Encourage my 1-month-old baby to "suckle softer"

December 3, 2010 2:45 PM

Is there anything we can do to help encourage my 1-month-old baby to "suckle softer"?

My wife and I just had our first child, Lucan.
He's now 1 month old.
My wife has been doing a great job breastfeeding until her milk taps out each night. And Lucan latched on successfully from the moment he was born.

But it seems like Lucan gets more desparate with each day; as if he's not getting enough food. We suppliment with organic formula when there's no more milk in the breasts (meaning we feed him at least every 2 hours).
But he still feeds each time as if he hasn't eaten in weeks; though he's actually gaining weight at above the average rate (but still healthy).
He suckles so hard that it REALLY hurts my wife.

I know breastfeeding isn't supposed to be easy, and it hurts many people.
But it only started really hurting in the last week or so.
I thought this is when it was supposed to start to get easier for her.

Is there anything we can do to help encourage Lucan to "suckle softer"?
Or at least lessen the pain for my wife?

posted by swafo to health & fitness (21 answers total)

Some misconceptions = problems...

Lactating breasts are never empty. They are constantly making milk -- higher-fat milk at the end of a feed, too. Good read

If you have been supplementing for a while now you likely have two problems, viz: a for-real too-low supply, and a nipple-confused baby.

These problems are both fixable.

Weaning from formula supplements
Is My Baby Getting Enough Milk?

You may want to get help. Finding A Breastfeeding Support Person

This IS coming up on the point when things should be getting easier -- if a good foundation has been laid. But bottles and formula = nursing problems. Metrics for insufficient milk = insufficient output via growth/diapers, not "feels empty" or "fussy baby." It IS supposed to be easy; mammals would not have flourished if this wasn't a highly successful process. You and yours just need a bit of confidence in the process.

Read the links -- consider getting qualified help -- in the meantime, she can try nursing him the very moment he starts to stir, before he's even quite awake and aware he's hungry, and nursing in the bathtub can mean a nice calm feed for some babies. Double and triple-check that the latch is just right. Latching videos
posted by kmennie at 3:02 PM on December 3, 2010 [10 favorites]

Babies will start nursing like crazy when they are having a growth spurt to help increase mom's supply and help her catch up. Since you're supplementing already, what about giving Lucan a little bit of formula first so that he's not starving when he latches on? If he then doesn't nurse enough to empty the breasts, give him less formula next time. Hopefully, once the pain subsides a bit she can go back to full time nursing. I had some trouble breastfeeding two of my babies and the tiny break of formula helped me get over the pain and keep going. (And going, and going. My two year old just stopped on her own recently.)
(Note: My sister had a giant starving-all-the-time baby. He would nurse for an hour straight, scream for a bottle, drink 8 ounces of formula in minutes and then nurse again immediately. For months. I was recommending that they start feeding him cheeseburgers or something. Anyway, he kept breastfeeding with no problems with supply. My friend's giant always-starving baby figured out at around 6 months that he got fuller faster with formula than breastfeeding and then refused to breastfeed. So, YMMV, but be prepared for one option or the other if she can't ever catch up and you keep giving formula. My oldest was perfectly happy switching back and forth until she quit breastfeeding. She had a bottle until she was 3 though. Whatevs, baby's gotta eat!)
posted by artychoke at 3:16 PM on December 3, 2010 [2 favorites]

kmennie has the best advice you're going to get here: your wife almost certainly does not have low supply. Your baby wanting more milk and nursing even after her breasts are empty is what tells her boobs to ramp up supply. Breastfeeding works on supply and demand, and it's really efficient.

One more thing: sometimes babies who are voracious, never-satisfied nursers are suffering from reflux - the milk temporarily soothes the burn. But if your little one has reflux, you'd probably notice other signs, like weird phlegmy "goaty" sounds when lying flat.

And now I'm just repeating kmennie, but if the suction hurts, double-check your baby's latch. You shouldn't actually feel suction "on" the nipple very much with a proper latch.

Good luck to you guys - and good for your family for being so gung-ho about breastfeeding! You are doing a wonderful thing for your baby.
posted by thehmsbeagle at 3:59 PM on December 3, 2010 [1 favorite]

The bottle is 'teaching' Lucan that milk comes fast. Personally, I'd stop doing bottle feedings.
posted by k8t at 4:01 PM on December 3, 2010 [3 favorites]

kmennie, Thanks for the links and info.
We actually have a midwife still working with us and she has worked with Lucan and mommy to make sure the latching is correct. Even the midwife commented on how forcefully he was latching on. Short story: latch is as good as can be with a forceful latcher.
Again, he wasn't always like this. It's been a slow progression.

Also, to be clear about the "running out of milk" statement. I understand that the breast is never really OUT of milk. What I mean is that we breastfeed until Lucan fits and screams to get MORE than the breast can provide at the time. My wife tries to feed him even then, but at some point we have to give him some formula (rarely more than 150 ml a day).
And as soon as he gets the formula he's quite and happy (and chugging).

I'll check out all the links and see if anything helps.
Thanks for the feeding advice. We'll try both (sleeping feeding, and bathtub feeding).

artychoke, Thanks as well.
As stated to kmennie, we try to breastfeed throughout the day, and only use the formula when necessary. So starting off with the formula might not be what we want to do afterall...
But it might be an interesting idea/way to give her a break.

All in all, Lucan seems to pretty much always be hungry (except when he sleeps).
(Also another side-note: he creates plenty of appropriately dirty nappies)
posted by swafo at 4:13 PM on December 3, 2010

Thanks thehmsbeagle.
We try to breastfeed well past the point of him fidgetting and whining.
But it's hard. He seems almost in pain. We can only take so much of seeing him in pain before we feel the need to do something about it. So we give him the formula...

Very interesting point about the reflux. We've noticed that he's occasionally had some wheezy/goatie breathing sounds when we lay him down.
I'm assuming that it's normal for them to sometimes breathe normally, and then sometimes do the wheezing.
What's the best way to find out if it's reflux? Go see a doctor?
Any suggestions on treatment (if it is reflux)?

k8t, we'd love to.
But see above explanation...
posted by swafo at 4:27 PM on December 3, 2010

On reflux
Alternative feeding methods

&

Supplementing the breastfed baby, My baby fusses or cries during nursing - what's the problem?

If Mom is in pain and you are getting "Yup, looks good" from your support person, that is usually an indication that it is time to check out different support people. You really want to deal with somebody with an "IBCLC" certification, not a midwife (or doctor), for serious nursing issues. To be plain: if you had been getting good breastfeeding advice from this person -- you would not be in the position you are in now.

That the kid is fussy does not necessarily mean he is hungry, and that a reflex action is gulping down a bottle doesn't mean that it was required. Really, the best thing to do here is read as much as possible, seek better support, have more confidence in the process and scrap the formula. Nothing you're describing is uncommon or indicative of a problem, at least not beyond the problem being a bit of nipple confusion. He nurses for a good long time, he gets to his fuss phase -- what happens when she hands him over to you and you take him for a brisk walk around the room, a carry in a sling, or a ride in the car? It sounds kinda like you guys panicked, thought 'Yikes, need milk,' and got stuck in a rut of giving a bottle as a pacifying sort of deal, and that's now starting to sabotage the nursing. If he's always hungry, great -- just keep putting him on the breast for frequent feeds *. Watch the diapers. A kid who is regularly at the breast and keeping you hopping with the diapers is getting enough milk and bottles do not make sense.


* I want to reassure that this is so normal right now, the constant nursing -- and it will settle down; the light in this tunnel is not far off at one month!
posted by kmennie at 5:17 PM on December 3, 2010 [3 favorites]

The nipple-mincing latch got better as baby anachronism got older. Laying down feeding was hands down the best method for us, but we also did block feeding once my supply went up. We'd feed on the one side for ages and if she got fussy we'd burp her and play with her. Feeding while sitting up and reclined is supposed to be good as well. The almost in pain comment really makes me think reflux and burping and changing positions more.
posted by geek anachronism at 5:25 PM on December 3, 2010

Most of the prior commenters covered what I was going to say, but I just wanted to add that for me, the nipple pain during latch/let-down (my lactation person called it the "kick the table" moment) faded right around 5 weeks. And all of my kids went through times in these early months where they wanted to nurse every 90 minutes or so.
posted by MeiraV at 5:35 PM on December 3, 2010

Excellent advice so far. Some additional suggestions - if you feel the need to continue supplementing (I agree you can probably cut it out, but I'm throwing this out there anyway), then make sure the bottles you are using use a slow flow nipple. Baby bottles are designed for formula fed babies, and use a completely different latch (ie no latch required, it just pours in), so a baby that gets used to a bottle gets frustrated with the breast because it requires work AND its slower. Keeping the nipple slow flow reduces the frustration, because the two are closer in speed. Note however that not all slow-flow nipples are the same speed (sigh). I vaguely remember that the Playtex nipples tended to be slow, and the bornfree nipples tended to be too fast. And the age recommendations on nipples should be ignored unless you are 100% bottle feeding.

Another thought - is it possible that your wife or son have thrush? This is exceedingly painful.

I second the recommendation to seek out an IBCLC for a second opinion.
posted by Joh at 6:38 PM on December 3, 2010

On the reflux question: is he calmer and does he sleep better when his head is a bit elevated -- in your arms, or in a bouncy seat or swing? My babies have all gotten a little reflux-y at around a month in age, and I've put them to sleep in their car seats until it settles down.
posted by palliser at 6:55 PM on December 3, 2010

A little fenugreek might help supply. Ask the midwife. It helped my daughter when she was nursing her first. Also make sure your wife is drinking lots and lots of fluids.
posted by St. Alia of the Bunnies at 7:05 PM on December 3, 2010

If you have reflux questions you can find a wealth of information at reflux.org - the PAGER site. Very helpful folks there. Reflux doesn't always mean that the child vomits - there is something called "silent" reflux where the formula comes up and then back down, burning both ways. I will say that since you didn't mention extreme fussiness, arching or squirming during and after feeds, I doubt it is reflux, but it's worth looking into.
posted by PorcineWithMe at 8:21 PM on December 3, 2010

Congratulations to you and your wife! A new baby is exciting and confusing and breastfeeding is hard, especially for a first time mom in a culture where we rarely see models of breastfeeding. But you can do it!

A couple points of advice:

1) Latch and position. You can look this up online for details, but in brief, position is the most important factor in making breastfeeding comfortable and effective. The baby should face the breast - his neck should not be turned. Bring the baby TO the breast, not vice versa. Prop pillows under him and under mamas arms so she is not huched over. Wait till his mouth is wide open, then put him onto the nipple and as much of the surrounding breast as possible. The nipple should be deep in his mouth.

2) Let him feed as often as he wants, for as long as he wants until breastfeeding is well established in another month or so (then you can make a few limits about time and so forth). The more you nurse, the more milk you make.

3) Avoid formula and pacifiers. Just as the more you nurse, the more milk you make, also remember, the less you nurse, the less milk you make. If you give formula, the milk supply will diminish, worsening this problem! It is very, very rare to truly not have enough milk. But sometimes you need a couple days of strong nursing to make the milk supply "catch up" with demand. So avoid replacements that can undermine the nursing process! Also, giving a little formula quickly leeds to weaning for many people.

4) Try other methods for comforting your baby. This is where you can be really helpful, as the non-nursing parent. After he drinks and drinks, if mama needs to rest or he's very fussy or whatnot, try bundling him up tightly (newborns find swaddling very comforting) and take him into another room. Rock him. bounce him. Play some music. Run the shower. Take a bath with him. He does not need to eat in that moment (if he just nursed at length). But he might need comfort - and you can do that for him!

Good luck, you're still very early in. Stick with it and it will get easier!
posted by serazin at 8:45 PM on December 3, 2010 [2 favorites]

I disagree strongly with some of the advice you've had above. 

Undersupply DOES happen. It may not the problem in your case; I have no way of knowing and nor does anyone else replying here. But for anyone to dismiss it out of hand is really irresponsible. Sure, your baby may just be having a growth spurt, and your wife could try drinking more water, fenugreek, getting more rest (ha!), etc - but don't assume anything. 

Secondly, how much pain is your wife in? If it is excruciating, look into nipple shields. A lot of rubbish is written about how they ruin your supply but I have been using shields for almost 4 months and I do not have a supply problem. The shields available these days are very thin silicon (get medela  brand and check the sizing). It's only in the past couple of weeks I've been able to feed without a shield. It took that long for my nips to toughen up. I had a tonne of LC help with latching correctly; didn't help. The problem was a strong latch (even now she leaves them quite purple sometimes) combined with very sensitive nips. 

Likewise I have never heard of a baby getting nipple confusion from a pacifier or bottle. As far as I can tell, that's only relevant to babies with a weak suck/latch, if at all. My baby switches easily between nipple shield, bare nipple, and bottle. 

 It sounds like you and your wife are pretty well informed and good at observing your baby, so I would suggest you follow your intuition and, as suggested above, maybe try another LC. LLL may be helpful but they also may just make your wife feel bad. 

Oh, and check out the Atlantic story 'The case against breastfeeding' (I'm on my phone and can't link, sorry). Ignore the incendiary title; it's very informative and I found it quite balanced. YMMV. 

Good luck! One way or another, this will be easier fairly soon. And then you can get down to the really crazy-making issue of sleep... 
posted by 8k at 1:25 AM on December 4, 2010

kmennie has great advice, really great. I'd just like to offer a glimmer of hope: it was after one month of nursing that my nipples stopped being so sore. The 1-month-hump was so difficult with at that point very very very sore nipples, I did cry while nursing at some point. It will pass.

Don't supplement (yet) unless the baby is loosing weight, you'll mess up the milk production and his latching.

Watch out for baby-need-more at 3 months and at 6-months. He'll be begging to latch more to make more milk at these times.

also, congrats!
posted by dabitch at 4:42 AM on December 4, 2010

Listen to kmennie, she knows what she's talking about.

Thirding the suggestion of going straight to a qualified lactation consultant. The amount of misinformation about breastfeeding that's floating around, even amongst people who work with babies and should know better, is astounding (and makes me very sad). A professional lactation consultant will spend an hour or more with mother + baby, check the breasts and nipples, watch the feed, take the baby's personality into account, and give personalised advice based on that. There's a lot more to it than just checking the latch.
posted by rubbish bin night at 7:25 AM on December 4, 2010

Likewise I have never heard of a baby getting nipple confusion from a pacifier or bottle. As far as I can tell, that's only relevant to babies with a weak suck/latch, if at all. My baby switches easily between nipple shield, bare nipple, and bottle.

My baby switches easily from breast to bottle too. But that doesn't mean that nipple confusion doesn't exist. It is very common. There are plenty of babies who will refuse the breast after a while because it's too much work compared to drinking from the bottle.
posted by rubbish bin night at 7:27 AM on December 4, 2010

Rubbish bin night, do you actually know of any babies who've suffered 'nipple confusion'? I'm on a very active mothers' forum and a very large IRL mothers' group and can't think of anyone saying this is a problem. Yes that's only anecdotal but so is most breastfeeding 'knowledge', and at least I have a large sample. Maybe in the first few days it is a risk, maybe for babies with a weak latch, but I'm sure it's feared much more than it should be.
Lots of parents however end up tearing their hair out at 2, 3 , 4 months when their baby won't take a bottle!

OP - I mistakenly thought you were already seeing an LC but nowrealise you actually said it's a midwife. Yes you definitely should try a qualified LC who will spend time with mama and baby - plain midwives don't have enough knowledge in my experience.
posted by 8k at 8:04 AM on December 4, 2010

Also, a lot of well-meaning people will assume that by 'pain' your partner is just suffering the same level of discomfort that they themselves experienced. BFing is more painful for some people than others; if it's making her miserable then she really needs some help and not to just be told it will probably go away soon. A good LC will take severe pain seriously.
posted by 8k at 8:13 AM on December 4, 2010

Thank you ALL for everything.
Being a first time parent, you never know when to be really concerned about things.
We try to be as informed and prepared as possible.... but you know how that goes with your first child.

I have only just now logged back on since my last post (so i have a lot of reading to catch up on).
Let me first update everyone on the latest and then I'll finish reading everything.
My wife and midwife are now certain that it's thrush.
So we've RE-sterilized everything (and continually doing so) and have an appointment with the doctor.

Once again, thank you all.
posted by swafo at 1:44 AM on December 6, 2010