lazy latcch?

[@llli*pookybosch]

Abigail is 2 months old now. She was born at 33wks4d (placenta previa threatening). She had no concerns at all, just needed to stay in the NICU until she was feeding on her own and proving she was gaining. I was able to breastfeed from the start, and I have no supply issues either. We were given a nipple shield to help with her latch as her mouth was so tiny.

I'm still using the nipple shield and supplementing with my EBM as she needs after most feeds (about 1/2oz each feed). Our dr said we should wean off the shield and then stop the supplements. I think she's lazy with latching now without the shield. She doesn't open her mouth very far, certainly not the huge "yawn" newborns are supposed to do. She seems to be getting lots of milk with little trouble, but after the feed my nipple has a slight lipstick shape to it, so I'm thinking that's a bad latch? Not sore yet, but slightly uncomfortable sometimes when she nurses. What should I do?

I'm getting super tired of dealing with the nipple shield and supplementing and pumping and I really hope to be done with all that and nursing normally soon! Also at this moment just very frustrated that she's not nursing well even with the shield. Sometimes she clicks very loudly while nursing, mostly at night when she's not completely with it, and her shirt gets wets on the shoulder, so I don't think she has a good seal. Don't know what to do about that either.

sorry for the length of this. I've never had nursing problems, and I know these are probably minor, but I'm burning out here.

[@llli*mommal]

Hey, I think everyone gets a bit burnt out at 2 months, even when everything is going perfectly and the was no stressful NICU stay or c-section (i presume) in the mix.

If your LO had been able to stay in until term, she'd be a newborn right now. And newborns tend to have tiny mouths, which even at their widest do not open very wide and even at their best do not latch on very deep. Newborns also have trouble controlling milk flow, which can lead to clicking, milk spillage, and nipple compression (since compressing the nipple helps control the flow). The "slight lipstick" look your nipple has post-feeding is probably a result of this combination of factors- a tiny mouth, a slightly shallow latch, and compression.

So, what do you do about it? Here's what I suggest:
1. Patience. I know you've been at this for 2 months, but if nature had her way your baby would be a brand-new newborn right now, still learning to nurse.
2. Try to put her to the breast before she is really hungry. She may latch on better when she's not freaking out from hunger.
3. Show her what you want her to do. When you latch her on, open your mouth very wide. She may mimic you!
4. Google the "nipple sandwich" technique- that can help you achieve a deeper latch.
5. See a lactation consultant, preferably an IBCLC, for hands-on help. When you're having trouble with a newborn, nothing beat this approach!
6. Pat yourself on the back! You've made it 2 months with a preemie and no formula, and have managed to transition off of using a shield. Those are enormous achievements!

[@llli*zorkycharlemagne]

I am using a nipple shield too so I know how annoying it is trying to use it ALL THE TIME. Trying to figure out where you left it and keeping it clean and placing it just right..

Unfortunately I feel like I have the same problem as you. DS will not latch to bare breast for very long and ALWAYS gets frustrated without the nipple shield. I asked my local LLL leader what to do and she said to just be patient and start feedings with the shield and then try taking it away towards the end. She said not to worry much about it as long as he is nursing either way.

I notice sometimes it works but sometimes DS is just too persistant to have the shield. You can try, though, because I have seen some improvement.

[@llli*firespiral]

patience and persistence .. I really do not believe in the word lazy

in regards to the clicking sounds, might be a clue an osteo-cranial may be able to help with?

[@llli*LLLKaren]

I'm sure some babies do it, but personally I have never seen that "wide-like-a-yawn" mouth you're supposed to wait for when latching your baby on. I would have been waiting a long time with my babies!

I agree with mommal's suggestions, and it might also be worth trying "laid-back" nursing. There's some info about in the LLLI FAQ on positioning, and more at biologicalnurturing.com.