Newborn Not Latching
The short answer
Difficulty latching is one of the most common breastfeeding challenges for new parents and newborns. Many factors can contribute, including the baby's positioning, tongue tie, flat or inverted nipples, engorgement, or the baby being sleepy or overstimulated. Most latching problems can be resolved with proper support from a lactation consultant. In the meantime, expressing colostrum or milk by hand or pump ensures the baby receives adequate nutrition.
By Age
What to expect by age
In the first hours after birth, skin-to-skin contact is the most powerful tool to encourage latching. Many babies will instinctively crawl toward the breast and self-attach (the "breast crawl") when placed skin-to-skin. Some babies, especially those born by cesarean, after a medicated labor, or slightly premature, may be sleepy and less interested in feeding. Colostrum is produced in very small amounts (teaspoons) but is rich in antibodies and perfectly sufficient. If the baby is not latching, hand-express colostrum into a spoon or syringe and feed it to the baby. Request a lactation consultant before discharge.
Persistent difficulty latching during the first few days can be related to positioning (try different holds such as cross-cradle, football, or laid-back breastfeeding), engorgement as milk begins to come in (making the breast too firm for the baby to grasp), tongue tie (a tight frenulum restricting tongue movement), or flat/inverted nipples. A nipple shield may be recommended temporarily by a lactation consultant. It is critical to continue removing milk by pumping or hand expression at least 8-12 times per day to establish supply. Monitor wet and dirty diapers to ensure the baby is getting enough.
By now, your milk should be transitioning from colostrum to mature milk. If latching is still not happening, continue pumping every 2-3 hours and feeding expressed milk by bottle, cup, or syringe. A formal evaluation by a lactation consultant (IBCLC) is strongly recommended. They can assess for oral anatomy issues (tongue tie, lip tie, high palate), evaluate your baby's suck pattern, and create a personalized feeding plan. Many babies who do not latch in the first week go on to breastfeed successfully with proper support.
If tongue tie was identified, a frenotomy (minor procedure to release the tie) may significantly improve latching. After treatment, tongue exercises and practice at the breast are important. If the baby has been exclusively bottle-fed, transitioning back to the breast can take time and patience. Try offering the breast when the baby is calm and not frantically hungry. Paced bottle feeding can help prevent a strong bottle preference from developing. Some babies who would not latch initially begin latching well around 3-4 weeks as they grow and their mouth gets larger.
What Should You Do?
When to take action
- Your newborn is learning to latch and is successfully feeding with some positioning adjustments and assistance
- Your baby latches well sometimes but struggles at other times, particularly when very hungry or sleepy
- You are supplementing with expressed breast milk while working on latching with a lactation consultant
- Your baby initially had difficulty but is now latching and breastfeeding successfully after tongue tie treatment or other intervention
- Your baby has not latched at all within the first 24 hours and you have not yet seen a lactation consultant
- You suspect tongue tie because the baby's tongue appears heart-shaped when extended or does not extend past the lower gum
- You are struggling emotionally with breastfeeding difficulties and need support or guidance on your options
- Your baby is not feeding at all (by breast, bottle, cup, or syringe), is producing fewer wet diapers than expected, or shows signs of dehydration (dry mouth, sunken fontanelle, no tears, lethargy), as newborns need to feed frequently to maintain blood sugar and hydration
- Your baby has lost more than 10% of birth weight, is excessively sleepy and difficult to wake for feeds, or has developed a yellowish skin color (jaundice), as these signs require urgent medical evaluation
Sources
Related Resources
Related Feeding Concerns
When to Introduce Allergens to Baby
Current guidelines recommend introducing common allergens (peanut, egg, cow's milk products, tree nuts, wheat, soy, fish, shellfish, sesame) starting around 4-6 months when your baby is developmentally ready for solids. The landmark LEAP study showed that early introduction of peanuts (by 4-6 months) reduced peanut allergy risk by 80% in high-risk infants. Do not delay allergens - the old advice to wait until 1-3 years has been reversed because early exposure actually prevents allergies.
I'm Worried My Baby Is Aspirating During Feeds
Aspiration means liquid or food enters the airway instead of the stomach. Occasional coughing during feeds is common and does not usually indicate aspiration. True aspiration is less common and may present as recurrent respiratory infections, a wet or gurgly voice after feeds, or chronic cough. If you are concerned, a swallow study can provide a definitive answer.
Baby Biting Nipple While Nursing
Biting during breastfeeding is a common challenge, especially when babies start teething. It can be startling and painful, but it is almost always a phase that can be managed. Babies cannot actively nurse and bite at the same time because their tongue covers the lower teeth during proper sucking. Biting typically happens at the beginning or end of a feed when the latch is not active. With some gentle strategies, most babies learn quickly that biting ends the feeding session.
My Baby Keeps Choking on Food
First, it's important to distinguish between gagging and choking. Gagging is a normal protective reflex that helps babies learn to eat, while true choking is silent and requires immediate intervention. Most "choking" episodes parents describe are actually gagging, which is common and expected as babies explore new textures. However, if your baby frequently struggles with swallowing or shows signs of true choking, it's worth discussing with your pediatrician.
Baby Choking or Coughing on Milk or Liquids
It is common for babies to occasionally cough, sputter, or have milk come out of their nose during feeding, especially in the early weeks. This usually happens because of a fast milk flow (letdown), an immature swallowing coordination, or feeding in a position that is too reclined. Occasional choking episodes during feeding that resolve quickly are usually not serious. Adjusting feeding position, pacing the feed, and using a slower-flow nipple can help.
Baby Choking vs Gagging - How to Tell the Difference
Gagging is a normal protective reflex that pushes food away from the airway - your baby will cough, sputter, or make retching sounds and will usually be red in the face. Choking is when the airway is partially or fully blocked - your baby may be silent, unable to cry or cough, and may turn blue. Gagging is noisy and resolves on its own. Choking is often silent and requires immediate action. If your baby cannot breathe, cry, or cough, begin infant back blows and chest thrusts immediately.