By Yasmin Dera
IBCLC, Maternal Health Coach, Doula, Educator
In the middle of the night, many mothers across the globe sit in a quiet dimly lit room with their baby at the breast, wondering how this feeding is really going. Their baby’s latch looks fine. She can even see his jaw moving, but there is something inside that feels off.
The feeding feels endless, but her baby is still cue-ing and fussing for milk. The baby may fall asleep within minutes of latching, then wake up crying as soon as you put him down. Sometimes, or maybe even most times she’s gassy, or arching her back in discomfort. Meanwhile you are trying to figure out what exactly the issue is. Is she getting enough milk? What am I doing wrong?
As an expert lactation consultant with almost a decade of experience working with breastfeeding mothers, there is something important you need to know. In most cases like this, milk supply is not the issue, nor is your mothering. The issue has to do with your baby’s suck pattern, which is what makes breastfeeding work. If the suck pattern is disorganized or weak breastfeeding will feel like you’re fighting for your life just to feed your baby.
The Hidden Work Behind Every Feeding
When watching those breastfeeding education videos, it looks so simple and natural. The baby’s always holding onto the breast with ease. What we do not often know is that inside your baby’s mouth there is an intricate milk removal system doing its best to coordinate an effective suck, swallow, breathe pattern.
When your baby has a deep, strong latch, the tongue is able to cup your breast and move like a wave. The jaw opens widely, creating a vacuum/suction, then closes for the tongue to compress the breast and massage the milk out for your baby to swallow. You may have noticed your baby’s suck pattern at the beginning of the feeding is light, quick, flutter-like suck pattern. This stimulation signals your brain to release oxytocin, the hormone in charge of milk expression. Then your baby’s suck pattern changes to a slower, deeper rhythm, with the baby’s jaw moving strongly with audible swallows that sound like “mk-ah” after a few sucks.
However, when a suck is weak or disorganized, there is very little pattern during the feeding. A baby may look as if he is “nibbling” on the nipple. The jaw activity is minimal and sometimes barely noticeable. In this case there is minimal milk transfer and may be considered a non-nutritive or comfort sucking rather than a feeding. Because there is little milk transferring from the breast, feedings are often over an hour. At the end, the baby is likely to still be hungry or put down to sleep seemingly calm, only to awake within 30-60minutes.
It is unlikely for a baby to sustain an optimal, deep latch with a weak suck pattern in the same feeding session. Sometimes a baby can start the feeding with a deep latch but if the suck pattern is weak or disorganized, the baby may begin to slide toward the nipple or completely unlatch.
A pinching sensation is what most moms describe when their baby’s mouth slides from the areola (the darker skin between your nipple and the rest of your breast) down towards the tip of the nipple. Once unlatched, the nipple is noticeably angled, with a crease, resembling the shape of a new lipstick. The misshapen nipple is a classic sign of a shallow latch, weak suck or indication the baby needs more support with achieving a deep latch.
When there is a latch and/or sucking issue that is not addressed, there is a ripple through the rest of the day and even weeks when. This one shallow/poor latch turns into another and before you know it, that’s a long frustrating day for a new mom and baby. Mom and baby are a couple. When one is affected by an issue it also has an impact on the other. For example, When the latch is shallow and or painful, the baby is also unable to transfer enough milk towards a satisfying feeding. Immediately, the baby may be fussy, unable to rest and overtime, this leads to an issue with weight gain for the baby. Ultimately, the message is sent to the mom’s body to reduce the amount of milk being produced because the milk available is not being used.
A side effect of a weak suck is also gas and colic. Typically when a baby has a weak or disorganized suck there is also an inadequate seal on the breast. This creates a situation where less milk and more air is transferred to the baby. Many times there are audible indications of a weak/poor seal, clicking, smacking, baby sliding/popping off the breast often after 1-5 minutes or less. The air that the baby swallows goes right to their stomach and intestines creating discomfort and gas that can be challenging for newborns to work out. You may notice your baby pulling their legs up to their check squirming, unsettled when it is time to be put down or crying after feeding.
Another sign of a weak/poor suck pattern is feeding fatigue that leads to a cycle of exhaustion, for both mom and baby. A baby who is not sucking properly, will get very tired very quickly. They may even fall asleep at the breast making the mother think she is fully satisfied. However this baby will be tired from working so hard for a small amount of milk. They may stay asleep for no more than 1-hour. Thereafter, they will wake very hungry, now both mom and baby are awake trying repeatedly to breastfeed. Neither will get deep rest until they get latch support from an IBCLC.
If you hear or see something . . .
As you breastfeed you will likely be the one to hear and see these red flags first. Please take these as a note that you and your baby need help with the latch. The sooner you get help the sooner you can experience comfort and confidence with breastfeeding:
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The “Flutter”: You see tiny, fast trembles of the chin instead of deep, wide jaw movements throughout the feeding.
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Clicking or Smacking: The baby is losing their suction. Each “click” is air entering their tummy.
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Dimpled Cheeks: If the baby’s cheeks pull inward like they are sucking a lemon, there is no pressure inside the mouth encouraging milk transfer.
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No Swallowing: You see the baby moving, but you don’t hear any “gulp” or “swallow” sounds.
Do something . . .
This is not the time to “grit and bear it”. Breastfeeding should not be painful. It’s best to stop, unlatch and start the process over. Follow the steps below:
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Break the Suction: Gently slide a clean finger into the corner of the baby’s mouth to break the seal. Let your baby gum on your finger. This protects your nipple.
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“Tummy to Tummy”: Make sure the baby is flat against you and their nose is right at your nipple.
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Squeeze, Hold, Release: If the baby starts to “flutter” suck or fall asleep, give your breast a firm (but gentle) squeeze, hold, release a few times. This moves milk to the baby, as a reward for them for sucking and encouraging them to take deeper pulls.
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The “U-Hold”: Support your breast with your fingers well back from the dark area (areola). Index and thumb and 9 and 3’olock. This helps the baby get a bigger mouthful of breast tissue.
When to Seek Professional Help
Most babies become more proficient with feedings as they grow and get older. Some babies need support before they get stronger and better at feeding. Reach out to an IBCLC or your pediatrician if:
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Breastfeeding remains painful after you try to reposition.
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The baby has less than 6 wet diapers a day.
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The baby hasn’t returned to their birth weight by 2 weeks of age.
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The baby chokes or coughs often during feedings.
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Your nipples are cracked, bleeding, or damaged.
A lactation professional can check for things like tongue-tie or muscle tension that might be making it hard for the baby to suck, as well as make referrals as needed.
A Reassuring Message
You are both on a learning curve, as this is your first time learning to breastfeed with one another. Learning to breastfeed is a developmental stage like any other. It takes time and practice, as well as compassionate support and guidance along the way.
Trust your gut when something feels off. You are doing wonderful and help is available to help you and your baby through the challenging moments. Your journey is uniquely yours. Be gentle with yourself.
Disclaimer:
This article is intended for general educational purposes only and is not meant to provide medical or clinical advice or replace individualized care. Every parent and feeding journey is different. If you are experiencing ongoing pain, concerns about milk production, or persistent pumping challenges, please seek personalized support from an International Board Certified Lactation Consultant or other qualified healthcare professional who can provide guidance specific to your situation.