Written by Alison Blenkinsop RM IBCLC
Frequent feeding, fussiness and slow weight gain.

Some babies seem super-glued to the breast at times, especially in the evenings, and have colicky behaviour. They may be getting lots of milk in volume, with lots of poos and wees, but not grow well. It’s common for people to assume that baby is hungry and needs more milk than mum can produce. But the reason could be that baby isn’t getting the full quota of milk fat. This can happen if the attachment to the breast isn’t complete,
so the breast drainage isn’t complete from all areas - so some fat may be left behind, and then gets reabsorbed before the next feed.

If there is any pain on feeding, and/or the nipple looks different before and after a feed, it’s likely that baby hasn’t got quite far enough into the breast tissue to keep the nipple comfortably at the back of the mouth. If there’s some pressure on the bony roof of the mouth, the nipple can looked squashed, pinched, wedged, or blistered. This can quickly lead to damage and excruciating pain. If the nipple is where it’s meant to be, well back at the soft part of the mouth, but there’s some tension or slippage of the nipple, it can come out looking pulled out, elongated or pointed. The reasons for incomplete attachment could be that baby isn’t close enough to the breast; isn’t approaching the breast chin first, with the nipple well above the tongue, so it’s long enough to go straight to the back of the
mouth; the breast is swollen from fluid retention or milk; baby’s tongue is pulled back by a tongue-tie; baby isn’t opening the mouth very wide because of tension or discomfort from the birth.

So baby is on the breast, reasonably well, and getting good quantities of milk. But if the attachment isn’t complete, and some of the fat is being left behind, baby will have to take in more milk to get the same amount of calories and feel full. It’s a bit like getting stuck on the soup course and never reaching the chocolate pudding. The tummy fills up, baby feels full, but isn’t yet satisfied, so he/she has a break - or dozes off but doesn’t let the breast go - and quickly wants more. Lots of milk, containing lots of milk sugar, but low in fat, rushes through the system, and the high sugar load creates lots of griping wind in the intestine. Baby can have explosive poos (sometimes greenish) and might get a sore bottom. As baby is uncomfy, he/she will want to do the most comforting thing - take the breast again!

If there is any sign that baby isn’t fully on the breast, then it’s well worth spending some time with an experienced person to improve the attachment, to get richer milk. This could be by finding a more comfy position for mum and baby; softening an overfull or swollen breast so baby can attach more deeply; undressing baby to increase skin contact and prevent overheating, making him/her more alert; getting a tongue-tie snipped; having cranial osteopathy to ensure any tensions are eased. Other things which will help to increase the fat in the milk are carrying baby around and offering the breast very frequently; increasing night feeds by being as close to baby as possible; encouraging baby to release the breast when he/she’s fallen asleep on it, and (if intake is generally good) finding
another way to soothe baby for a while before the next feed; getting lots of help over a couple of days so mum has the time, energy and space to do all the above!

When the attachment improves, feeds will nearly always become more comfortable for mum, easier for baby, shorter, although still frequent (which is good for baby, and not so hard for mum as they don’t last long!). Colic will improve, and breastfeeding will become what nature intended: completely comfortable and enjoyable.

Alison Blenkinsop
Midwife and International Board Certified Lactation Consultant