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Thread: Low supply due to weak suck/shallow latch

  1. #1

    Default Low supply due to weak suck/shallow latch

    I'll try to start from the beginning! Breastfeeding was going great up until 2 months. Baby started being fussy at the breast. Saw a LC who saw a posterior tongue tie. The fussiness was probably due to my low supply, due to her inefficient transfer. I started pumping and supplementing. At her 2 mo appt the next week she had dropped from 50% to 9%. Frankly the pediatrician scared me, so I started some formula. I realize now that was a slippery slope, but that ship has sailed. She is about 1/2 breastmilk 1/2 formula at this time. Finally got tongue tie revised last week after the run-around from a pedi dentist about her high palate. We saw a chiropractor twice, but I ended up doing the revision with an ENT. Prior to the revision, her latch was sloppy. Not very wide, and she would get milk all over her chin somehow. She would get tired (quivering lower lip) after just a few minutes. Luckily breastfeeding was never painful. After the revision, that day and the next, I thought we were good! But it seems she has reverted to old ways. There is no reattachment. I don't know if she has a weak suck, not wide enough latch, or if this high palate business is truly a problem, or some combination.

    Our routine is this: I feed for about 20 minutes on the breast (left breast just for a few, it is very flacid and not a big producer) then bottle feed 2 oz formula. I try to pump after each session, but don't always, producing about 1.5 oz total. According to weighted feeds she transfers about 2 oz from the breast in a typical session. What I pump during the day I save for overnight feeds, so I don't have to get up to prepare formula. I also pump my right breast during the night while she feeds from the left, giving bottled breastmilk after.

    My goal, obviously, is to nix the formula. (Perhaps except for one bottle in the afternoon/evening for my husband, unless I get to the point where I can easily pump 3/4 oz at one time). I am taking shatavari, goats rue, moringa, prenatals, eating oatmeal and drinking a lot (of water, ha). I have ordered domperidone, waiting on its arrival. She has a cranio-sacral appt next week.

    My main question regards her suck/transfer. Even when she appears fatigued at the breast, she still easily downs a 2oz bottle of formula. I know it's a different sucking action, but is she just too used to a bottle? Should I try the lact-aid? Would that help her suck/latch, or just reinforce bad habits, as the milk is still being "handed to her"? I feel like we're at a standstill. Not a very sustainable one, as the feeding/pumping takes up too much of our precious time! I hope I can up my supply with domperidone, but what is the point if she can't transfer? Or will she get better when my supply is up & milk more free flowing?

    Thank you to whoever has the stamina to read this!!

  2. #2

    Default Re: Low supply due to weak suck/shallow latch

    I forgot to add, she is now 13 weeks. Has been gaining an ounce a day on our current program.

  3. #3
    Join Date
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    Default Re: Low supply due to weak suck/shallow latch

    So baby is currently transferring about 2 ounces, mostly from one breast, in 20 minutes? That sounds like ok transfer. How many times a day does baby nurse and how many times does baby get the 2 ounces in the bottle? What I am wondering is it you could start doing some "only nursing" sessions (no supplementing, no pumping) that could be perhaps a little longer as a step toward your goal?

    What makes you say baby is 'fatigued" at the breast? Also I am not aware that a quivering lower lip means a baby is tired...maybe I am thinking about something else but I recall my babies doing that. I assumed it was a way to get the milk to flow more. Like a 'lip kneading" action.

    I know it's a different sucking action, but is she just too used to a bottle?
    yes, quite possibly.

    Should I try the lact-aid? Would that help her suck/latch, or just reinforce bad habits, as the milk is still being "handed to her"?
    A lactation aid used properly should not be like milk is being 'handed" to baby. But not all moms love dealing with a lactation aid, and there is a learning curve. On the other hand, they can be helpful for time management. See this article: http://cwgenna.com/smartnothard.html

    I hope I can up my supply with domperidone, but what is the point if she can't transfer? Or will she get better when my supply is up & milk more free flowing?
    I am not convinced the problem is low production. But it probably would help baby get more milk more quickly from the breast if your production increased. That is just the way it works even when there are transfer issues.

    Also, I think your baby has proved she can transfer milk. 2 ounces is not bad transfer. It is normal transfer. 2 ounces is a normal sized meal which is why many babies have to nurse 12 or more times a day. Yes I get it, by this age many babies transfer a little more than that at some sessions, but your baby has had some issues and is also being supplemented, so how much of the true story the transfer # is telling is unclear. What if baby nursed for 30 minutes or longer? Nursed both sides more? In other words, two ounces transfer is something that can be built on.

    How about breast compressions? Any success with those?

    I feed for about 20 minutes on the breast (left breast just for a few, it is very flacid and not a big producer)
    So, is baby refusing to nurse on that side or are you thinking you want to keep baby on the higher producing side more? Just some thoughts about that... It is normal for one side to produce less milk, and also, at this age, it is normal for even a normally producing breast to no longer feel full. Also, if this breast is producing less, having baby nurse from it more (as well as pumping that side more) will help increase production on that side.


    I suggest the book Making More Milk, and also kellymom.com articles on increasing milk production and weaning off formula supplements.

  4. #4

    Default Re: Low supply due to weak suck/shallow latch

    Thank you! I'll try to answer in an organized fashion, but no promises. So I guess I can't bring myself to believe she transfers 2 oz always. And the 20 minute thing is self-imposed by her. And I feel like it's getting shorter. She only nurses vigorously for 1-2 minutes each side then it's a lot of popping off, turning her head until my nipple falls out, frustrated sounds. When I squeeze my nipple, I express either fat drops or at least one thin stream, so I know there's still milk there. It must be too slow for her liking though. And yes, the only thing keeping her on for that time is breast compressions! Thank goodness for them. So, while 2 oz is decent, if she gets that, she is still hungry, putting her hands to her face. When she does seem content, I don't give a bottle, but it's not every time.

    The lip-quiver as fatigue I heard from an LC, so I don't know. It happens during the latch on, pop off periods.

    As far as my left breast is concerned, I don't know, it's just so saggy! She can't seem to get a good latch or hold on as well. Only happened after a case of plugged duct/engorgement around 10 weeks. It seems to produce less, but yes, I agree, I need to give it equal treatment.

    So, basically, I need to get her used to my flow, and off the bottles! I'm sure it's possible, just a long road. Is the lact-aid the best way? Or just keep nursing, and only offer the formula supplement when she seems to still be hungry and won't be satisfied with nursing? Is there any suck training I can do? I feel like her suck is strong, but maybe the mechanics are off, plus she doesn't open her mouth wide enough. When she was little I could push her chin down to open her mouth, but she won't let me anymore.

    Thanks for all your advice. I know our situation is not hopeless. Just frustrating sometimes. I hate it most when I don't have enough milk at the moment to nurse her to sleep. We'll keep working at it! I just started domperidone yesterday so we'll see how that goes.

  5. #5
    Join Date
    Jun 2009
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    10,695

    Default Re: Low supply due to weak suck/shallow latch

    I don't understand if she is still hungry why she stops the nursing session after 20 minutes. When was the last time you met with an LC for a complete consult? I just wonder if something is getting missed.

    Have you tried offering her a little supplement before nursing? This allows baby to finish at the breast but still be supplemented and this may help baby be happier comfort nursing/nursing longer/nursing to sleep like would happen typically if she is not thinking about getting a bottle.

    I am pretty sure lip or chin quivering is just normal, if that is still happening. A healthy normally gaining baby would probably not be getting fatigued by nursing. Babies, even newborns, nurse for hours, they nurse in their sleep, etc. it is just not a fatiguing thing to do. Of course if a baby is not taking in enough calories overall, then everything would be fatiguing.

    Is the lact-aid the best way? Or just keep nursing, and only offer the formula supplement when she seems to still be hungry and won't be satisfied with nursing? Is there any suck training I can do? I feel like her suck is strong, but maybe the mechanics are off, plus she doesn't open her mouth wide enough.
    I am afraid these are not questions I am equipped to answer. Many moms find a lactation aid helpful but others are frustrated by it. It is just too individual a situation.
    When you say she does not open her mouth wide enough, what do you mean? Does nursing hurt?

    If you cannot see an IBCLC again, there is a book written for IBCLCs written by Catherine Watson Genna ( I linked her article on lactation aids above) called supporting sucking skills in breastfed babies (or something like that) and if you wanted you could buy it and see if it has any ideas for you. But again this is not written for the lay person but for professionals, I have never read it and have no idea how straightforward it is. I think she has info on her website on tongue tie as well. http://cwgenna.com/publications.html
    Last edited by @llli*maddieb; June 12th, 2017 at 08:36 PM.

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