What is a good latch?

How a baby latches on is very important to increasing the breastmilk intake by the baby and also to prevent sore nipples in the mother.

 

There is a shift in breastfeeding thinking that should have occurred a long time ago. A shift to the “asymmetric”. An asymmetric latch. When the mother is able to achieve an asymmetric latch is the baby receives more milk from the breast and the mother is less likely have sore nipples, while at the same time the asymmetric latch treats sore nipples. Showing mothers what an asymmetric latch looks like and how to actually latch the baby on with an asymmetric latch, are amongst the first things we do at our clinic when helping mothers with breastfeeding. Together with breast compression, it is a foundation for everything else we do.

 

Help with breastfeeding

 

Why does the latch make a difference? I think that almost all those who help mothers prevent and overcome breastfeeding problems will agree that the deeper (or “better”) the baby’s latch on the breast, the better for mother and baby. It is better from the point of view of mother’s having pain or not, and how well the baby gets breastmilk from the breast.

 

Pain during breastfeeding is a sign the mother needs help; so, if breastfeeding hurts, almost always, the baby´s latch is not as good as it could be. Even Candida (“thrush”, “yeast”) infections, overly diagnosed incidentally, are due to an underlying problem, since Candida does not grow on normal skin; the damage of the nipple and areola from a less than adequate latch is the underlying problem which is too often ignored and needs to be attended to if we are to provide a permanent solution to Candida or nipple pain of any kind. As well, the better the latch, the more breastmilk the baby will get from the breast.

 

The experience of my time in Africa provided me with an interesting insight: one of the things I noticed back many years ago was that the mothers were often latching the baby on with what I would consider a poor latch. I discussed this with the person in charge of teaching for the Baby Friendly Hospital Initiative. I wondered why, if how the baby latched on were so important, what explained that mothers we were seeing had babies with really poor latches sometimes and yet neither the mother nor the baby had problems with breastfeeding. True, sore nipples, even there, were considered “normal” but most mothers seemed to overcome their sore nipples. I didn’t anticipate her answer: “Yes, quite right, but the mothers in this area are reputed to have their milk drying up very early, usually within the first 4 months”.

 

And we see this problem in Toronto as well. Mothers who started off with an abundant milk supply, around 3 or 4 months after birth have babies who start acting as if they are not getting fast enough flow of milk from the breast. They pull at the breast, they fuss at the breast and fuss between feedings, they are frequently sucking their fingers much of the time, and they may even refuse to take the breast, especially during the day. And all this may occur despite the baby breastfeeding exclusively and even gaining weight well. Which makes it difficult for the mothers to believe their milk supply has decreased – this decrease being relative to the copious milk supply the mother had in the beginning.

 

Because of continued good weight gain in many, the babies are diagnosed with “reflux”, or allergy to something in the mother’s milk. But these diagnoses can only be made if one does not look at the whole picture and watching to see if the baby is drinking well from the breast or not. Watching the baby at the breast will verify that the baby is pulling, crying, popping off and on the breast when the flow of milk slows.

 

This baby tries to latch on, but the latch is not particularly good.  He sucks, gets small amounts of milk, but pulls off and on the breast.  He is “gassy”, and not happy at the breast.  Due to late onset decreased milk supply and one sided feedings.

 

And we see this problem in Toronto as well. Mothers who started off with an abundant milk supply, around 3 or 4 months after birth have babies who start acting as if they are not getting fast enough flow of milk from the breast. They pull at the breast, they fuss at the breast and fuss between feedings, they are frequently sucking their fingers much of the time, and they may even refuse to take the breast, especially during the day. And all this may occur despite the baby breastfeeding exclusively and even gaining weight well. Which makes it difficult for the mothers to believe their milk supply has decreased – this decrease being relative to the copious milk supply the mother had in the beginning.

 

Because of continued good weight gain in many, the babies are diagnosed with “reflux”, or allergy to something in the mother’s milk. But these diagnoses can only be made if one does not look at the whole picture and watching to see if the baby is drinking well from the breast or not. Watching the baby at the breast will verify that the baby is pulling, crying, popping off and on the breast when the flow of milk slows.

I commonly hear from mothers that they were told the baby’s latch was good. However, when we see the mothers and babies at the clinic, it is clear the baby’s latch could be much better and we show then how to make a shift to the asymmetric latch.

 

With the asymmetric latch, the baby’s chin is in the breast, but the nose is not. The baby covers more of the areola with his lower lip than the upper lip. The second photo below shows the opposite of the asymmetric latch. And why is one asymmetric latch better than the other?

 

In the photo 1, the baby has an asymmetric latch, the chin is in the breast, the nose is not. In photo 2, the baby does the opposite – the nose touches the breast and the chin does not. In photo 1, the baby has more of the breast where his lower jaw and gums, and the tongue are.

 

Latching a baby

Photo 1: This baby has an asymmetric latch – the chin is in the breast but the nose does not touch the breast

 

 

An example of poor latch when nursing.

Photo 2: This baby has a poor latch – the opposite of an asymmetric latch, the nose is in the breast, the chin is not.

 

In photo 2, the baby has more of the breast where his maxilla (upper jaw) is. In photo 1, the baby’s lower jaw and tongue can stimulate the breast to release its milk, to stimulate rapid flow. In photo 2, the upper jaw does not move, so the stimulation of the breast is just not effective since the lower jaw and tongue are very shallowly attached to the breast.  Furthermore, the baby’s tongue is stimulating the nipple, not the breast tissue. The situation becomes even worse if the baby has a tongue tie and thus, the baby’s tongue cannot stimulate the breast tissue well.

 

If you need help with breastfeeding, make an appointment at our clinic.

 

Copyright: Jack Newman, MD, FRCPC, 2017, 2018

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