Positioning and attachment

Positioning at the breast

Using the cross cradle position the staff will recommend you position your baby using the below guide.  We refer to this as the “CHINS” tool.

Close

Head free

In line

Nose to nipple

Sustainable

  • First of all make sure you are in a comfortable position so you are able to SUSTAIN the position.
  • Using the opposite hand from the breast you are about to use bring your baby in CLOSE by running your arm along the spine, finger and thumb under the ears ( a bit like holding a bagpipe) and little finger under your baby’s arm pit.
  • Allow your baby’s HEAD TO BE FREE, to tilt back, which will enable their chin to lead. Contact through your baby’s shoulders with the heal of your hand will support this movement.
  • Their head and bottom should be IN LINE so your baby is not having to turn to the breast..
  • With your baby’s chin touching the breast YOUR NIPPLE SHOULD BE IN LINE WITH YOUR BABY’S NOSE. This will enable your nipple to run along your baby’s palate allowing for a comfy feed.
  • Your other hand should be cupping your breast but not moving it out of its natural position. Once your baby is attached well you can swap hands by keeping pressure on your baby’s back.

chins

When positioning your baby at the breast try NOT to use a pillow to support your baby.  It changes the angle at which your baby comes to the breast which can make your nipples sore and affect milk transfer.

Once your baby is feeding look and listen for swallows.

Adjust the positioning so there is a straight line from your nipple to the back of your baby’s head.  “The angle of dangle”. If you imagine your nipple as a collection of straws if the nipple is bent or compressed just like a bent straw it will be harder for your milk to pass through.  This may lead to your baby falling asleep before a feed is completed and not finish a feed.

Positioning Recap

Firstly: Make sure you are in a comfortable, sustainable position.  The feed may last an hour.  If your baby falls asleep at the breast do not assume the feed is finished, wake and offer again.

  • Your baby’s head and body should be in a straight line.
  • Chin indenting the breast with the nipple resting across the top lip and up their nose
  • Ensure your baby’s bottom lip touches your breast well away from the base of the nipple.
  • Wait for your baby to open the mouth widely and reach up to the breast.
  • Flick your nipple into their mouth using your thumb
  • Aim your nipple to the roof of your baby’s mouth.

Signs of a good attachment:

  • Your baby should be content at the breast.
  • Rapid sucks initially turning to slow deep sucks with swallows.
  • Chin indenting the breast.
  • Cheeks rounded and no dipping in.
  • No pain for you after the initial few sucks.

When to feed your baby:

Rarely do breastfed babies feed 3 hourly it is much more common for the length and frequency of the feeds to vary, your baby should feed a MINIMUM of 8 to 12 times in 24 hours.  Remember breast milk is also a thirst quencher, pain relief and offers comfort for your baby as well as passing over your immunity.  Be guided by your baby’s feeding cues, crying is the last cue.  Your breasts will also tell you when to feed your baby, if you are feeling full offer your baby a feed.

Signs that breastfeeding is going well:

  • You should be able to hear and see rhythmical swallows.
  • Plenty of wet, heavy nappies.

Changing poos: 

Meconium (black and sticky) on day 1 and 2.

Changing stool (green like pesto) on day 3 and 4.

Yellow (like whole grain mustard) on day 5.

By day 5 your baby should have at least 5 to 6 really wet nappies per day plus at least three poos the size of a 50pence piece. A breastfed baby should have dirty nappies every day until they are 4 to 6 weeks old. Please contact a member of staff if your baby has not had their bowels open for 24 hours in the first 10 days so a feed assessment can be performed.

Aim to feed your baby a minimum of 8 times in 24 hours.  It is normal for your baby to have a period of feeding frequently and then sleep for 5 to 6 hours.

©2017 Royal Surrey County Hospital

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