Latch questions- sustaining the Fish Lips and sleepy baby

Baby Boy Nick- 7 weeks, breech-c section birth
I can get Nick to latch with fish lips but he then goes back to tucking one or both of his lips under. He feeds/swallows w pattern so he's getting milk and there is more than enough supply. He's gaining 1-1.5 oz per day. How do I get him to sustain the fish lips? I have tried getting him to open up with my fingers while he is on the breast as well as re-latching at least 3 times before I just let him eat. He'll eat for about 10 minutes and then fall asleep even if I rub him with cold hands, towels and move his arms & legs around. I usually wake him up by trying to burp him and he's still pretty sleepy. When I get him to get back on the breast, he isn't efficient, swallowing every 4-5 sucks. Makes me think that if the latch was better, he might be able to get more milk out with fewer sucks. I know that there is ample supply bc I can manually express very easily so it's not that.
I am giving him a bottle of pumped BM 1-2 times a day with Dr Brown's bottle lvl 1 nipple. He can easily take down 4-5 oz per bottle. I am pumping 4-7 oz per session depending on time lapse between feeding.

Answer from the lactation consultant

One of several things could be the issue.
1. My first thought is that he has some kind of tongue tie. All they symptoms are consistent. It could be a lip tie (upper lip) and/or lower lip tie. These are VERY VERY common and quite often overlooked by doctors and even lactation consultants. The main symptoms are inability to sustain a latch and painful nipples. (you did not mention this but if they are sore, this is the first area to pursue) Google Dr. Kotlow. He has some excellent information on this topic on his website. I refer my local patients to him in New York for treatment. Yes, they fly there to have the laser treatment, all the way from Texas. He is that good.
2. BUT, if he takes a bottle well without getting gassy, then it could just simply be that he is adjusting his latch to be more like the bottle and he is getting lazy in between letdowns. If you think this is the case here are some tips for that:
a. Used paced feeding when you do bottle feed. Feed for 10-20 seconds take the bottle out for 30 seconds. Repeat. Make him wait to down the bottle so it mimics breastfeeding closer. Make the bottle feed take a minimum of 15 minutes.
b. Dr. Browns are one of my LEAST favorite bottles because the nipples are smaller and they are really rigid. I like the First Years breastflow bottle the best.

Also, when you are breastfeeding, are you doing breast compressions? If not, begin the practice now. This will help stimulate him to suck. Here is a video on how to:

3.Probably the best advice I can give for any mom experiencing latch problems is to have a in person appointment with a lactation consultant, a breastfeeding expert. You did not leave information on where you live or I would given you local resources. So go to ilca.org and find a lactation consultant that way. It is well worth the investment. If you cannot afford a visit with a lactation consultant, then contact your local la leche league (lalecheleague.org) and find a peer support counselor who can help you. This is a free support group and they will often come to your home to help for free.

Also, just want to make sure, that when you are giving the bottle, you are pumping in place of that nursing session. In other words, you cannot give bottles at night or any other time,and not continue to empty your breast at regular intervals or this could effect your supply.

Hang in there, this is a resolvable issue.

Hope this helps,
Liz Pevytoe, RN, IBCLC


This question took the registered nurse, lactation consultant 26 minutes to answer.