Attaching the baby to the breast correctly is the first and most important step towards successful breastfeeding. The vast majority of breastfeeding problems are caused by improper latch-on (the second leading cause of breastfeeding problems is feeding on a schedule instead of on demand). Here are some problems that incorrect latch-on may cause:

• Sore nipples. These result when the baby holds just the nipple in her or his mouth instead of opening up her or his mouth wide and taking in a good mouthful of breast tissue.
• The baby cannot milk the breast effectively unless she or he is latched on properly. The milk reservoirs are located behind the nipple under the areola. A baby who is sucking on just the nipple cannot compress the milk reservoirs to get the milk out. This may lead to:
  • Engorgement. Your milk comes in and the baby can't remove it from the breast. Your breasts can become engorged.
  • Mastitis. Engorgement that is left untreated can lead to plugged milk ducts and mastitis. The treatment for engorgement is emptying the breast. If your baby does not latch on correctly, she or he cannot empty the breast.
  • Poor weight gain. If your baby does not latch on correctly, she or he does not get enough milk. Furthermore, most of the milk she or he gets will be the thin foremilk. Your baby may fail to thrive.
  • Insufficient milk. Your breasts make more milk as they are emptied. Milk left in the breast tells your body to slow down milk production. If your baby is not latching on properly, you may lose your milk supply.

OK, so it's really important to latch the baby on properly. Fortunately, it's not very hard (although it takes practice; it might take anywhere from a few days to two months for your baby to become a pro at this). Here are a few things to pay attention to:

• Take full advantage of your baby's rooting reflex.
  • The rooting reflex has two parts: turning and opening the mouth.
    1. When you touch your baby's cheek or lip lightly, she or he will turn her or his head towards the touching object.
    2. She or he will also open her or his mouth really wide, as in a big yawn.
    3. Soon, your baby will learn that your breasts are her or his source of comfort and nourishment, and she or he will turn her or his head from side to side and open her or his mouth whenever she or he wants to nurse.
  • If your baby is already facing your nipple, you can just tickle her or his lip with your nipple until she or he opens up really wide.
  • If the baby is facing away from the breast, tickle her or his cheek with your nipple When she or he turns toward your breast, tickle the lip with your nipple.
  • Make sure you continue tickling until your baby opens up really wide. Don't try to attach a baby whose mouth is only slightly open, or you might have sore nipples and all the other problems associated with improper latch-on.
  • A very common mistake is to try to push and turn a baby's head towards your breast. The rooting reflex makes the baby want to turn towards the pushing object. Many people interpret this to mean that the baby is turning away from the breast. They say the baby "rejects" the breast, and resort to artificial feeding. Don't fall into this trap! Just tickle the baby's cheek with your nipple, and she or he will turn towards the breast.
  • When the baby opens up really wide, pull him towards your breast all the way to your chest. It's important to pull the baby close to make sure she or he gets a good mouthful of breast instead of just the nipple.
• When a baby is correctly latched on:
  • Her or his lips should be flanged out, not sucked in. You should be able to see the inner surfaces of the lips on your breast.
  • Her or his tongue should be covering the lower gum. You can see this by pulling the lower lip slightly out.
  • Her or his cheeks should not be dimpled. Dimpled cheeks during sucking indicate poor latch-on and suction.
  • Her or his nose should be touching your breast. If the baby's nose is away from your breast, she or he is sucking on just the nipple. You'll have sore nipples, and the baby won't get enough milk.
• You might wonder whether you should hold your breast with one hand while you are breastfeeding.
  • You can hold your breast to make it easier for the baby to latch on.
  • If you do, make sure your thumb and fingers are well behind the areola.
  • Many people do a good job of keeping the thumb way back, but they put their fingers too close to the areola, just behind the nipple. Avoid this! Your baby needs to take in as much breast tissue as she or he can comfortably fit into her or his mouth. If your hand is too close to the nipple, the baby will just take the nipple in. You'll get sore nipples.
  • Avoid the "scissor hold" in which you hold your breast between your index finger and ring finger. This style of holding the breast very often causes the baby to latch on to the nipple instead of to the breast.
  • Use the "C" or "U" hold, where you form a C or U shape with your thumb and fingers (as if you are holding a water glass). Hold your breast so that its compressed shape is in line with the baby's open mouth (remember, you are doing this to make it easy for the baby to take in as much of the breast tissue as possible).
  • You can also hold and lift your breast to bring it to the level of the baby's mouth. This is useful for mothers with large soft breasts.
  • You don't need to worry about pulling the breast back from the baby's nose to let the baby breathe. Babies' faces are made for nursing. They can breathe with no problems with their faces smushed right into your breast. Pulling the breast away from the baby can lead to improper latch-on and sore nipples.
  • If you have flat or inverted nipples that stand out when you squeeze the areola, hold your breast so your nipple protrudes until your baby is latched on.
  • Once the baby is latched on and nursing, you can usually let go of the breast.
  • If your baby is able to latch on correctly without your holding your breast, you don't need to hold it. Women with smaller breasts are more likely to be able to nurse a young baby without holding the breast. As your baby grows, you'll probably find that you won't need to hold your breast, no matter how large or soft it may be.
• If your baby is not latched on correctly, remove her or him from the breast and try again. You should keep trying until the baby gets it right, even if you have to try twenty times. Pretty soon, your baby will learn to latch on properly, and will be able to do it without any help.

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