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Thread: 5 week old - won't open wide enough for a deep latch

  1. #1

    Default 5 week old - won't open wide enough for a deep latch

    Hi all,

    I would appreciate any advice on this as I feel like I've exhausted all options.

    My daughter turned 5 weeks old yesterday and I'm still struggling with her inability to open wide enough for a deep latch. In fact, the only time I've seen her open wide is when either crying or yawning. She's never opened wide in response to any specific positioning or placing/dragging of nipple anywhere on her mouth or nose. This is frustrating because all the literature and advice says "wait for baby to open wide" to flip the nipple in. Except she never does the gape. Holding the nipple to her lip either results in a tiny pursed mouth or ignoring the breast or wailing.

    The only time I get anywhere close to a deep latch is if she wails and I manage to shove in the nipple sandwich/flipple, aiming for the roof of her mouth for the asymmetric latch. Even then, she clamps down so quickly and eventually slides back to just having the nipple tip in her mouth. She will suck and swallow but the result is lipstick nip, pain, line across nipple, cracks. It seems the best I can do is the sandwich to get the nipple in, hold her super close and tight to try to prevent her sliding back and then doing compressions directly into her mouth the whole feed. I've done weighted feeds and she does get 4-5 oz this way if I manage to get her to take both breasts. 2-3 oz if I can only get her to take one side.

    I've seen 3 pediatricians who've confirmed no tongue or lip ties and 3 IBCLCs who also inspected her mouth for ties. The IBCLCs gave all the standard advice about positioning, sandwich, flipple and in the end their advice was to just "keep trying to get her to latch deeply". Which is what I've been doing every time anyway.

    She will go on the nipple shield readily. My nipples are of the "puffy" type and I never understood them to be that big or unmanageable until now. They'll only just about squeeze into the medela large shield. The IBCLC at the hospital had to search hard to find a large size shield for me. Other than that she said I had a perfect nipple shape for breastfeeding.

    My goals are in order:
    1. keep her fed, healthy, and growing
    2. keep her fed with my breastmilk (protect the nipples)
    3. keep per fed with my breastmilk directly from breast feeding


    More background: She was born at 37 weeks and spent 3 days in the NICU for antibiotics and jaundice. My waters were broken for 24 hours and despite being 10cm dilated, she would not descend, I developed a fever, so was given a c-section. In the NICU she was bottle fed formula by the nurses. I did not get to hold her or breastfeed her until 12 hours after she was born. I did however, pump copiously and produced enough colostrum to mix into the formula, gradually getting up to 30 mls per pump by the time we were discharged on her 5th day. Since being home she has been bottle fed my breastmilk and I have been trying to get her to latch on a daily basis, trying all the different positions, cradle, cross cradle, football, laid back, side lying.

    Appreciate any advice and thank you and advance!

  2. #2
    Join Date
    Jun 2009
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    10,754

    Default Re: 5 week old - won't open wide enough for a deep latch

    I am confused. So even at this point, baby is being supplemented almost exclusively? It would help to understand how often (how many times a day) baby nurses and how much she is getting in supplements of your expressed milk and/or formula. If your baby continues to be almost exclusively bottle fed after you have seen 3 IBCLCs I have to wonder why they are not identifying the issue better for you and helping you get baby nursing. Are your appointments like this?: http://www.cwgenna.com/lconsult.html
    I've done weighted feeds and she does get 4-5 oz this way if I manage to get her to take both breasts. 2-3 oz if I can only get her to take one side.
    !!! That is intake that indicates a large feeding-much larger than the norm of 1-4 ounces at this age... I wonder if baby is clamping in order to slow a fast milk flow? That might explain the pain and lipstick nipple.

    She will suck and swallow but the result is lipstick nip, pain, line across nipple, cracks. It seems the best I can do is the sandwich to get the nipple in, hold her super close and tight to try to prevent her sliding back and then doing compressions directly into her mouth the whole feed.
    What kind of positioning and latch techniques have you tried? This article has an excellent overview: http://feedthebabyllc.com/latch-and-positioning/

    As far as all the literature saying baby should gape, some babies just do not do that. In fact more recent breastfeeding literature barely mentions "gape." The understanding now is that babies latch and nurse comfortably a wide variety of ways and the stress is on laid back positioning or "Natural Breastfeeding" positions as explained my Nancy Morhbacher in a series of videos. As long as baby is getting enough to eat at the breast and nursing is comfortable for mom, it does not matter how baby latches and nurses.

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