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Breastfeeding Positioning & Attachment


This checklist is useful when feeding or sucking difficulties are suspected with a young baby. It is difficult to assist a mother with positioning and attachment, without observing her breastfeed. But, the below checklist can be useful when it is not possible to see the mother and baby.

1. Mother's and baby's clothing adjusted, so there are no restrictions.

2. Mother positioned comfortably, well supported, neither leaning back nor hunched forward.

3. Whatever the position, the baby's whole body should he turned towards mother, supported behind shoulders, not head, which is free to tilt back slightly.

4. Baby's lower arm out of the way, around mothers waist or tucked at baby's side, body flexed around hers, chest and lips held in close, neck slightly extended

5. Baby's at same level as breast, which is supported by a roll of cloth if necessary.

6. While attaching, use thumb and index finger well back from areola to tilt the nipple towards the baby's nose, making the breast tissue below more accessible to latch on to.

7. Instead of centering the nipple, position the baby just short of the nipple. Aim to offer areola breast tissue, rather than the nipple itself.

8. A crying baby will have difficulty latching on because tongue will be up. Soothe, try again

9. Encourage wide gape, with tongue well down, by stroking lower lip with breast tissue rather than the nipple. Repeat until wide gape. Be patient, it may take time.

10. Bring baby onto the areola/breast tissue. Plant lower lip first, well down on areola, then roll baby on, aiming top lip just above nipple The lower jaw and tongue need breast tissue to work on, so the aim of attachment is to get more breast tissue against the tongue and not so much against the roof of the mouth If the areola is large, more should be visible above the top lip than below the lower lip

11. Check that the chin is well against the breast. This will also help leave the nose clear.

12. Baby should have mouth wide against the breast, not with pursed lips. Baby's lips should be flanged out, creating a seal, not rolled in.

13. Baby's tongue is over lower gum, and is sometimes visible, or can be checked by gently rolling down lower lip.

14. Fast 'sucking' rate (2+ per second), slowing (to about 1 per second) as milk volume per 'suck' increases after let-down, with occasional pauses, more irregular later in feed.

15. When baby is actively feeding, the jaws and even the whole head will move; frequent swallows should be observable.

16. Baby should stay attached, and not keep sliding on and off the nipple

17. Breast should not appear stretched or distorted. Position the baby so there is no 'drag' on the breast.

18. Baby's cheeks should not hollow with each 'suck', nor should there be loud tongue clicks. However, swallowing may be noisy.

19. If baby is taken off while actively feeding, the nipple will appear slightly elongated. Trauma is indicated by ridges, red stripes or blanched areas on the nipple.

20. Breastfeeding with good positioning and attachment should not be painful .

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