Sometimes infants do not latch-on to the breast right after birth, and other times they will have a few good nursing sessions the first day and then not latch-on again before leaving the hospital. There are several reasons why this might happen. The following are fairly common:

• The infant is sleepy and/or premature, and does not sense the breast tissue in his mouth.
• For whatever reason(s), the infant received bottles right after birth.
• The milk supply is low in the hospital, and the infant is frustrated and too impatient to sustain nursing.
• The infant has a tongue-tie or other physical or motor issue, such as torticollis or pain.
• The breast is very difficult to grasp either for maternal or infant reasons.

If a newborn is unable or unwilling to latch, mother can hand express colostrum into a spoon and offer it every 1-3 hours until infant latches or her milk “comes in.” Hand expression is ideal for the small volumes of sticky, thick colostrum. Once her breasts are increasing milk production, a breast pump is typically more effective, especially combined with manual expression.

If the infant is not latching by discharge, evaluation by a lactation specialist is important to sort out the underlying reason. The family will need a feeding plan at the time of discharge, along with coordination of care for follow-up as outpatients.