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Latch

Breastfeeding information about Latch - Anoka County Public Health
by

Melissa Schraut

on 18 June 2013

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Transcript of Latch

Baby will get all of the milk and nutrients needed

Mom will not experience pain, irritation and infection
Application of the LATCH
Outline
Latch
Importance of a Good Latch
Importance of the LATCH assessment tool
Importance of a good latch
Breastfeeding positioning
Anatomy of a good latch
Methods for obtaining a latch
Identifying a successful latch
Assessing breastfeeding with the LATCH tool
Breastfeeding with a cleft palate
Breastfeeding multiples
The LATCH assessment allows nurses to:
Assess key components of breastfeeding
Evaluate maternal and infant variables
Define areas of needed intervention
Determine priorities in education and patient care

We will now examine each component of the LATCH to:

Determine the purpose of each component
Identify how to score each component
L: Latch
The infant’s ability to latch is essential to successful breastfeeding

In order to accurately assess breastfeeding, the nurse must identify key components of a successful latch

Purpose of the Latch Component
Scoring the Latch component
Score: 2
Infants gum line is placed well over the mother’s lactiferous sinuses
Tongue is positioned under areola
Both lips are flanged outward
Jaw movement is visible at the temple area
Rhythmic sucking bursts of 6-7 compressions every 10 seconds

Score: 1
Repeated failed attempts to obtained a successful latch
Staff holds nipple in infant’s mouth
Infant has to be repeatedly stimulated to suck
Infant is unable to compress the lactiferous sinuses

Score: 0
Infant is too sleepy or reluctant to nurse
No latch achieved

A: Audible Swallowing
Purpose of the Audible Swallowing component

Swallowing should be assessed to ensure milk intake and to reinforce the mother that the infant is receiving milk

Swallowing at the breast is an indicator of milk intake
Score: 2
Swallowing is heard as a short, forceful expiration of air.
<24 hours old swallowing is spontaneous and intermittent
>24 hours old frequency of swallowing increases and becomes more rhythmically

Score: 1
Swallowing is heard infrequently
Or swallowing only occurs with stimulation

Score: 0
No swallowing heard

T: Type of nipple
Purpose of the type of nipple component
The shape, size, and texture of nipple affects the infant’s ability to latch.

The nipple type is an indicator of the amount and kind of intervention required.


Scoring the Audible Swallowing Component
Scoring of the Type of Nipple Component
Score: 2
Everted nipple that projects outward at rest of after stimulation
No intervention needed

Score: 1
Nipple projects forward minimally

Score: 0
Nipple is inverted

C: Comfort (Breast/Nipple)
Purpose of the Comfort Component
Comfort of the mother is an important factor influencing continuation of breastfeeding.
Comfort may also indicate whether the infant is properly latching.

Pain in the breast and nipple can also negatively affect let down of milk.

Scoring the Comfort Component
Score: 0
Breast are engorged, firm, tender with nonelastic tissue
Nipples are cracked, bleeding, reddened, or have large blisters or bruises

Score: 1
Decreased breast tissue elasticity
Reddened nipples
Small blisters
Mother indicates mild to moderate pain while breastfeeding

Score: 2
Breast tissue is soft and elastic
Nipples have no visible signs of redness, bruising, blistering, bleeding, or crackling
Mother states that she is comfortable while breastfeeding

H: Hold (Positioning)
Purpose of the Hold component
Assessing hold (breastfeeding positioning) is an important indicator of the mother’s need for further education or referral.

The assessment also documents the level of assistance needed.

Scoring the Hold Component
Score:0
Mother needs full assistance to position and attach during entire feeding

Score: 1
Mother needs assistance with positioning and attachment of the infant on the first breast, but independent with latch-on of the second breast

Score: 2
The mother is independently able to successfully position the infant at the breast
No assistance needed

Implications of the LATCH
The total composite score helps the nurse identify if interventions are needed
Individual scores determine the need for specific interventions
It is normal for LATCH scores to vary from one feeding to the next
Nurses need to look at previous scores to determine overall need for intervention

The LATCH Assessment
The LATCH assessment was developed to:
Define key components of an effective breastfeeding session
Clearly state the nature of a problem if one existed
Document staff-observed assessments and mother-reported description of individual breastfeeding sessions.
Anatomy of a Good Latch
Identifying a Good Latch
With a good latch:
The anatomy of the mouth dictates how good the latch will be and if there will be discomfort
Use your own tongue in our mouth to feel the hard palate
Move your tongue back until you feel the soft palate
The start of the soft palate is the "comfort zone" where the nipple end should rest
Finding the nipple tip "comfort zone"
Methods for Obtaining Latch: Parent-Led
This is the most commonly seen method
Align the baby's nose with the mother's nipple
Let the baby drop his/her head back to allow the chin to touch the breast first
If the baby's mouth does not open, stimulate the baby's rooting reflex to open the mouth wide
To stimulate the rooting reflex - use the nipple to stroke vertically down on the baby's bottom lip
Quickly and gently bring the baby to the breast before the baby's mouth closes

** This method can be very frustrating to mothers who may not be quick enough, or if the
baby does not open wide enough
Methods for Obtaining Latch
Nipple Placement
Shallow Latch
Good Latch
Examine the difference between the two latches:
Nipple tip
Shallow latch tip ends in hard palate, can cause:
Pain
Skin irritation
Low milk flow
Good latch tip ends past the hard palate so it does not rub on the hard palate and become irritated
Nipple shape
Review of Anatomy and Baby-led Latching
Method for Obtaining Latch: Baby - Led
Methods for Obtaining Latch
There are two main methods used to obtain a latch

The mother-led latch has been the most common in the US

The baby-led method is now becoming more popular

***It is important that the mother try many different methods to find the best for her and her baby, THERE IS NOT RIGHT OR WRONG METHOD

This presentation will provide you with information about each method to ensure you are prepared to help the mom find the best method for her and her baby
REMEMBER: THERE IS NO RIGHT OR WRONG METHOD, the goal is to find the best method for the mother and baby
Baby should be doing the majority of the work and the mom can gently guide

Start with the nipple under the baby's nose, not at the mouth

The chin should touch the breast first - this is called asymmetric latch

Allow the baby to reach for the breast and position his/her head and mouth

Mom will need to assist by position the baby's body

What a good latch looks like...
Cheeks
Sunken Cheeks - what you do NOT want to see
Full cheeks - what you want to see
Lips and Areola coverage
Both lips should be completely flanged against breast

Chin should touch breast

A majority of the areola should be covered by the baby's mouth
A good latch should include:
Nipple that is fully in baby's mouth
Baby's chin that is touching the breast
Baby's lips that are completely flanged against breast
Baby's lips that are far back on the areola and not on the nipple
Baby's nose that is close to OR touching the breast
Cheeks that are puffed out
Baby's jaw that opens and closes in a smooth pattern - temples appear to be throbbing
Suck becomes rhythmic
Common good latch problems:
What to do if the lips are not flanged...
Use a finger to push the breast tissue in and up to get the lips uncurled and flanged
What to do if mom feels a pinch of pain...
Try to move the baby's jaw downward gently:
Mom should remove a hand from the breast if it is on the breast (remain holding baby with other hand)
Place thumb and forefinger of free hand on baby's lower jaw
Gently move the lower jaw and the pain should subside
Sucking
Sounds of Sucking
Listen for an "uh" sound
No clicking sound
Quiet drawing noise
Regular breaths
Can listen with the stethoscope
Pattern of Sucking
Non-Nutritive Sucking:
Nutritive Sucking:
6-7 sucks / 10 seconds
It is important that the baby is able to obtain as many nutrients as possible during a feeding...

Therefore - the baby should be engaging in nutritive sucking...
Indicators of a
poor latch
Nipple damage
Nipple pain THROUGHOUT the feeding
Feedings that do not have a definitive end - the baby coming off the breast spontaneously
Breast pain
The feel of a good latch:
Ask the mother what the feeding feels like...
It should feel like a deep, firm pull without pain


Try to gently let the baby's head come away from the breast
The nipple should NOT slip out of the mouth if the baby is well-attached
Nipple Pressure:
The baby applies pressure to the areola and nipple with it's mouth

Where on the pressure is applied directly affects how much milk a baby receives


Good Position:

Ensures a proper latch
Baby feeds most efficiently
Prevents Nipple soreness and pain

Experiment with different positions -there is no "right way," although some positions may work better for different situations.
Breastfeeding Positions
Mom's Position: The Basics
Mom should be as comfortable as possible!
Support your back
Use pillows to support Mom's arms
If sitting, use a stool or phone book to support Mom's feet.
Use one hand to support the baby's back and neck.
The other hand hold's the breast - so it is not pressing on the baby's chin. Use the "C" hold, or the "U" hold.
Baby's Position: The Basics
If possible, have a helper hand you the baby once you are comfortable.
Position the baby close with hips flexed
Baby's mouth and nose should face the nipple, without baby needing to turn his or her head.
Baby should be high enough so he/she does not have to reach for the breast. Use multiple pillows if necessary.
Baby's chin should "dive" into Mom's breast.
"C" Hold:
Support your breast with your thumb on top, well back from your areola and the fingers underneath. Your fingers should also be well back from your baby's mouth.
Breast Support Techniques
"U" Hold:
Place your fingers flat on your ribcage under your breast with your index finger in the crease under your breast. Drop your elbow so that your breast is supported between your thumb and index finger. Your thumb will be on the outer area of your breast and your fingers will be on the inner area.
Cross Cradle Position
Used in the early weeks of breastfeeding, because mom has more control.
Baby lies across your body, tummy to tummy.
Support your breast using the hand from the same side of the body as the breast in use.
Tuck your baby's body into the crook of the arm opposite from the breast in use.

Football Hold/ Clutch Position
Good position for women who have had a C-section, or who have very large breasts.
May help if mom has a strong milk ejection - baby can handle the flow more easily from this position.
Mom also gets a better view of the latch.
Good when feeding twins.

Side-Lying Position
Good when Mom needs rest or at night (remind to return baby to his/her usual sleeping position when finished)
Can use pillows behind Mom's back and between Mom's knees for comfort.
A pillow or rolled blanket behind baby's back keeps him/her from rolling away.
Mom can cradle the baby with one arm while supporting/helping the baby with the other.

Support your breast using the hand from the opposite side of the body as the breast in use.
Tuck your baby's body into the crook of the arm on the same side of the body as the breast in use.
With baby's hip's flexed, point the soles of the feet up so he/she can not push against the back of the chair.
Put a pillow on your lap and along your side, under baby, for comfort. Using a chair with wide, broad arms also promotes comfort.
Cradle Position
Similar to Cradle Position, but used after the first few weeks, when baby's head does not need as much support.
Support the baby in the crook of your arm on the same side of your body as the breast in use.
Hold your breast only if baby needs assistance.

Importance of Position
Cleft Palate & Breastfeeding
Cleft Lip & Cleft Gum
** Keep fingers back from the areola while supporting the breast.
Cleft Palate
Position baby semi-upright to limit the amount of breast milk entering the nasal passage.
Hold the infant so that head, neck and shoulders are in a straight line, or the chin is tucked in slightly.
You cannot prevent the baby from swallowing air - the baby will need to burp frequently.
Monitor the baby closely for signs of respiratory distress: head pulling back, no breath sound for 3-4 sucks, coughing or a look of alarm.
A lactation specialist can assist with finding the correct duration of feeding and methods of burping which will not overly interrupt feeding.
Tips for Feeding
Considerations
If the baby only has a cleft lip, no loss of suction occurs and breastfeeding is possible.
If the baby has a cleft gum, expect some loss of suction.
Parents sometimes can hold the space in the lips together without blocking the nose to improve suction.
A lactation consultant can assist with positioning, which can facilitate breast tissue closing the space created by cleft lip.
A baby with cleft palate is very challenging to breastfeed.
If the cleft palate is very small or very far back in the mouth, the baby will have little difficulty.
Medical providers sometimes discourage women from breastfeeding babies with cleft palate, but a combination of pumping, bottle feeding and breastfeeding may work for families who are motivated to breastfeed. Consult a lactation specialist!
Baby with cleft palate breastfeeding with an assistive device.
Cleft palate creates an air leak which prevents adequate suction for breastfeeding.
Mom must consult with a lactation specialist.
Mom starts pumping breast milk in the hospital - even if breastfeeding is possible, baby needs supplemental bottles.
Baby will need a modified bottle designed to improve milk flow when suction is reduced.

References
Ameda. (2007, December 9.) Your Baby Knows How to Latch-On [Video File].
Retrieved from

Evergreen Perinatal Education. (2011). Professional Education in Breastfeeding
and Lactation with Lactation Educator Track. Class held March 21-25,
2011. St. Paul, MN.

Jensen, D., Wallace, S., & Kelsay, P. (1994). LATCH: A breastfeeding
charting system and documentation tool. JOGNN, 23(1), 27-32.

London, M. L., Ladewig, P. W., Ball, J. W., Bindler, R. C., & Cowen, K. J.
Maternal and Child Nursing Care. 3rd ed. (pp. 645-647). Upper Saddle
River, NJ: Prentice Hall.

Mayo Clinic Staff. (2012, April 10). Slide show: Breast-feeding positions.
Retrieved from: http://www.mayoclinic.com/health/breast-feeding/
FL00096&slide=3

Mayo Clinic Staff. (2012, April 4). Breast-feeding multiples. Retrieved from:
http://www.mayoclinic.com/health/breastfeeding-twins/MY01944

(2013, February 11). How do I position my baby to breastfeed? Retrieved from: http://www.llli.org/faq/positioning.html#Breast%20Support%20Techniques
Video Review of
Latch Topics
Review of what to look for
and what the mother should feel
An example of good drinking
Recognize five breastfeeding positions
Recognize how to help a mother achieve a good latch
Understand how to use the LATCH assessment tool
Objectives
This method is the new trend in breastfeeding

It is also called laid-back nursing

This method is based on the principle that babies will instinctively find the nipple and breast just as other mammals do
Baby-led breast feeding:
Breastfeeding Multiples
Breastfeeding multiples can be challenging but with patience and support a mother can successfully breastfeed multiples
Breastfeeding allows mothers of multiples special time and connections with each baby
Should a mother breastfeed the babies at the same time?
AT FIRST each baby should be feed separately to evaluate the baby's ability to latch, address any issues and establish a feeding pattern

Once a pattern is established, a mother can continue to feed them separately
**BUT a mother try to feed both babies at the same time
and figure out what is best for her and her babies

Feeding babies at the same time has many advantages:
Saves time
More stimulation will cause the release of more hormones to make more receptors
A stronger baby can elicit more milk for a weaker baby
Positions for multiples
A mother should try all positions to find the best one for her and her babies
Double-clutch position
(Double-football hold)
Each baby should lie on his or her back with his or her head at the level of the nipple.

The mother should place the palm of one hand at the base of each baby's head to provide support.
Cradle-clutch position
Hold one baby in the cradle position — with the head on the mother's forearm and the body facing the mother
Hold the other baby in the clutch position.

Use the cradle position for the baby that has an easier time latching on to your breast or staying latched
Cross Cradle Position
(Double Cradle Hold)
A mother should support each baby's head with her arms (the head may rest in the elbows)

Turn the baby's body towards the mother

The baby's legs should overlap and make an "X" on the mother's lap

Producing enough milk for multiples
Most mothers of multiples are worried that they cannot produce enough milk for the babies

This is a common struggle for mothers of multiples, but many woman are able to produce enough milk

Tips to increase milk flow:
Start breastfeeding right after birth

Pump

Switch the breasts that each baby feeds on

Bring the baby to the breast (instead of bending over to bring the breast to the baby)
Full transcript