breast feeding (attachment of infant to breast)

Last reviewed 01/2018

Stimulation of the nipple and removal of milk from the breast is important to ensure that there is an adequate supply and a good flow of milk. In order to achieve this, the baby needs to be well attached to the breast so he or she can suckle effectively.

  • most of the breastfeeding problem such as nipple trauma, mastitis, low supply etc. are usually due to poor positioning and attachment (1)
  • inexperience of the mother and lack of skilled help from the health workers are the main causes of poor attachment. In addition use of a feeding bottle before breastfeeding, flat and inverted nipples, very small or weak infant are also important

A baby is said to be well attached when all four below mentioned signs are present:

  • feeds with a wide mouth and an active tongue
  • more areola is visible above the infant's upper lip than below the lower lip
  • the infant's chin is touching the breast
  • lower lip is turned back (although mothers are unable to see this) (1)

In addition, suckling should be painless and comfortable to the mother (1).

Note:

  • in women with big areolas, the amount of areola outside the baby's mouth is not by it self a good indicator of poor attachment
    • equal amount of areola above and below the baby's mouth or amount of areola more below the lower lip are more reliable indicators of poor attachment (1)

Tips for good attachment:

  • mother
    • support the body by leaning back which will reduce the tension in the shoulders and allow the infant’s body to be supported by the mothers body
    • infant should be held with the arm on the side of the breastfeeding (cradle hold), the side of the infant’s head is leaned on the forearm and back is supported by mothers hand
  • infant position
    • infant’s body face the mother with the head, neck and back in a straight line
    • infant lies diagonally, body under other breast, legs supported on hip
    • chest close against mother’s chest
    • nose in line with the mothers nipple
    • chin should be touching the breast which will stimulate the infant to open the mouth wide for latching
  • infant latch
    • infants mouth should be wide open before latching
    • angle of infants mouth should be >1000 to facilitate the nipple and areolar deep into the mouth of the baby while the tongue moves in a wave like manner underneath the breast tissue and to press on the ducts to effectively drain the breast
    • chin should be deep into the breast, nose should be resting on the breast or clear of the breast
    • initially the jaw moves fast but once the milk has let down it will move in slow regular motion
    • should be able to hear swallowing
    • cheeks remain rounded during the feed (not drawn in or “straw sucking movement)

Reference:

Related pages:

breast feeding