Breastfeeding Barriers: 4 Infant At-Risk Conditions

Evi Dewhurst / October 2017


Are you an L&D nurse, a maternity nurse, or neonatal nurse? I’ve got something for you. It’s something that will help you deliver more human milk nutrition to infants in your care.

I recently wrote about 10 at-risk conditions for mothers which negatively impact breastfeeding success and duration. Interest in such information is high, because clinicians want to fully understand how to anticipate these conditions in order to be proactive in the human milk process.

Successful breastfeeding for mothers can be difficult due to existing conditions and birth-related events, but specific infant conditions can prevent successful breastfeeding as well.

Early identification of these infant conditions can help your clinical team focus on improving the odds of long-term, successful breastfeeding (or human milk provision). Often these infant conditions can be assessed prior to birth, or immediately after.

Breastfeeding initiation: More important than you think

Your goal to help mothers provide human milk to their infants is based on providing ideal nutrition for infant health (and those side health benefits for mothers aren’t too shabby, either). Many best practices have been established within healthcare to make that goal a reality, thanks to improved guidelines over the years.

But something was missing.

Recent studies indicate that a critical window of time exists to initiate a mother’s breastfeeding capabilities.

Lactogenesis II, which occurs after birth and is the beginning of plentiful milk secretion, typically occurs between 30 and 40 hours following the birth of full term infants.1 Within one to two days, plentiful milk secretion is established.

However, Parker et al discovered there is a one-hour window immediately following birth that cements the success or failure of plentiful milk secretion in the very low birth weight (VLBW) population.2 In this study with premature infants, milk expression within one hour of delivery produced significantly more milk over the next seven days and the duration of the six-week study period. You can read more about this in Irene Zoppi’s recent post, “Why Mothers Should Pump Within One Hour of Birth.”

The important thing to remember is this: a delay in the lactogenesis II process can actually lead to secondary failure of lactation.1

In other words, if consistent and proper emptying of the breast (either by an infant or breast pump) does not occur during that critical one hour window, a mother’s body may not reach its full milk feeding potential. Instead, she may struggle, her infant may need supplements, and she might experience the number one reason why mothers quit breastfeeding: a perceived lack of production.

Identify at-risk infants: 4 conditions

Just as identifying mothers with breastfeeding at-risk conditions is important, so too is identifying infants with at-risk conditions. Ultimately you will be better prepared to help mothers either breastfeed with the infant’s condition, or pump if the condition prevents repeated and successful emptying of the breasts in those first few days (and possibly beyond).

These 4 at-risk conditions are by no means comprehensive, however, they are a start to your identification process.

1. Preterm birth

1 in every 10 babies was born premature in 2015 in the United States. While this at-risk condition may be obvious, it is important to connect a mother’s breastfeeding health to premature birth incidence.

Does your hospital have a breastfeeding protocol for mothers of premature babies? Does the L&D team have access to a lactation professional for guidance, or do they themselves have the training, tools, and resources for these mothers? Remember that 40-hour window, in which successful pumping must be established.


2. Tongue-tie (also called ankyloglossia) and other latch issues

Tongue-tie occurs when the membrane of skin connecting the bottom of the tongue and floor of the mouth is either too short or too far forward.

This condition can cause an inability to open the mouth wide enough to breastfeed. As a result, the infant may not latch at the correct angle.

It is important to assess both infant and mother for a proper latch. If a proper latch is not possible, lactation support and tools such as a breast pump can usher in lactogenesis II.


3. Palatal anomalies

Nearly 6,800 babies are born each year in the United States with cleft palate or cleft lip. These conditions occur during pregnancy when the sides of the lip and roof of the mouth do not fuse properly.

Infants with cleft lip do not always have feeding difficulties, and may be able to latch properly. Unfortunately, this is not always the case, and each infant requires careful assessment.

Prepare a specialized team to assess these conditions immediately after birth. The team will decide the best course of action for each mother/infant dyad. If immediate breastfeeding is not possible, provide a breast pump, specialty feeding supplies, and continued lactation support with the goal of establishing breastfeeding at the soonest future opportunity.


4. Congenital heart defects (CHD)

If a congenital heart defect is discovered during pregnancy or immediately after, breastfeeding may not be possible for a mother and her infant.

CHD can include aortic valve stenosis, pulmonary valve stenosis, ventricular septal defect, and more.

Infants with CHD may have a poor appetite, a weak suck, fast breathing, and short sucking bursts followed by a long rest period. All of these can impact breastfeeding success during that 30 – 40 hour window after birth, which may delay lactogenesis II.

Assembling a specialized team to assess CHD severity and ability to breastfeed would be helpful to determine the best course of action.

Be proactive in removing breastfeeding barriers

These conditions, and others, can limit successful breastfeeding. But it doesn’t have to be that way.

By identifying at-risk conditions such as these four, assembling a responsible task team, and obtaining the right breastfeeding support tools, your hospital can make a big difference in breastfeeding outcomes. That in turn leads to improved patient outcomes and reduced readmission rates. And that’s a win for everyone.

Learn more about Symphony® PLUS™, the hospital-grade (multi-user) breast pump that helps moms of preterm or term infants initiate, build, and maintain their breast milk production.


  1. Hurst, NM, “Recognizing and treating delayed or failed lactogenesis II,” JD Midwifery Women’s Health (2007) Nov-Dec;52(6): 588-94
  1. Parker LA, Sullivan S, Krueger C, and Mueller M. Association of timing of initiation of breastmilk expression on milk volume and timing of lactogenesis stage II among mothers of VLBW infants. Breastfeed Med. 2015. 10(2):84-91.