Breastfeeding Latch Issues

Breastfeeding latch refers to how a baby attaches to their mother’s breast during breastfeeding. A proper latch allows the baby to extract milk effectively and helps prevent discomfort or nipple damage for the mother. It’s common to face latch issues in the first few weeks of breastfeeding as both you and your baby are adjusting. 

Common breastfeeding latch issues

Shallow latch

A shallow latch occurs when the baby latches onto only the nipple, missing enough breast tissue. This can push the nipple too far back into your baby’s mouth, causing pain and damage during feeding.²

Signs and symptoms

• Pain 
• Cracked or bleeding nipples 
• Clicking sound — your baby may make these noises as they readjust and try to relatch with each suck 
• Pinched nipples after breastfeeding 
• Milk leaking from the mouth 
• Decreasing milk supply¹

Nipple confusion

Nipple confusion occurs when babies, after exposure to artificial nipples, struggle to express a preference for one feeding mechanism over another.³

How does nipple confusion affect breastfeeding?

Reintroducing breastfeeding after short-term use of an artificial nipple can lead to latch-on difficulties. Bottle nipples have a faster flow and feel firmer. If your baby gets used to the bottle, they might find it easier to latch onto it t than the breast, resulting in refusal.⁴ Nipple confusion can also lead to incorrect sucking patterns, causing sore nipples and a low breast milk supply.⁴

Preventing nipple confusion

To prevent nipple confusion, consider waiting before introducing a bottle or dummy. If bottle feeding is required, use paced bottle feeding to slow the flow of milk.⁴

Painful latch

Pain experienced in the first few weeks of breastfeeding is normal. Both you and the baby are learning a new skill, and there is an adjustment period for you both. 

Signs and symptoms

• Pain on latch 
• Itching 
• Redness 
• Changes in the texture of your skin around your nipples 
• Sensitive to touch⁵

Alleviating pain

As a mother, you may feel reluctant to breastfeed due to the pain. To alleviate the pain you could: 

• Use Vaseline or lanolin to restore moisture to dry and cracked nipples.⁶
• Allow nipples to dry after feeding before getting dressed and changing breast pads
• Avoid nipple shields and breast shells 
• Continue breastfeeding without shortening feeds. 

Tongue tie

Tongue tie (ankyloglossia) occurs due to restricted tongue movement when the tissue connecting the tongue to the floor of the mouth is shorter than normal.⁷

This can lead to breastfeeding latch issues and sore, cracked nipples for the mother.⁷

Type of tongue tie

There are different types of tongue-tie categorised according to the Coryllos ankyloglossia grading scale.⁸

Signs and symptoms of tongue tie

• Baby’s tongue not moving freely, .e.g., side to side 
• Your baby has a heart-shaped tongue 
• Breastfeeding difficulties 
• Feeding refusal 
• Clicking noises 

Tongue tie can affect both mum and baby in many ways. For the mother, this may include a reduced milk supply, sore or cracked nipples, and engorged breasts, which can lead to mastitis due to a poor latch and ineffective feeding. 

If treatment is required, a small surgical procedure called a frenotomy is performed by cutting the tissue under the tongue and reconnecting the bottom of the tongue to the floor of the mouth. 

Breastfeeding is recommended following the procedure to aid the healing process. 

It’s important to note that babies with tongue tie may not always experience breastfeeding latch issues and may still be able to feed well, not requiring treatment. 

What does a good latch look like? 

The LATCH acronym outlines signs of a good latch:

L - Lips flanged out, observed with a wide, gaping mouth to accommodate the areola and nipple 

A - Asymmetric latch, with more areola above the baby’s top lip 

T - Tummy to mummy, with the baby’s ears, shoulders, and hips in alignment 

C - Chin to breast, ensuring the nose is free in the sniffing position

H - Have a listen and watch for active suckling and swallowing, indicating milk transfer

Breastfeeding positions

Infant-led latching 

The natural and intuitive way of breastfeeding is when the infant finds the breast without guidance. This is helpful when the infant is learning how to breastfeed or if you have sore nipples. 

1. Sit comfortably, lean back, and ensure the infant has skin-to-skin contact with your upper chest, with their head tilted back slightly into the sniffing position 
2. The infant will look for the breast, which may appear like bobbing or pecking 
3. Once the infant has found the nipple, support their back and shoulders and bring their bottom close to your body

Nipple tilting 

This technique makes it easier for the infant to lower their jaw and achieve a deeper latch. 

1. Press your thumb on your breast near the nipple, aligning your nipple and the baby’s mouth 
2. The thumb (or finger) pressing on the breast should make the nipple point up and away from the infant, exposing more of the areola for the baby to latch 
3. Bring the baby’s lower chin into contact with the skin, and their mouth should open wide as a reflex 
4. Roll the rounded side of the areola into their open mouth for a deep latch and watch for swallowing

Breast sandwich

To get more breast tissue into the infant's mouth and ensure an effective latch. 

1. Gently squeeze or compress your breast from top to bottom with your fingers on one side and thumb on the other, away from the areola 
2. Let the baby’s chin come into contact with your breast and their mouth open wide
3. Bring your baby close to your chest and support their upper back and neck, keeping it slightly extended 

Other breastfeeding positions

• Dancer hand-hold (for special circumstances, use if your baby can latch but is unable to maintain it)
• Cross-cradle 
• Cradle 
• Football 
• Side-lying 

For a step-by-step process on how to latch your baby onto your breast and additional breastfeeding positions, you can seek guidance. 

When to seek professional help?

If you are experiencing persistent latch issues or nipple pain, or if you suspect the baby is not feeding well, speak to your midwife, healthcare visitor, or lactation consultant if they are available in your country. 

In the UK, you can call the National Breastfeeding Helpline on 0300 100 0212 or join a local support group with other breastfeeding mums. 

You can also use breastfeeding aids such as nipple shields, breast pumps, or supplemental nursing systems (SNS), but it’s essential to seek advice from your healthcare provider if you are considering them.

Support and guidance are available at any stage of the process, so do not hesitate to seek help and support.

4 Tips for a successful breastfeeding latch

1. Ensure a comfortable environment and position for both you and the baby 
2. Maintain proper breastfeeding hygiene:
   • Keep nipples clean and dry 
   • Change breast pads often or when wet 
   • Wear loose clothing in a breathable fabric like cotton and avoid padded bras 
   • Apply a small amount of breast milk on nipples after breastfeeding and allow them to air dry¹⁰
3. Look after your well-being:
   • Have regular meals 
   • Get enough rest and sleep if possible 
   • Get active and get out of the house if you can¹¹
4. Be patient with yourself with time and the right support, you and your baby will be able to establish a good latch 

Summary

Breastfeeding latch issues arise when the baby struggles to achieve an effective latch.

Common issues include a shallow latch, nipple confusion, painful latch, and tongue tie. 

A good latch includes the following: 

L - Lips flanged out, observed with a wide, gaping mouth to accommodate areola and nipple 

A - Asymmetric latch, with more areola above the baby’s top lip 

T - Tummy to mummy, with the baby’s ears, shoulders and hips in alignment 

C - Chin to breast, ensuring the nose is free in the sniffing position

H - Have a listen and watch for active suckling and swallowing, indicating milk transfer

Achieving an optimal breastfeeding position can help to improve breastfeeding.

If breastfeeding latch issues continue without resolution, then seek professional support and assistance. 

Latch issues are common in the first few weeks of breastfeeding as both you and your baby are adjusting. 

• Speak to your midwife or healthcare visitor
• Call the National Breastfeeding Helpline (UK) on 0300 100 0212