Improper Latch

After enjoying delightfully successful breastfeeding relationships with my first two children, I am having an issue with my third. He is 13-months old-and has four teeth on top. While he never noticeably bites me during breastfeeding, I have to assume that his teeth are pressing or gouging into my flesh. I have developed wounds on both sides in the spots where his two top teeth touch me when we nurse in our usual cradle position, and sore, red spots from nursing in other positions. His teeth are hitting a millimeter out from where my nipple meets the areola. I thought babies were supposed to be getting more areola in their mouths than that. What should I do? Has my son suddenly developed an improper latch, and is he too old to retrain (he sure can get bossy!)? For now, breastfeeding is excruciating, and I don’t know what to do. My doctor, of course, can’t imagine why I’m breastfeeding my 13-month-old anyway, and recommends that I stop. I DEFINITELY don’t plan on stopping, but what can I do about these wounds and the terrible pain?

I’m sorry you are in so much pain! And, I’m sorry your doctor has been less than helpful. A 13-month-old is not at all too old to be breastfed. In fact, the American Academy of Pediatrics recommends at least one year of breastfeeding and the World Health Organization recommends at least two years. A nursling’s latch remains important throughout the duration of breastfeeding. And, yes, sometimes latch problems can develop well into the breastfeeding relationship. When teeth put pressure too close to the nipple, it can result in exactly the symptoms you are describing. A deeper latch should help your wounds heal and prevent new wounds from forming. There are several aspects of a good latch that you might be able to improve. First, nurslings tend to get attached better to the breast when they attach themselves. Second, being skin-to-skin with your baby can help trigger breastfeeding reflexes that facilitate comfortable breastfeeding. That said, as babies get older, they can turn into little gymnasts at the breast and even an initially good latch can deteriorate during a feeding—especially when a nursling falls asleep. So, you still may need to watch for how your baby is latching on and encourage behaviors that contribute to more comfortable breastfeeding. For example, what part of your son’s face is aimed at your nipple just before latching? It should be his nose, which will mean that he needs to tip his head back a little and open wide in order to latch on. You can also model a wide latch by saying ?wide? and opening your own mouth wide as he latches on. What part of your son’s face meets the breast first as your son is about to latch on? It should be his chin. Does your nipple show signs of compression just after nursing? If it has a somewhat angled appearance—like a new tube of lipstick—or if there is a white or red compression stripe across the tip of your nipple, then the latch was too shallow during that feeding and your nipple was compressed between your son’s hard palate and tongue. Better support of the arm that holds your nursling’s weight during breastfeeding can help keep your son more deeply on your breast. You can experiment with one or more pillows under your arm or a rolled up towel behind your son’s back if you are nursing in a side-lying position. Encourage your son to nurse in a position that avoids turning his head in relation to his chest. Varying your breastfeeding position—as you’ve been doing—is an excellent idea while you try to figure out how to help your son latch on more deeply. Pay special attention to when his latch seems better and when you are in less pain—what is different? In what position were you breastfeeding? How did he attach to your breast? Was he awake or asleep? Try to do more of whatever seems to be working better! Also, broken skin is at risk for bacterial infection as well as yeast overgrowth (thrush). If you don’t have thrush, a little expressed milk can help your wounds heal. You can consider consulting a local International Board Certified Lactation Consultant. She can observe a breastfeeding session, offer suggestions, and direct you toward a physician who is more knowledgeable about and in support of breastfeeding—and who can help you assess whether you may have acquired a bacterial and/or fungal infection that needs treatment. The mothers of nursing toddlers in your local breastfeeding support group may have additional ideas for how to regain a comfortable breastfeeding relationship with your son. Best wishes!

Mothering Your Nursing Toddler by Norma Jane Bumgarner

The Latch and Other Keys to Breastfeeding Success by Jack Newman, MD

Baby-Led Breastfeeding: The Mother-Baby Dance by Christina Smillie, MD (DVD)

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