The early days of breastfeeding are a time for you and your baby to get to know each other and learn to breastfeed effectively. Every nursing mother must make some adjustments during this time because every baby is unique. As you get acquainted with your baby, you will discover that babies with Down syndrome have physical characteristics that may have an impact on breastfeeding. While you probably will not encounter all of the challenges discussed here, understanding your baby’s particular needs will help you to get breastfeeding off to a good start. In some cases, you may need to advocate for yourself and your baby to get the support you need. Babies with Down syndrome can and do breastfeed. Often it takes time and patience. We hope that these tips help you and your baby have a successful breastfeeding experience. However, you may need further support or your baby may not breastfeed at all. Find the way that works best for you and your baby.
IMPORTANCE OF BREASTFEEDING FOR YOU AND YOUR BABY
Breastfeeding a baby with Down syndrome is not only possible, but provides important benefits to both mother and child.
• Human milk will boost your baby’s immune system and protect against numerous autoimmune disorders such as celiac disease, asthma, and allergies. This is especially important for babies with Down syndrome since they are prone to respiratory and viral infections.
• Breastfeeding will strengthen your baby’s lips, tongue, and face. This serves as a stepping stone for future speech development.
• Breastfeeding is convenient! It is always available and contains all of the nutrients, calories, and fluids your baby needs until about the middle of the first year.
• Hormones produced during breastfeeding help your uterus to shrink back to the size it was before pregnancy.
• Breastfeeding has been shown to reduce the risk of developing ovarian cancer and breast cancer.
• Breastfeeding provides warmth and closeness. The physical contact of this relationship helps create a special bond between you and your baby.
POSITIONING
Many mothers find the laid-back position helpful in getting a deep latch with no nipple pain. This position is especially helpful in the early days or weeks after the birth. To use this position, place your baby on your bare chest. Use pillows to support yourself as you lean back at about a 45 degree angle. Your body supports your baby. And the prone position helps babies open their mouths wide.
There are other positions mothers use when sitting up or lying on their side. Positioning your baby in a comfortable and supportive arrangement will preserve their energy and allow them to use this energy for feeding. Proper positioning will also help your baby get more milk for their effort and better stimulate your milk supply.
• Use pillows, as needed, to support your baby’s body so their mouth is level with or slightly below your nipple.
• Hold your baby very close into your body for comfort and the best latch.
• To avoid strain on your muscles, use pillows to support your back, shoulders and arms. When your baby is tucked right in against your body, your arms aren’t working so hard. Remember to relax! Your milk will flow best when you are calm and comfortable.
LATCHING ON
Express some milk onto your nipple prior to breastfeeding. This may encourage your baby to latch on. Also ensure your baby gets a large mouthful of breast tissue. This will help your baby draw the milk out and stimulate the breasts to produce more. One way to achieve a deep latch is to hold your baby in a comfortable position and use your free hand to support your breast in the C-hold (thumb on top, fingers underneath) well behind the areola, the pigmented area around your nipple. Tickle your baby’s lips lightly with your nipple and wait for your baby to open their mouth very wide. Then pull them in close to your breast with the nipple pointing up into their mouth. If it doesn’t quite work the first time, be patient and try again.
SIGNS OF A DEEP LATCH
Perhaps the most obvious sign of effective breastfeeding is adequate weight gain in your baby. This should not be solely relied on, however, as babies with Down syndrome often gain weight at a slower rate than traditional milestones suggest. Although you cannot actually see the milk going into your baby, there are signs you can check to ensure your baby is nursing effectively:
• Your baby has taken a good-sized mouthful of breast, so that their gums can compress the milk ducts that lie behind the nipple. The nipple is drawn far back in their mouth as they suck. If your baby is latched deep enough, it won’t hurt as they suck.
• Your baby’s chin is pressed into the breast with their head tipped back slightly. Their nose is lightly resting on the breast or not even touching the breast.
• Your baby’s tongue is cupped under the breast. You can see the tongue by pulling down gently on the bottom lip. The tongue should be visible between the breast and your baby’s gum.
• Your baby’s mouth has a secure seal on the breast. Both lips are flanged out. To release the seal when taking your baby off of the breast, try slipping a clean finger in the corner of their mouth, or press down gently on the breast near their lips.
• Typically, it takes one to two minutes of your baby on the breast before the milk begins to flow. During this time, your baby will suck rapidly, pausing after every 3 or 4 sucks to swallow and breathe. Once the milk is flowing, sucking becomes slower and longer with a pause between most sucks.
• Listen for sounds of swallowing coming from your baby, approximately two to three seconds apart. Swallowing noises may be subtle and difficult to hear. You may find it helpful to have a partner or professional listen with a close ear the first few times you breastfeed. You can also try placing a finger lightly under your baby’s chin— you should feel a delicate, repetitive movement as they swallow.
SIGNS OF MILK TRANSFER
If your baby is latched on deeply and sucking steadily, they will drink lots of milk. The following signs help you know your baby is drinking well.
• Your baby is sucking with a steady rhythm and few pauses.
• You can hear swallowing.
• You are not experiencing nipple pain.
• Your breast feels softer after your baby feeds.
• Your baby has 6-8 wet diapers and 2-5 stools each 24 hours.
• Your baby is gaining weight.
Potential Influences
HOLDS
As babies with Down syndrome often have low muscle tone, including reduced muscle strength in their tongue and lips, good head support is particularly important for your baby during breastfeeding.
There are a variety of ways you can hold your baby while breastfeeding to support their head, neck, and upper back. Applying gentle, steady support to the base of your baby’s head will help them to suck well without tiring. Your hand is on your baby’s neck and upper back, supporting the base of your baby’s skull. Pressure on your baby’s head can make your baby push back away from the breast.
Laid-Back Position
The laid-back position mentioned above (see Positioning and Latching) can help you get breastfeeding off to a good start.
If you prefer to try another position, some different ways to hold your baby are:
Cross-Cradle Hold
The cross-cradle hold allows you to provide your baby good head support during breastfeeding. Hold your baby using the arm opposite the breast at which your baby will feed (i.e., the right arm when nursing at the left breast).
Position your hand to support your baby’s neck and head, like a shirt collar, while their body extends along the length of your forearm. Your free hand will hold and position the breast. This position offers a good view of your baby at the breast and helps you to control and support both the head and body. Support the base of your baby’s head so they can tilt it back slightly. Avoid placing any fingers above their ear level.
Football Hold or Clutch Hold
The football hold also allows you to support your baby’s head and gives you a good view of their face so you can watch for latch-on and sucking problems.
To feed on the right breast with the football hold, clasp your baby’s torso under your right armpit. Your baby’s legs will not be visible as they will be tucked behind your arm, along your side. Use your right hand to position your baby’s head to your breast.
To feed from the left breast, hold your baby’s torso under your left armpit and use your left hand to position their head onto your left breast. You will find it helpful to support your baby with a pillow at your side to ensure you and your baby are comfortable. Applying gentle, steady support to the base of your baby’s head will help them to suck effectively without tiring. You should be supporting the upper back area and neck, keeping your baby’s head steady with your fingers below their ears.
Dancer Hand Position
Another way to physically support your baby’s sucking is to use the Dancer hand position. This position is particularly useful for babies with low muscle tone.
To do so, support your breast using the C-hold (thumb on top, four fingers underneath). Slide the hand supporting the breast forward, supporting the breast with three rather than four fingers. Your index finger and thumb should now be free in front of your nipple. Bend your index finger slightly so it gently holds your baby’s cheek on one side while the thumb holds the other cheek. The index finger and thumb form a “U” with your baby’s chin resting on the bottom of the “U”. The Dancer hand position keeps the weight of the breast off your baby’s chin and helps them hold their head steady while nursing. It also provides support for weak cheek muscles.
Side-lying Position
A great way to get more rest while you are breastfeeding is to nurse while lying on your side, with your baby parallel to you on a flat, firm surface, like a bed or the floor.
To do this, lay down on your side with your baby facing you. Using your upper arm, bring your baby close to you. Your baby will be on their side touching your body. Their chin will be pressed deep into your breast and their nose will be opposite your nipple. You may need to prop yourself up on the arm you are lying on in order to help your baby latch. Once your baby is latched comfortably, you can lie back down on your side and place a pillow under your head.
Other Positions To Improve Milk Flow
If you find your baby seems to be drinking too quickly, and is coughing, try:
•Moving your baby upwards so their throat and neck are higher than your nipple. •Leaning backwards similar to the laid-back position your body farther back.
•Having your baby sit up in a straddle position on your lap.
These positions can help avoid gulping and coughing, which may be a problem for some babies with Down syndrome.
If your milk flows slowly or moderately, try starting your milk flow prior to putting your baby to the breast. Gently massage the underside of your breast to encourage your milk to let down or start flowing. Placing a warm, damp cloth on your nipple before nursing may also promote milk flow.
SLEEPINESS
Many babies with Down syndrome are very sleepy the first few weeks after birth, which can hinder their feeding routine. To establish your milk supply and ensure your baby gets enough milk, it may be necessary to wake them to feed every two hours, or at least 8-12 times a day. It may also be challenging to keep your baby awake for the duration of the feeding. The hind milk, obtained in the latter part of the feeding, is higher in fat and calories which are important for growth. It is important that your baby receive these nutrients.
There are a variety of tips you may use to keep your baby awake during breastfeeding:
• Dim the room so your baby doesn’t have to close their eyes against the light.
• Remove your baby’s clothes before breastfeeding to keep them cool and aware.
• Stimulate your baby’s senses by lightly touching the edge of their outer ear, stroking their arms, and talking to them during feeding. These touches and sounds will distract your baby from becoming drowsy and help them to focus on feeding.
• Try placing a cool, damp washcloth on your baby’s belly, leg, or forehead. The cool sensation is bound to wake them up.
Your baby can be encouraged to continue active suckling, and get more milk, by using breast compression and/or switch nursing.
TONGUE THRUST
Babies with Down syndrome may have a protruding tongue that can push against your nipple. This may pose a challenge for your baby when latching on, as he or she may push the nipple out of their mouth. If your baby is latched on properly, you should be able to see their tongue cupped under the nipple, resting on their lower gum.
When you are latching your baby onto the breast, watch for their mouth to open wide, with their tongue forward and down. To encourage your baby to bring their tongue forward, use your index finger to press down softly on your baby’s chin while they latch on. This opening of the jaw will cause the tongue to protrude further out of your baby’s mouth.
Don’t be disheartened if your baby needs some initial encouragement to keep their tongue down while latching on. Facilitating oral stimulation can help move the tongue into position to breastfeed. To do so, place your index finger on the center of your baby’s tongue, encouraging the tongue to form the shape of a trough. Push down on his tongue while gradually pulling your finger out of their mouth. Try repeating this exercise several times before latching your baby onto the breast.
Weight Gain & Supplementing
Babies with Down syndrome are typically born underweight, so it is important that they are monitored for weight gain. If you are breastfeeding, ensure your baby is actually receiving and swallowing milk from you. If your baby is not gaining weight, seek advice from your doctor. Five ounces a week is considered adequate weight gain. It is not unusual for a baby with Down syndrome to gain slowly even when he or she is receiving enough nourishment. If your baby is not being given anything but your milk and is getting enough to eat, you’ll see at least six really wet diapers (more if using cloth diapers) and three to five bowel movements a day (beginning after the fourth day). An older baby may have bowel movements less frequently, but they should be plentiful.
A baby who is not nursing effectively or long enough may not be getting the hind milk. Sometimes using breast compressions, massage or switching sides twice during the feeding will help your baby to obtain that higher calorie milk. If that doesn’t enhance your baby’s intake and weight gain, you can express this calorie dense milk and offer it as a supplement after your baby has finished nursing. This will ensure they are receiving all of the nutrients they need to grow.
It is better to avoid giving supplements in a bottle until your baby has been breastfeeding well for three to four weeks. While they are learning how to breastfeed, exposure to artificial nipples and a different type of milk flow may cause nipple confusion, since sucking at the breast is different from sucking on a bottle.
If you decide to offer your milk as a supplement, there are a variety of methods for you to choose from. If your baby can latch and needs supplements of either expressed human milk or formula, you can use a nursing supplementer or another method that avoids artificial nipples. The nursing supplementer is a small soft tube that rests on the breast like an outer milk duct. This method is helpful because the baby suckles at the breast while receiving the extra flow of milk from the small tube.
Bottles are difficult to avoid if your baby is unable to maintain a deep latch and effective suck at the breast. The need for bottles may diminish as your baby matures and their muscle tone improves. Some parents have found ways to bottle-feed in a manner that supports breastfeeding.
During the time that your baby is learning to breastfeed effectively, you may need to offer supplements after most feedings. Some babies nurse better if they get some of the supplement before they are put to the breast, rather than waiting until they are upset with hunger. One size does not fit all; your family physician or lactation consultant will be able to offer you guidance on what techniques will work for you and your baby.
BREAST COMPRESSION AND SWITCH NURSING
Breast compression is done when your baby is breastfeeding but sleepy or not actively sucking. Use one hand to squeeze the whole breast firmly but not so hard that it hurts. Your baby should start to swallow. Keep squeezing until your baby stops or slows down their sucking again. When you release the pressure, your baby will increase swallowing. Once your baby’s sucking slows down, squeeze again. Repeat the squeezing and releasing until it no longer works, and then offer your baby the other breast.
To try switch nursing, watch for your baby to lose interest in active suckling, then slip a finger in the corner of their mouth to break the suction and offer the other breast. Your baby should nurse more vigorously and the milk starts to flow on the second breast. When their sucking slows again, switch him back to the first breast. Keep repeating this until your baby seems satisfied. You can combine breast compression and switch nursing or do just one or the other. You will see what works best for your baby.
Support For Breastfeeding
All babies benefit from breastfeeding or receiving human milk. If there are challenges, you may need information, support, and/or practical interventions to reach your goal. International Board Certified Lactation Consultants (IBCLC) can assist with latching and milk supply issues. They can also instruct you in using supplemental nursing devices and pumps. Sometimes, breastfeeding just doesn’t work out. Your health nurse or doctor can provide information on other feeding options.
La Leche League (LLL) is a mother-to-mother, peer-to-peer support group. Volunteer LLL Leaders provide breastfeeding support in person, by phone, online, and at informal Group meetings. They provide evidence-based information on breastfeeding and human milk. They live and parent in the communities they serve and tailor programs to the needs of each community.
Talking to other mothers with up-to-date information about breastfeeding and basic infant needs can give you the confidence to succeed. Correct information—even before the baby is born—can help a mother avoid common problems. La Leche League meetings provide a friendly place and an opportunity to share experiences.
There is no cost to receive support from an LLL Leader and all regular informal Group meetings are free of charge. La Leche League volunteers feel privileged to support families during the exciting first days, weeks, months and even years of raising children. La Leche League is here for you and your baby. Find a Local Group to get support.