Two month baby still has poor latch and nurses all the time

[@llli*flutey16]

Hi - I would love to get your opinion on our breastfeeding journey. My baby is two months old and breastfeeding has been a struggle for us since the very beginning. I was in tears pretty much the entire first 6 weeks as feeding was excruciatingly painful. I saw multiple LCs who all said our latch was "fine" and that my baby did not have tongue tie. In the last 2-3 weeks, his latch has gotten a little better so that nursing only hurts about a level 3 or 4 (out of 10). However, it's still painful at times as he seems to lose his latch often. Other things I have noticed:
-he constantly makes "smacking" sounds while eating either while nursing or bottle (pumped milk)
-my nipples used to have a severe lipstick shape after nursing and now has a slight lipstick shape after nursing.
-my areola is sore
-he starts off each nursing session with some clamping, no matter how much of my nipple/breast I get in his mouth

Any ideas as to why it's still hurting? Everyone said it's supposed to get painless by at least the end of month 1.

Other than the pain, another issue we have is that he wants to nurse all the time (seems genuinely hungry every 45 min-hour or so when nursing) but if I give him a bottle of pumped milk, can go about 2-3 hours in between feedings. I wouldn't mind nursing him that often if it didn't hurt so much but my poor nipples can only take so much. A part of me just wants to give up nursing all together and exclusively pump but I hate washing all the parts! Any tips as to how I can get him to eat more and efficiently during our nursing sessions as he does with the bottle?

He has been gaining a good amount of weight and typically has yellowish poops.

I'd love any insight!

[@llli*mommal]

Welcome to the forum!

I hate it when people- especially people who should know better, like LCs- tell a mom that the latch looks fine and therefore must be fine, despite the fact that the mom is in pain and has evidence of compression (the lipstick shape). If you're in pain and getting lipstick-shaped nipples, then it doesn't matter how good the latch looks from the outside because it is imperfect on the inside. WHY it is imperfect is the harder question to answer. I know the LCs dismissed the tongue tie possibility, but you may still want to look into that a bit more- there are subtler types of tongue tie and lip tie that often get missed, even by professionals. If your baby's tongue can't get much past his gumline, or his lip always curls under when he's nursing, those types of ties may still be a possibility. You might consider seeing a pediatric ENT or dentist- sometimes they know what to look for.

Sometimes the problem is simply that small babies have small mouths, and even at the best of times they have difficulty getting a lot of breast into their mouths. The best thing about that problem is that babies grow. I know "everyone" said nursing was supposed to get less painful at the end of the first month, but unfortunately that is not true for all moms. I still think you have reason to be hopeful- your nipples aren't as badly compressed as they were, and you've made it this far without getting cracked (right?). To me that says you don't have to wait too much longer before the pain goes away, though I'd be going way out on a limb if I gave you any kind of time estimate.

Frequent feedings are 100% normal at this age. Infant tummies are tiny, breastmilk digests fast. A lot of babies nurse every 90 minutes or so- and that's 90 minutes from the beginning of 1 feeding to the beginning of the 2nd, meaning that a lot of that 90 minutes may have been spent at the breast. Also, babies nurse not just for nutrition but also for comfort.

How much milk are you putting in the bottles?

[@llli*lllmeg]

with mommal. Forget what others have told, you-what, if anything , have you tried for improving the latch pain? Different positions? Latch techniques? The pain is telling you something is wrong. yes, it may fix on its own overtime but that does not mean you just have to grin and bear it in the meantime.

Exclusively pumping is extremely hard. Way way harder than exclusively nursing. Latch pain is a real issue with real solutions, it’s a matter of finding the right solution for you.

Babies will and should nurse for many reasons aside from hunger. I would suggest not reading too much into the long stretch of not nursing when baby gets a bottle. This is only important for you because nursing hurts, which is very understandable. But there is no other reason to be concerned about frequent nursing, which is entirely normal. nursing should not hurt. That's the problem. Once that is solved, you can relax and just nurse as much as you and baby wish.

[@llli*flutey16]

Thank you for the support! I made an appointment with a pediatric ENT in the area who has experience with tongue tie.

I am putting about 4 ounces in the bottle. I tried 3 ounces but he seems genuinely hungry after that. I'll try distracting him after giving him 3 ounces to see if he'll be satisfied once his brain registers that he's "full" but it doesn't seem to work.

I'm in too much pain to nurse him for every feeding at this point so I have resorted to pumping half the time and nursing him the other times. This way my nipples get a break. They're not cracked now but the skin looks raw and is still sensitive to the touch (although not as nearly as painful as it was the first month).

[@llli*mommal]

Let us know how it goes with the ENT!

The reason I asked about the size of the bottles is that big meals from a bottle often result in long intervals between feedings. And 4 oz is a big meal- average intake for a baby who is nursing at the breast is around 2-4 oz. So instead of thinking of the 2-3 hour period after a bottle as a normal length of time for a baby to go without eating, think of it as an unusually long interval that comes from baby being quite full. The shorter intervals between nursing sessions are normal, when seen through that lens.

[@llli*lllmeg]

I saw multiple LCs who all said our latch was "fine" and that my baby did not have tongue tie.

Were any of the appointments wiht an IBCLC and like this: http://cwgenna.com/lconsult.html

I just do not understand how you could have seen multiple professional LCs and no one assured you that such severe nipple injury & pain is NOT NORMAL. I find this frustrating. Even if they could not fix the issue, they should have recognized there WAS an issue. Did anyone talk to you about positioning ideas, such as laid back nursing, or latch on ideas such as breast sandwich latch? nipple care, bacterial infection, thrush...anything? have you researched these for yourself?

I hope the ent has answers for you. Please be aware that tongue tie knowledge and knowledge about tongue tie as it affects breastfeeding negatively are not always the same thing.

meanwhile, it is smart to keep your production up by pumping. Bottles can be given in this way which is considered more supportive of breastfeeding: -bottle feeding the breastfed baby
Information sheet: http://www.llli.org/docs/00000000000...astfedbaby.pdf Video: http://www.youtube.com/watch?v=UH4T70OSzGs (Don’t worry about what she says about time between feeds- typically, best to cue feed whether nursing or bottles.)

[@llli*flutey16]

@momma - thanks for the info re: bottles. I didn't realize 4oz is a lot! He just always seems so hungry!

@lilmeg - My appointments with the 2 LCs (4 appointments total) were not nearly as detailed as what's described in the link. Both watched me nurse him but I wasn't given much feedback other than that he has a good latch and was told how to bring his torso closer to me. I was taught the breast sandwich latch which did help get his mouth around the nipple. One LC I saw was at the hospital where I gave birth and she taught me the football hold but didn't go into much else. I was told I did not have thrush. I was given a Rx for APNO cream which I used pretty religiously the first month.

I spent a lot of time researching and have tried to do the laid back nursing and side nursing after watching some youtube videos...however I felt that my nipples were more sore after both these positions.

I hope the ENT has answers for us too!

[@llli*lllmeg]

Ok, when did you last see either LC- after the visible nipple injury and pain? And what was the explanation for the nipple injury and pain?
What position(s) do you like to use? If it helped, are you still doing the breast sandwich carefully?

I have lived through bad latch pain & injury and the related issues with two babies. It is often not an overnight fix, it can take time to improve. But in both cases the IBCLCs I saw gave me ideas that helped tremendously. So I am very sorry you did not have the same experience. I wonder if there is someone else locally for you to see. If the issue is tt and baby is treated of course that should help, but even then, you may need help getting baby latching well with the new tongue movement.

Did you find that APNO did not help? Is that why you stopped using it?

laid back is not one position. It just refers to mom being leaning back, even just slightly, and baby can be in any position. So you can have baby latched in whatever way and whatever position works for you and YOU relaxed back & supported. It is a much more comfortable position overall, generally, but it may take practice and of course if you have another position that is working well for you no need to change anything. I have links I like, let me know if you are interested.

did you ever consider or try nipple shields?

[@llli*flutey16]

I last saw the LC at about the 5th week mark - when there was still visible nipple injury from the first month of pure pain but it was on the way to getting better. The explanation I got from the LC was that my nipples were injured due to some former poor latches so it would take some time before I stopped feeling pain. I am still doing the breast sandwich and find that it is definitely helpful but not perfect. I mainly use the cradle hold and football hold. I find it easier to get a better latch with the cradle hold as I can see where my baby's mouth is going but find the football hold more comfortable.

I am in NYC and both LCs I saw were referred by my pediatrician. I would love any recommendations of LCs in the area if you have any.

The APNO did help a lot but I ran out (the amount I got from the pharmacist was very small) and it was so expensive the first time around as insurance didn't cover it that I haven't refilled the prescription.

Ah - I thought the laid back position was when the mother was reclined back/almost lying down and the baby was laying on the mother's torso and found the nipple. I would love to see the links.

I was told I had "great" nipples and that nipple shields wouldn't help so I never considered them.

[@llli*lllmeg]

If you are in NYC you are near at least one of the most respected IBCLCs in the country-Catherine Watson-Genna, who wrote the article about what to expect at a IBCLC appointment that I linked above, and literally wrote THE book on supporting sucking skills in breastfed infants. I think she lives and practices in Queens and her website has lots of good info, including on latch and tt. http://cwgenna.com/index.html

Also there are many LLL Groups in NYC. They may be able to give you names as well, plus of course an LLL Leader is a good resource for support and information in general. Look on home page of this site for the LLL Group lookup. And here is an IBCLC look-up: http://www.ilca.org/i4a/pages/index.cfm?pageid=3432

Many years ago pre-motherhood I lived in Brooklyn and also the East Village.