Suck Problems During Breastfeeding

Baby not sucking properly?

Baby's anatomy needed for best suck and swallow

A baby sucks, swallows and breathes all at the same time.

Baby’s lips help to make an air tight seal while breastfeeding, and the cheeks have fatty pads in the beginning (as a newborn) that help baby keep the nipple in the mouth. Preemie babies may have less of this fatty deposit in the cheeks, which can make it more difficult for them to feed.

The tongue is extremely important for breastfeeding; the tongue draws the nipple into the mouth, shapes the nipple and areola into a teat, it compresses the teat in a wavelike motion (allowing for milk to flow) and it funnels the milk to the back of the throat.

The hard palate helps to position the nipple and areola and this holds the breast in place. The soft palate is towards the back of baby’s mouth and this is the area in which the nipple should be. If the nipple is not far enough in the mouth and touching the hard palate, mom might experience bad nipple pain.

The baby has more than 40 muscles controlling the lips, tongue, jaw, cheeks and soft palate to coordinate sucking, swallowing and breathing. There are also 6 cranial nerves that help control these actions. Problems with a baby’s muscles or nerves will therefore have an impact on how well baby can breastfeed.

Here are some breastfeeding tips and advice on how to deal with various suck problems during breastfeeding.

Oral Problems that can Interfere with Breastfeeding

* Cleft palate or a cleft lip palate: Baby is not able to create a seal whilst breastfeeding so as to suck properly.

* A retracted jaw or retracted tongue: Baby’s cheeks are usually dimpled and when baby breastfeeds, baby usually makes some clicking sounds. You will need to make sure that baby’s head and neck are positioned correctly. Short-term use of a nipple shield can help baby feed with a retracted jaw.

* U-shaped cleft palate: Also called “Pierre-Robin malformation sequence” or “Microngnathia” This is when the tongue is positioned too far back in the mouth and on the outside the chin looks recessed.

* Tongue tie: Also called “short tongue” or “short frenulum”. This is when the frenulum, the membrane that attaches the tongue to the floor of the mouth, is unusually short, making it difficult for the baby to pull out his/her tongue far enough to grasp the underside of Mom’s nipple.

* Baby has oral thrush: (Candidiasis, infection caused by fungi, of the oral cavity) This can cause discomfort whilst breastfeeding.

Other contributing factors that can cause Baby to have Suck Problems

* Your baby is sleepy most of the time: Your baby is premature or your baby might have some medical issues.

* Baby keeps rooting for the breast, but does not attach himself/herself: Neurologically impaired babies often have this breastfeeding problem. Try to firmly support baby’s body and control his/her head and jaw.

* A habit that may have developed in the womb, is when baby sucks his own tongue. This can then in turn also affect the breastfeeding relationship and cause some suck problems.

* Baby bites down on your nipple instead of sucking: Try to increase baby’s awareness of his/her mouth by playing with the mouth.

* Your baby has a weak suck usually caused through newborn sleepiness: This is when your breast keeps popping out of baby’s mouth. Make sure that baby is latched on correctly and try

supporting baby’s head and jaw. This can also be caused by Mom having very large breasts or nipples. Read more on this here

* Baby is uncomfortable during breastfeeding: Try the different breastfeeding positions.

* Infant tongue thrust and breastfeeding: Tongue thrusting is when you put your tongue between your teeth before swallowing. Babies have a tongue thrust reflex that protects them against choking. When a foreign substance is placed in their mouths they will immediately push it back out.

Breastfeeding a baby with chronic tongue thrust can cause huge breastfeeding problems. Many Moms will need to train their baby’s tongues so that when they breastfeed, they stop thrusting the tongue. The training usually involves putting a gloved finger into baby’s mouth and pressing down. Babies are then taught to suck correctly.

If your child has tongue thrust, breastfeeding is the best choice since it helps baby with the development of teeth and jaw. The sucking during breastfeeding encourages the growth of straight, healthy teeth.

Tongue thrust is more common amongst bottle-fed babies. Doctors have found that forward tongue thrusting in infants may result in breathing from the mouth, lip biting, gum disease and strange facial features.

Some breastfeeding Moms might find that baby only has tongue thrusting problems when they try to feed baby purities or other solids. Moms should just remember that children are still developing during the first few years and that usually by the age of 6 years, any normal thrusting should lessen. 97% of all newborns have tongue thrust when they swallow. By the age of about 12 years, children have usually grown completely out of tongue thrusting.

* Baby doesn’t want to open his mouth for the breast: This usually happens because of a clenching jaw. Try beginning the rooting reflex by putting your nipple near the top of baby’s mouth just under his/her nose. Sometimes you will have to help a baby open their mouth. This sometimes happens when baby is not fully alert or awake.

* Nipple Confusion “nipple preference”

What is nipple confusion?

When breastfed babies are given an artificial nipple to drink from, they might become confused and not know how to drink from the breast. These two feeding methods entail completely different tongue and mouth movements and swallowing skills.

During breastfeeding babies use their jaw and lips to pump and grip the nipple and breast for effective breast drainage. The suction needed during breastfeeding actually helps for oral development in babies.

Not all babies will develop nipple confusion! Some babies have no problem going back and forth between the bottle and the breast. It also usually only occurs in the first few weeks of baby’s life.

Read more on nipple confusion here

The best thing to do if you would really like your baby to drink from an artificial nipple sometimes too, is to introduce it early enough (after 6 weeks) so that baby can get familiar with both the breast and artificial nipple. This can really help if Mom is thinking of returning to work after a few months because baby will need to drink the pumped breast milk from the artificial nipple.

If your baby has any of these suck problems, it will be best to get help from a lactation consultant. Until these problems have been sorted out, you will be able to supplement baby with pumped breast milk. Some moms might even decide to pump exclusively. Most babies, with these breastfeeding problems, can overcome them with your patience, perseverance and with some professional help.

Other pages on “breastfeeding problems” related to suck problems

- Overactive or under active let down

- Alternative breastfeeding methods

- Latching on problems

- Colic and breastfeeding

- Tongue tie