How to Fix Nipple Confusion: Step One

The most obvious indication that a baby is nipple confused is that he won’t latch on to the breast. There are other reasons aside from nipple confusion for a non-latching baby, but regardless of baby’s reason for not latching, the advice below will help. Next week, I will share some of my best tricks for helping non-latching babies get on the boob. Until then, here are some tips for protecting your breastfeeding relationship while you seek help for your non-latching little one.

A baby who refuses to latch on is a very frustrating situation. Whether baby won’t latch due to nipple confusion or another root source, it is not a lost cause! Follow these instructions to get baby latching again. There are different instructions depending on how old your baby is, so be sure you are following the correct notes.

Plan for 0-72 hours of life

  • Attempt to latch baby about every two hours:
    • Maintain skin-to-skin contact with mother as much as possible, especially right before trying to breastfeed. Your baby has an instinct to look for the breast when he is near it.
    • Look for early feeding cues (lip smacking, tongue darting, rooting, sucking on his hands). This is the best time to attempt a breastfeeding session, not when baby is very hungry and crying.
    • If baby becomes very hungry and frustrated at the breast, allow the baby to suck your finger to calm him. If that isn’t enough, try giving baby about ten milliliters of supplement to “take the edge off” his hunger.
    • Express some milk onto your nipple and let the baby lick it off.
  • Feed the baby if latching isnt successful:
    • Sources of supplementation:
    • Here are the amounts breastfed babies eat at each feeding (every two to three hours) and their expected output. If your baby’s output is low, increase the amount you are feeding her.
    • Methods of feeding:
      • Spoonfeeding: ideal for hand expressed colostrum, about one to two teaspoons
      • Fingerfeeding: ideal for small amounts of pumped milk, about ten to 20 milliliters
      • Bottlefeeding with wide base, slow flow nipple: ideal for larger volumes of milk, about 20 milliliters or greater
  • Protect your milk supply so your body knows it still needs to make milk!
    • Before your milk is in (around 72 hours), hand express before pumping and collect this milk in a spoon to feed directly to baby. Then pump.
    • Pump both breasts about every three hours, for a total of no fewer than eight pumps in a 24 hour period.
    • Go no longer than five hours without pumping your breasts.
    • The pump vacuum should be set at the highest comfortable It shouldn’t hurt!
    • Pump for about 15-20 minutes. If you are still getting milk at the end of 20 minutes, pump a little longer, but no longer than 30 minutes.
    • Note: You won’t see a lot of milk when you do this; don’t be discouraged. The goal of pumping is to send your body a clear message that even though baby isn’t breastfeeding, we still want it to make milk!

Plan for 72+ hours of life

  • Get help! If by day three or four of life your baby is still not latching onto the breast, schedule an appointment with an IBCLC at The Birth Center.
  • Attempt to latch baby about every two hours, but it is okay to skip this sometimes. It can get really frustrating to try to latch your baby every single time, especially when she is screaming at you!  It is okay to skip the attempt, pump instead, and enjoy calm skin-to-skin time.This is a time when a nipple shield may be helpful. Try it out, but be sure to still see an IBCLC.
  • Feed the baby: At this point, a bottle is the most convenient, least stressful way to feed your baby.
    • Sources of supplementation:
      • Moms own expressed breastmilk by hand expression or pumping
      • Formula
    • Here are the amounts breastfed babies eat at each feeding (every two to three hours) and their expected output. If your baby’s output is low, increase the amount you are feeding her.
  • Protect your milk supply so your body knows it still needs to make milk!
    • Pump both breasts about every three hours, for a total of no fewer than eight pumps in a 24 hour period.
    • Go no longer than five hours without pumping your breasts. You can, however, take a four to five hour break overnight and pump a little more frequently during the day. Just be sure to get in eight pumps every 24 hours.
    • The pump vacuum should be set at the highest comfortable suction. It shouldn’t hurt!
    • Pump for about 15-20 minutes. If you are still getting milk at the end of 20 minutes, pump a little longer, but no longer than 30 minutes.