waits to see if the baby is drinking or not (pause in the chin). If the baby is not drinking, she compresses, holds the compression until the baby stops sucking or stops drinking and then releases. She waits for the baby to start sucking and if the baby starts sucking but does not drink, she repeats the process.
When the baby latches on to the nipple only, he gets very little milk.
When the baby latches on where he should, the milk flows rapidly.
A good alternative to the bottle. Particularly useful for the baby who is refusing the breast.
Note that the baby laps the milk up with his tongue. One does not pour the milk down his throat.
This is an older baby, about 3 or 4 months of age, whose mother’s production has decreased. See the information sheet Slow Weight Gain Following Early Good Weight Gain for some reasons this decrease in milk production might occur. Some of the reasons that may result in a decreased milk production include the mother’s using a hormonal birth control method (including hormone releasing intrauterine devices or intravaginal hormone releasing rings), the mother’s feeding one breast at a feeding “as a rule” instead of “finishing” one side and then offering the other. But the most common reason is the one discussed in the paragraph “This reason (number 11) requires more explanation”.
The baby is jiggling and unsettled at the breast because the flow of milk is slow. Note that he hardly drinks at the breast (very few pauses, see the videos Really Good Drinking, and Good Drinking), though his chin is a little bit difficult to see.
This sort of behaviour is often said to be due to an over rapid milk flow but by watching the chin one can see that this behaviour in this case is due to too slow milk flow. However, babies pull at the breast more frequently because the flow of milk is slow rather than because the flow of milk is “too rapid”.
Note that giving such babies bottles, may quickly result in their refusing to latch on.
A simple and quick procedure that can make a significant difference in breastfeeding success. The research supporting tongue-tie release is compelling.
This mother’s nipples turn white after baby has finished feeding. They turn white for some time and then eventually turn pink again. This change in colour is sometimes accompanied by throbbing and burning in the nipples. This is often due to poor latching and/or a yeast infection.
Lactation support is not funded by any level of Canadian government. Your support helps us continue to offer the services for which it has become renowned – helping and supporting families to achieve their own breastfeeding goals. It also helps us to provide free support and resources via our website to families and health care providers unable to visit us in person.
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Donations can be made at canadianbreastfeedingfoundation.org. Please direct your donation (Fund/Designation) to ibc – The International Breastfeeding Centre.
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