My baby will not latch, what to do next

This is the phone call I get at midnight more than any other. The baby is screaming, everyone is crying, and someone is saying the words "she just will not take it". If that is where you are, the first thing to know is that a baby refusing the breast is not rejecting you, and it is not a verdict on whether you can breastfeed. It is information. Something is making it hard, and the job is to find out what.

The three jobs, in this order

When it is going badly, people try to do all of it at once and get nowhere. Take them one at a time.

1. Feed the baby. However that has to happen today. Expressed milk if you have it, formula if you do not. A hungry baby cannot learn to latch, and a frightened parent cannot teach them.
2. Protect your supply. Express every time your baby would have fed, aiming for at least eight times in twenty four hours including once overnight. Your supply is being set in these weeks, and this is the part people skip because it feels like the least urgent. It is not.
3. Work on the latch. Calmly, often, and never for the first time in the middle of a meltdown.

Why babies will not latch

• They are too upset. A baby past the point of hunger cannot organise themselves to feed. Calm first, feed second.
• They are very sleepy. Common after a long labour, after some pain relief, in jaundice, or in the first day or two.
• Positioning. The breast is being brought at the wrong angle, or the baby is being held so their chin cannot lead into it.
• Anything in the mouth. A tongue tie, a high or bubble palate, or restricted tongue movement.
• Body tension or a preference for one side. Common after a difficult birth, a long pushing stage, an assisted delivery or a breech baby. They may latch perfectly on one side and refuse the other.
• Very full breasts. When the breast is hard, there is nothing soft for them to draw into their mouth.
• Flat or inverted nipples, which can make it harder to get a deep enough mouthful at the start.
• They have got used to a bottle that is faster and needs less work.

What actually helps

• Skin to skin, a lot of it. Not as a technique with an expectation attached, but as the default place your baby lives for a few days. Babies latch from skin to skin who will not latch from anywhere else. There is more in Skin to skin and the golden hour.
• Offer before they are hungry, when they are drowsy and calm. Trying at the peak of hunger sets everyone up to fail.
• Laid back feeding. Lean back, put your baby tummy down on your chest and let them find their own way. Babies have reflexes for this that get switched off when we hold their head and steer them.
• Soften the breast first if it is firm. Hand express a little, or use reverse pressure softening around the nipple, so there is something for them to take.
• A little milk on the nipple so the reward is immediate.
• Stop before it becomes a battle. Five calm minutes twice is worth more than forty minutes of struggle. If you or your baby is distressed, feed them and try again later. Nothing is lost.
• A nipple shield can bridge the gap for some babies, particularly with flat nipples or a baby used to a bottle. It is a tool rather than a failure, and there is more in Nipple shields.

Protecting your supply while you work on it

This is the part that decides what your options look like in three weeks. A double electric pump is easier than single pumping, and hand expressing at the end will get the last, richest milk that a pump leaves behind. In the first few days, hand expressing is often more effective than any pump for colostrum. There is more in Ways to express milk.

Every drop you express is a feed for your baby and a message to your body to keep making milk. It is not a sign that breastfeeding has failed. It is what keeps the door open.

When to get help quickly

How a consultation helps when your baby will not latch

This is the problem where being in the room matters most, because the answer is usually something you cannot see yourself. I watch what happens when you offer, look at how your baby's body is holding itself, check inside their mouth, and try different positions with my hands there to help. Very often it turns out to be one specific thing, a side they cannot turn to comfortably, a tongue that cannot lift, a hold that is closing their chin off, and it changes within the appointment. If it is something that needs another practitioner, such as a tongue tie assessment, you leave knowing that too, along with a plan for feeding your baby and protecting your supply in the meantime.