Training of Roma Health Mediators in Reproductive Health

Some women have very large areolas, so you may not see a lot of areola outside the
baby’s mouth even though he is well attached. Compare how much areola you can see
above and below the baby’s mouth. When the baby is well attached, you will see more
areola above his mouth than below it.
There are 4 points of good attachment. The baby’s:
1. Chin is close to the breast
2. Mouth is wide open
3. Lower lip is turned outwards
4. Mouth is beyond the nipple and attached to the areola. (More areola will be
noted above than below the mouth).
Post the flipchart/project the overhead Baby’s Attachment to the Breast.
Ask participants:
‣ What signs of good attachment do you see?
• The baby's chin is touching the breast.
• His mouth is wide open.
• His lower lip is turned outwards.
• His cheeks are round, or flattened, against his mother's breast.
• There is more areola above the baby's mouth than below it.
• The breast looks rounded during a feed.
‣ How can you tell if a baby is suckling effectively?
• The baby is taking slow deep sucks.
• His sucks become deeper and slower (after the few quick sucks at the beginning of
the feed)
• You can see and/or hear the baby swallowing.
• The baby gulps as he swallows. Gulps are very loud swallowing sounds, when a lot
of fluid is being swallowed at once. This is a sign that a baby is getting a lot of
milk. It sometimes means that his mother has an oversupply, and her baby is getting
too much milk too fast. Oversupply is sometimes the cause of breastfeeding
difficulties.
‣ What signs of poor attachment do you see?
• The baby's chin is not touching the breast
• His mouth is not wide open (especially important with a large breast).
• His lips are pointing forwards (his lower lip is turned in).
• His cheeks are tense or pulled in as he suckles.
• There is more areola below the baby's mouth than above it, or the same amount
above and below.
• The breast looks stretched or pulled during a feed.
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RFHI/JSI Romania Training of RHMs in Reproductive Health Session 9: Breastfeeding