Latching on - how to make DS open his mouth??

[Sallypoo]

Hi all,

I am becoming desperate and considering dropping the bf. DS and I have had a run of problems... born at 36+6 so tube fed, then because early didn't know how to suckle so advised to use nipple shields from day 5 and sent home on day 6 not really knowing how to feed without them....

Then in week 2 I got mastitus because I'd expressed in hospital but DS couldn't get the milk out. As a result of the antibiotics my milk supply dropped so had to top up with formula after every feed.

We're now in Week 9. The positives are that DS is gaining weight well. I've dropped the nipple shields and my milk has increased as a result of the stimulation - not enough yet to drop the bottles of formula but I do feel like we're making progress.

However, because DS hasn't had to open his mouth particularly wide for the shields - you can just open about 2 - 3cm, he's lost the instict to do it, and my nipples are getting so sore I can't face the thought of him latching on. I chickened out last night and went back to using the shields to give my nipples a rest.

I've got small boobs, and fairly flat nipples, and a baby who doesn't seem keen on opening up. I've watched a few videos and have adjusted his position slightly today so that his neck is more extended... and I'm prepared to perserve for a week or two more... but the present situation isn't sustainable.

I don't know where to turn for advice. The breastfeeding councillor wants me to stop the bottles, and I would too, but not until I know he's feeding off me. He was only 6lb and at that weight it seemed crazy to risk him loosing weight. He's up to nearly 10lb now, but as he's gaining a lb a week he's hungry and certainly not getting anywhere near enough of me - I top him up with upto 3oz per feed.

Any ideas? The routine is taking an hour per feed because we're feeding off both boobs and then a bottle, and we're still feeding every three hours...

I feel so useless and frustrated that I can't achieve this one task.... and that plus now being sore and having a baby who just doesn't know what he's meant to be doing - what a mess.

Sallypoo

sally - babies born at 36-37 weeks can be a real challenge because sucking/swallowing co-ordination is not yet fully developed.

Nipple shields are (IMO) a major intervention, and I see and hear of many long term hassles with them (not to say they don't have a place in some situations).

So you have had a mountain to climb and it's great you are hanging on in there.

I agree with the bfc that dropping the formula is a priority in order to preserve the milk supply, but also understand your reluctance because of your concerns about his weight. I agree you can't just drop the formula like that - it is very likely your supply will not be enough to take the place of the formula without careful building up.

It sounds like he's having a lot of formula - at up to 3 oz a feed, he's probably getting something like 20-24 oz in 24 hours, and that's a really huge amount, honestly. If he was fully formula fed, he'd be getting something like 25 oz. So my concern would be that he's getting very little breastmilk....and you need to be realistic about this, so you know what to do to save the milk supply.

To increase the breastmilk supply, you will need to feed more often. 8 times in 24 hours (which is what you are doing now) is not really often enough to reverse the situation. He will need to feed more often, and to use both breasts at least once each every time....and to feed at night ad lib, too. At the same time, you can see if your HV will support you offering 2 oz of formula max each time, and work down from there.

The shields thing is not a priority, in my judgement, at the moment - he needs to enjoy feeding at the breast with no struggle while you are working on building up the supply and there'd be a concern that without the shields, at the moment, he would get even less. Maybe review this in a few days. See what the bfc thinks of all this, too.

I am a bfc with NCT, by the way.

Hope this helps.

hi tiktok,

I'm feeding at mo. Shields definitly stopped breast stimulation - as soon as i dropped them my boobs swelled for the first time since mastitus in week three.

Although I'm offering 3oz often he only takes just over 2oz. Last nihgt we managed a feed with no top up. Not possible with shields.... beleive me its much improved in the last week. He takes about 500mls of formula a day - I have kept a log.

We are using both breast at each feed (only started this yesterday) and this is agony as there is no time for the breasts to recover....

I need a better latch. He won't extend his neck as he's strong enough to hold it now and I'm getting really sore.

I also don't want to feed more than eight times a day, surely with a gradual reduction in formula, my milk will improve? If not maybe this the time to quit and go to fornula - I'd be down to 5 formula feeds a day and might be able to get my husband back in our room! I don't think he'd be pleased with more feeds as he does shifts and is already sleep deprived due to hour long feed sessions.

At the moment I just need a better latch. Formula reduction can then start, not while I'm still not able to give him a good feed....

sallypoo i really feel for you, feeding probs really are a nightmare.

my dd is 10wks and has never liked to open her mouth wide. i'm sure that has been one of the main causes of my pain/her slow weight gain.

we were also told to top up weith 2oz formula - i wasn't keen, did it over the course of one wknd then stopped. we've been told to do it again just now but dd has started to refuse them (and tbh i have more or less stopped offering)

anyway re the mouth - she has started to get a tiny bit better at it but not much. an hour long feed can take 2hrs because of the amount of times i have to correct her latch, or even attempt to get her on in the 1st place.

a bfc told me to try to help her by pulling her chin down once she's on - ive since read elsewhere you shouldn't do that, but it seems to work sometimes, have you tried that? also being really quick to pull her on on any rare ocasion she does open wide!

other things suggested to us were to get her checked for tongue tie and also maybe seeing an osteopath for any neck/shoulder problems caused at birth, eg by foreceps.

good luck and you have my full sympathy!

oh also, re extending his neck - i sometimes (gently!) pull/tuck in her legs after she's latched on - not hard enough to make her loose the latch but it can sometimes extend her neck just a wee bit more.

Sally,
can't offer more advice than before but, if you fancy a cuppa let me know. I also know a great childrens cranial osteopath in town if you want her number, we went with DS2 it was a miracle.

Sallypoo
You really have my sympathy as I am in a similar boat. My ds is 12 weeks and I have never had a comfortable feed. Fortunately for us he is getting plenty of milk and is thriving - it is me that is suffering. I have spoken to so many councellors, doctors etc and I am on the brink of giving up which is making me so sad. I am going to see a cranial osteopath tomorrow - our second session and really for me a last shot as I cannot cope with the discomfort for much longer - hope it sorts out for you

Thanks all. I will try and reduce bottles to 50mls (just under 2oz.)

Just fed DS from 17.45 to 19.00 and now given him 50mls of formula but not satified him so given another 30mls.

I'll keep perservering with the BF for another week or so, any advise on the latch would be gratefully received. I think this is the key to getting DS a more satisfing feed.

I'll investigate the cranial osteopathy, as DS was a ventouse delivery. I already regularly visit a osteo myself and he is a practicing cranial too.

Thanks JingleJen - I'll take you up on that cuppa next week. I'll see you Thursday for sure.

Sallypoo

the coach house clinic

LLL Cambridge: - 01638 741291 breastfeeding helpline

BfN Supporterline 0870 900 8787 (will connect you to local number)

each of these have local volunteers who could come and help.

Chin up sweetie, Jen x

Sally, the reduction of stimulation of milk is one of the several drawbacks of using shields, and it sounds like you have experienced this

500 mls of formula is less than the 20-24 oz I estimated, but, gosh, it's still a lot....likely to be the bulk of his nutrition, leaving not much room for breastmilk.

It's good you are now using both breasts at each feed. You're right that you need to get help with finding a pain-free attachment.

You say you don't want to feed more than eight times a day - this would not necessarily be a permanent thing, but something you would do in order to build your supply up. The more often your baby feeds, the more quickly and efficiently you will build your milk supply.

Hope you find some good help soon.

Sallypoo - I went to the cranial osteo today and she said that my ds was really tight around the neck and chest area and that could explain why he was not opening his mouth properly - it may or may not work but I think it is defo worth a shot

Hi Janx, tiktok & Jen,

Janx - Thanks for letting me know about the osteo. I do hope is helps with your DS. Please keep me posted....
DS definetly won't extend his neck, I've continued to try, but have gone back to nipple shields at the moment as pain was getting too much. It does sound like the osteo is worth a shot.

I also need to get help with latch. DS and I really aren't that sure about what we're doing. I'm going to speak to HV today, and probably call the BfN as well.

Tiktok, yes if/when I can bear to have DS feed without shields, I will feed more than 8 times a day or express to increase milk. However we're stuck at 1st base. If I increased feeds before getting latch sorted out, I'll get so sore that I'll definetly give up bf altogether because of the pain... If/when DS's latch is sorted, and DS is getting more milk (I check and he leaves milk in the breast at every feed but is still hungry) then I'll start reducing the formula....

I've decided to set myself a deadline to get this sorted out (probably another fortnight), as its now even painful to bf with the nipple shields as I'm so sore. I'm hoping nips will recover over the next few days, but milk has dropped again since I started to use the shields.

I had resorted to biting down on a pencil, but this does seem to be a bit extreme, and well if I'm that tense, then it can't be good for me or DS.... He does look at me like I'm quite mad when I've got a pencil in my mouth, not to mention what DH and guests must be thinking!

Jen - tried LLL. A nice lady did come out, but didn't know how to make DS open his mounth more... this really is the crux of the problem, so need to seek help elsewhere or put it behind us and go to formula...

I'll let you know how I get on with the BfN, HV and osteo.

Many thanks all, and good luck Janx

Sallypoo

Sallypoo - oh biting a pencil - not great - I grit my teeth! Do try the osteo - I felt it helpful thenm talking about the mechanics of his latch - I have seen so many people about it - feel like they end up saying the same thing. One midwife did photocopy some pages of a very in depth book on breast feeding - calle dthe breast feeding answer book - it really goes into detail about different reasons for poor latch -does your ds thrust his tongue alot - mine does and there seems to be little techniques you can use to help that. I am so hoping things improve

aaarg i used to clench my fists so hard i'd have nail marks...isn't br-ing a joy?!!

did you try the leg pulling? it can really help sometimes.

i have to say that although all the bf people i've seen have been really kind and helpful, NONE of them could explain why dd wouldn't extend her neck/open wide either, so I'd be interested to hear if you get any tips.

Good luck!

My son's the same, i.e. never opens his mouth wide. We started with shields, 'cause he was born at 2lb7 and his mouth was so tiny anyway! They really damaged my supply, though, so luckily we dropped them quickly. Still, sometimes it seemed like he took forever to painfully take not much milk, and would feed constantly if I let him.

It just got better with time. Now, he STILL doesn't open his mouth much, but he feeds well, and without pain on my part. He's six months now, and he improved a lot after he was around 3 months.

Have you tried different feeding positions? When he was bad, I used to find he fed much better in rugby hold than in "normal" hold.

Have you noticed it seems to be mainly boys with this problem

I don't think this is gender-led at all...sally's issue was caused by her baby being born slightly soon, and by being given nipple shields to a non-latching baby on day 5

She then went on to have mastitis, because her baby was not attached properly, and she then introduced formula after every feed (in the absence of someone supporting her to warn her what a devasatating effect this would have on her supply, and on her still non-latching baby's ability to learn to suck)....and as she says, he's lost the instinct to do it, and he is having huge amounts of formula because she feels she cannot push the breastfeeding while she is so uncertain of her supply.

This could all have happened to a girl. Poor support for bf is nothing to do with the sex of your baby

SallyPoo - sorry I was just being flippant. As you know I am having problems too - hope you didn't think I wasn't taking it seriously

janx - sorry, did not mean to sound as if I was telling you off

Just trying to set the record straight!

no worries tiktok

Hi all,

No offence taken by any of the comments I promise. Knowing I'm not alone helps greatly.

As for introducing the formula, well we did that because of the lack of support from the MW. However the HV did support it... didn't get to see her today, but will tomorrow and will ask about latching then.

I too was told in hospital that boys were worse at feeding, but yes, events have conspired against DS & I on the breast feeding front.

As for supply, its a bit better again today, so I think my stress levels yesterday didn't help. Nips are recovering after another days of shields which is good.

I need to know if I can improve latch, then drop shields and hopefully all the other things will fall into place.

The lack of support has been frustrating, especially from the NHS. All the support I've received so far has been from charities, volunteers and good friends... surely this isn't right? There are no workshops in our area either....

Anyway I'll put up another post when I've got some more news.

Sallypoo

Sallypoo - it is difficult. DD had major trouble opening her mouth wide enough to latch on properly to start with. We took her to a cranial osteopath and one session later she had the full hinge jaw thing sorted! She's still nursing now 16 months later so don't give up hope just yet. Could you try seeing an osteopath?

Sally

This may sound daft, but when I was having similar problems with my ds not opening his mouth, I was advised to say to him "big mouth, big mouth" and then heap praise on him when he did He was about 6 - 8 weeks old at the time.

Not 100% sure he did as he was told but it certainly made me relax a bit (usually because DH and my mum were wetting themselves laughing at my facial expressions while saying "big mouth" - same expression as when applying mascara). And when I relaxed, ds seemed to get the hang of it and realise that when he did open his mouth he got lots more milk. It's worth trying anyway.

You've done a wonderful job getting this far by the way - well done. breastfeeding can be tough and your nips can take a real bashing (Lansinoh saved my nips - have you tried that?).

Hope you find a solution one way or the other soon.

Hi all,

Cranial Osteo booked for Monday 3rd March in Cambridge.

Have contacted the BfN and the lady from Sudbury was really helpful. She's going to see if I can meet up with one of the Cambridge reps. They hold a drop in clinic at Homerton on Mondays, but because of the nature of my problem ie I've not really been shown how to hold DS or get him latched on it might not be suitable for a drop in session... however I'm not sure I'm going to be able to make it on Monday becasue of the time of my Osteo appointment....

I understand there is another clinic at Brookfields off Mill Road in Cambridge on Fridays - does anyone know what time its on? I've surfed the net and I can't find any info on it at all....

I'm hoping to hear from the BfN tonight to see if I can meet up with them, but would like to have the option of going tomorrow should I not hear back from the BfN. I think the one tomorrow is an NHS one.

Thanks
Sallypoo

Glad to hear you are getting some advice at least. Keep at it, it will get easier and it's just lovely that you are so committed to it - it can be really hard work but in the end, it's worth it

For other cambridge mums who can't find anything on the net about the breastfeeding drop ins...

Fridays @ Brookfields Health Centre on Seymour Street from 2.30 - 4pm

The alternative is on a Monday at Homerton. Details on the BfN website.

I'll be going today, so I'll let you know how it goes...

Sallypoo