For a function that’s so natural, breastfeeding is surprisingly difficult for many new mothers and infants. Feeding challenges, like reflux, oral aversion or even dysphagia, can make breastfeeding feel insurmountable.

And while there’s nothing wrong with relying solely on formula to feed your baby (despite the shame some natural parenting evangelists espouse online), many moms are determined to make some amount of breastfeeding work.

Nicole Lattanzio, RD, IBCLC can attest that breastfeeding is often possible, even in some of the most challenging cases. Working in the NICU and with virtual clients, she has supported countless moms and babies with breastfeeding and nutrition. Some simply need latching and positioning advice, but other more complex medical cases need significant support.

There are three requirements for successful breastfeeding:

• Feeding your baby

• Protecting the milk supply

• Having a positive experience at the breast

For infants with feeding challenges, aligning these three goals can take time and creativity.

The most challenging and most rewarding case Lattanzio recalls was a preemie with a G-tube, feeding difficulties and significant oral aversion. Her mom was committed to making breastfeeding work. Once the infant was released from the NICU, Lattanzio helped with lactation support while a speech therapist worked on oral skills and strength. Lattanzio is also a dietitian and monitored the infant’s growth and feeding tolerance. At first, the baby didn’t have the interest or skills to transition to breastfeeding. Instead, they focused on getting the baby comfortable resting skin-to-skin.

They did G-tube feedings while the baby nestled skin-to-skin. Gradually, they transitioned closer to a breastfeeding position, including giving her a pacifier as the G-tube was going. Next they worked on latching with a nipple shield and used some syringes into the nipple shield. At eight months, the infant had her first full meal at the breast. “It shows that babies at almost any age can learn to breastfeed. It was so cool to see that she got through that whole process, and the mom had her full milk supply,” says Lattanzio.

Whether you want to maintain your milk supply for bottle feeding or want to breastfeed, Lattanzio offers lactation advice for moms of infants with feeding challenges.

Understanding breastfeeding challenges

Swallowing is a complicated process that when broken down into parts can seem miraculous. Expert researcher Georgia Malandraki, PhD, CCC-SLP, explains the anatomy of a swallow in a way that makes anyone appreciate why the skill can be difficult to master.

On its own, difficulty breastfeeding does not mean a child will develop pediatric feeding disorder (PFD). However, many children who do have PFD also struggle to breastfeed.

Breastfeeding challenges can vary from simple to complex, but some of the most common issues include the following:

• Reflux

• Aspiration

• Oral motor dysfunction or coordination issues

• Respiratory problems that make it difficult to coordinate sucking and breathing

• Premature birth that causes a lack of skills

• Oral aversion

• Incorrect latch or positioning

• Tongue-tie or lip-tie

How can I identify if my baby is experiencing these issues?

Signs of breastfeeding challenges may include frequent spitting up, arching of the back, irritability during or after feeds, coughing, choking, crying, pulling away or difficulty latching. Early detection and consultation with your pediatrician or a lactation consultant are key to addressing these challenges effectively.

Tips for successful breastfeeding even with feeding challenges

Not all babies with feeding challenges and medical complications will breastfeed, and that’s okay. Babies and even postpartum mothers benefit from any amount of skin-to-skin and pumped milk. Infants fed entirely by formula still get the nutrition they need to grow. Key to successful breastfeeding is a relaxed mom, so be kind to yourself as you navigate whatever works for you and your infant.

Following are Lattanzio’s recommendations to support breastfeeding for an infant with feeding challenges.

Try different feeding positions

An obvious place to start for breastfeeding troubleshooting is to experiment with different positions. Positioning can make a big difference for a baby who may experience some reflux, colic, or aspiration (be sure to monitor this with a clinician because this can be dangerous).

Different breastfeeding positions can help your baby latch more effectively and reduce discomfort. Some infants with reflux or aspiration challenges benefit from being held upright, where gravity can help keep milk down.

Experimenting with positions can help you find the one that works best for your baby and you, promoting better milk flow and reducing feeding difficulties.

Be patient and open to feedback

Feeding challenges can be frustrating for both you and your baby. It’s essential to be patient and give yourself time to adapt and learn what works best. Be open to feedback from lactation consultants or healthcare providers who can offer valuable insights and techniques tailored to your baby’s needs. Remember, every baby is different, and what works for one may not work for another. Patience and willingness to adjust can make the breastfeeding journey more manageable.

For Lattanzio’s mom and baby, who finally successfully breastfed at eight months, she says, “This baby was very sensitive to positioning, so it was a lot of trial and error. Mom was very patient and open to adjustments and feedback, which set them up for success.”

Leverage breastfeeding tools as appropriate

For many babies, using breastfeeding tools, like a nipple shield, can help with latch difficulties. Especially for infants with feeding challenges and medical complications, a nipple shield can provide a larger target for the baby to latch onto and help regulate milk flow, making feeding more comfortable.

With the support of a lactation consultant, Lattanzio has helped mother use a syringe with the nipple shield. Consult a lactation specialist to determine whether these tools suit your situation.

Don’t force your infant to breastfeed

Breastfeeding, especially when there are feeding challenges or medical complications, can take a lot of trial and error. This might mean you have a few successful sessions and your baby shows disinterest.

Insisting on breastfeeding when your baby shows some signs of stress or overwhelm can cause breast aversion. “Skin to skin is usually a nice relaxing place for babies and later try to ease back to breast,” says Lattanzio.

If that doesn’t work, get some support to reassess what’s going on instead of forcing breastfeeding.

Pump with a hospital-grade pump to maintain your milk supply

If your infant isn’t breastfeeding full-time, you’ll need to pump if you want to maintain your milk supply. This is true even if your baby has many partial feedings. “I’ve seen preterm babies who are breastfeeding okay, but they’re sleepy. That can impact the milk supply,” says Lattanzio.

Many more convenient types of pumps, like the wearable ones, aren’t strong enough to maintain your milk supply. You’ll want to get a hospital-grade one if you’re using a pump often or exclusively. These pumps are designed to mimic a baby’s natural nursing pattern and are more efficient than standard pumps.

Initially, maintaining your milk supply means pumping eight times in 24 hours. “You can sleep for a stretch of time, but every time the baby is being fed by a bottle, you still have to pump in order to keep up your milk supply to be where it needs to be,” says Lattanzio.

Build a network of support

If nourishing an infant with feeding challenges feels challenging, that’s because it is. Your pediatrician, a lactation consultant, a dietitian and a speech therapist can all provide valuable insight to help you and your baby get what you need.

With eight feeds a day, plus pumping, feeding an infant with medical complications is literally a full-time job. Family and friends can offer practical assistance, such as preparing meals, helping with household chores and providing emotional support.

Finally, keep in mind that it’s okay if breastfeeding doesn’t work out as planned. Prioritizing your well-being as a mom means finding a feeding method that works for both you and your baby.

Sometimes successful breastfeeding means reassessing goals, says Lattanzio. “If the goal initially was exclusive breastfeeding, maybe we come to the point where it’s about finding a good middle ground where they’re comfortable, happy and it’s sustainable.”

Nicole Lattanzio, RD, IBCLC is a registered dietitian, board-certified lactation consultant, and mom of four. She works in a level III NICU in Phoenix, Arizona and runs the popular Instagram page @infant.nutritionist, where she shares about starting solids, navigating feeding challenges, tackling toddlerhood and more.