Why Do Some Babies Struggle With Feeding Even With a “Good Latch”?

Many people see breastfeeding as a natural process, but it may seem to be much more difficult than expected by many parents. When a baby appears to latch well but experiences feeding problems, a tongue-tie may be to blame. Parents often observe prolonged feeding time, popping off and on the breast, frustration (shaking the head) at the breast, or trouble transferring milk, leading to engorgement, plugged ducts, or mastitis despite seemingly appropriate breastfeeding methods.

In most of these situations, it is not merely a question of positioning. Moms work with skilled lactation consultants, and yet the problems persist. It’s important for moms to know the signs of tongue-tie in babies and how it can manifest despite a good latch. The reason for this is to help parents become aware of problems early and find appropriate support before losing the breastfeeding relationship.

What is a Good Latch vs a Bad Latch?

It is worth mentioning, before delving into other causes, that there is a difference between a good latch and a bad latch during breastfeeding.

A good latch would imply that the mouth of the baby occupies much of the areola, the lips are flared out, and the chin of the baby is touching the breast. The baby should have the entire nipple and most of the areola in his or her mouth, which would be a deep latch. If the baby is just on the nipple, they are “nipple feeding” and not “breastfeeding.” The baby ought to be able to draw milk without subjecting the mother to pain. It should not be painful to latch, even at the beginning. A little discomfort, maybe a 1 or 2 out of 10 pain initially, could be physiologic (normal for a time). But if it’s a 5/10, 7/10 (toe-curling), or a 10/10 pain, that is for sure not normal at any time! 

A bad or shallow latch usually leads to nipple pain, inefficient feeding, falling asleep at the breast, clicking noises, or frequent dropping off the breast. Infants who do not latch well may also take longer to feed, yet they may still seem hungry when they finish.

Signs of a Good Latch

Being able to identify the indicators of a good latch helps parents and caregivers determine whether feeding problems are due to latch issues or something else, such as tongue-tie.

The typical signs of an appropriate latch are:

• The baby’s mouth is open, and it covers over half of the areola.
• Rather than pulled or curled in, lips are turned out.
• The baby’s chin comes into contact with the breast, and the nose is clear to breathe.
• There is rhythmic sucking and swallowing.
• The mother experiences little or no pain during feeding.

Despite such positive signs, there is still the chance that babies cannot transfer milk effectively. When this occurs, the parents ought to consider other factors, such as oral restrictions and dysfunction, e.g., tongue-tie, lip-tie, or buccal-ties (cheek-ties).

The Hidden Factor: Tongue-Tie

A more common cause of feeding difficulty that is often neglected is tongue-tie, also known as ankyloglossia or a tongue restriction. This is an abnormality of the attachment between the tongue and the floor of the mouth (the frenulum), which is too tight, short, or thick. It does NOT have to be to the tip to cause issues. It can be minimally restrictive (maybe only 10-20% to the tip) but still cause massive issues latching. 

Due to the importance of tongue position and function in breastfeeding, restricted movement can certainly affect how a baby removes milk, even when the latch seems fine. Interestingly, a less obvious tongue-tie often causes MORE issues than a to the tip tongue tie in many babies. It’s an inverse relationship: a more obvious tongue-tie can cause just a few or no symptoms, while a barely-there tongue-tie can cause terrible pain with latching, falling asleep, poor milk transfer, gas, colic, and reflux. This is why it’s hard for pediatricians or other providers to make a proper diagnosis.

That is why it is crucial to be aware of the symptoms of tongue-tie in cases of feeding difficulties, even when a proper latch is observed. It’s hard to tell just by looking at the latch, or even just a quick check of the tongue. Instead, use two fingers under the tongue to elevate and challenge the tongue to see how restrictive it is. 

Evidence of Tongue-Tie in Infants

Newborn babies with feeding problems should be checked by parents and healthcare professionals for the presence of tongue-tie. It affects around 25% of babies and is extremely common. 

Common indicators include:

• Clicking or smacking noises when feeding
• Shallow latch, popping off and on the breast
• Prolonged or frequent feeding sessions
• Trouble bottle-feeding or taking a pacifier
• Colic, gas, reflux, or spitting up frequently
• Frustration or falling asleep at the breast in the middle of a feed.

Nipple pain, cracked, flattened, or blistered nipples, or frequent plugged ducts are also symptoms that some mothers might suffer.

These symptoms of tongue-tie are sometimes not very noticeable; this is why it is necessary to have them evaluated by a professional. Reach out to us if you have any of these symptoms, or take our Tongue-Tie Symptom Quiz. Even if a provider said there is “no tongue-tie” or at the hospital they said it’s a “mild” tongue-tie or would stretch out, if there are symptoms, it should be checked by someone who routinely treats tongue-ties (we treat around 30 tongue-tied patients a week). 

Why does breastfeeding still remain a challenge despite a good latch?

Although a baby demonstrates signs of a good latch, feeding problems may still occur for various reasons.

1. Limited Tongue Mobility

The tongue is required to move in a wave-like fashion in order to pull out milk from the breast. Milk transfer may be poor if a baby has limited tongue movement due to tongue-tie. Just the front half of the tongue can move, but the back is held down, like in a less obvious “posterior tongue-tie.” It would be like running with your shoelaces tied halfway. Even though they are not completely tied together tightly, it would still be hard if your shoelaces were tied together even a little bit. 

The infant can seem to be latching in the right way, yet still fail to suck and transfer effectively.

2. Fatigue During Feeding

Babies with oral restrictions work harder to obtain milk. If your shoelaces were tied together, you would have to work harder to walk. This can cause them to become fatigued very quickly, and they may refuse to take the full feeding, fall asleep, or have slow weight gain. 

This may cause frequent feeding (eating every hour or two), waking frequently at night or taking short naps, and frustration for both the parent and the baby. It can also lead to post-partum depression or post-partum anxiety for moms when babies don’t latch well and seem fussy all the time. 

3. Poor Milk Transfer

A baby may remain attached to the breast but not transfer enough milk. This can influence the baby’s weight gain (but not always), make the baby always seem hungry and never get full, or need to “cluster feed” frequently. This may also affect the milk supply because the mother’s body thinks the baby needs less milk since their suck is not effective. 

Role of a Tongue-Tie Release Provider

If the parents suspect an oral restriction related to feeding, a tongue-tie doctor, or tongue-tie release provider should be consulted.

The baby can be assessed by specialists, such as pediatric dentists, ENT doctors, neonatologists, or pediatricians with extra training and contemporary techniques (up to date) in evaluating tongue-tie and tongue mobility. You want to ensure they have completed recent continuing education, as this field is changing rapidly and new treatment techniques (laser vs. scissors), stretching protocols, and evaluation and diagnostic concepts are evolving (posterior tongue-tie, buccal ties, etc). A knowledgeable provider will be able to determine whether a tongue is restricted and prescribe the appropriate treatment.

With early diagnosis, it is possible to avoid ongoing feeding difficulties, promote healthier growth and development, support mother-infant bonding, and prevent later effects of tongue-tie on speech, eating, sleeping, and breathing.

Infant tongue-tie surgery

In some cases, when an infant has many symptoms of tongue-tie, doctors might advise a tongue-tie release or surgery. The most popular one is a simple surgery known as frenotomy or frenectomy.

This is a quick procedure in which the tight frenulum is released to ensure the tongue is more mobile and can do its important job. It is usually fast and is performed in a clinical environment, not an operating room. With our method, it’s around 15 seconds to treat a lip-tie, and a tongue-tie is typically just 5 to 10 seconds with a state-of-the-art CO2 laser. For infants, we use a sugar water solution, and older babies receive lidocaine numbing jelly. A baby should NOT be put to sleep under general anesthesia for this procedure due to additional unnecessary risks and the unknown effects of general anesthesia gases on the developing brain. 

Babies tend to have better feeding after treatment, but they can take a few weeks to re-learn the proper movements and muscle patterns. Many babies may also need assistance with feeding therapy, lactation support, and/or oral exercises to strengthen tongue movement and establish correct habits.

Helping Your Infant to Feed

Sometimes moms are overwhelmed with feeding their infants when it’s supposed to be so natural and seemingly easy to feed their newborn. Parents must remember it’s a journey and a process, and it can take some time. Other times, the baby pops on the breast and never has any issues (and those friends can’t seem to understand why it’s so hard for you and your baby!) 

If feeding problems persist despite the appearance of a good latch, it can be useful to consider oral dysfunction and limited tongue mobility. The awareness and familiarity of the symptoms of tongue-tie in babies and having an evaluation with a provider who regularly treats tongue-ties (not just once in a while, but several times daily) can save a lot of stress, heartache, milk supply, mental health, and mother-infant bond (as well as money on formula, bottles, and therapy in the future). 

With appropriate diagnosis, supportive care, and appropriate tongue-tie management, many babies will continue to breastfeed or bottle-feed comfortably without pain and thrive. 

If these symptoms and stories sound familiar, please reach out to our office to schedule a consultation at 205-419-4333 or send us a message, and we would be honored to help your family. 

FAQs

1. Is it possible for a baby to have a “good latch” and still have a tongue-tie?

Yes. A baby could exhibit the signs of a good latch and still fail to feed effectively in the case of limited tongue movement. In these situations, the baby could be continuously latched but unable to transfer milk, and that is why it is necessary to know the other symptoms of tongue-tie. If there are many symptoms in addition to poor milk transfer, then a tongue-tie is likely. 

2. When do parents require the services of a tongue-tie doctor?

Parents are advised to seek the care of a tongue-tie physician if their baby has a persistent feeding problem, prolonged feeding, failure to gain weight (should be an ounce a day), or any other symptoms that indicate that the newborn has a tongue-tie (gassy, fussy, colicky, reflux, spitting up excessively, hiccupping excessively, etc.). Early assessment can help identify the need for tongue-tie surgery in infants, and the sooner it is addressed and fixed, the better. Call our office at 205-419-4333 or send us a message and we would be honored to help your family.