Registered Nurses' Association of Ontario

Nursing Best Practice Guidelines

Latch, Milk Transfer and Effective Breastfeeding

International Lactation Consultant Association (ILCA)
Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN)

Latch (ILCA)
Observe infant for signs of correct latch-on:
  • Wide opened mouth
  • Flared lips
  • Nose, cheeks, and chin touching, or nearly touching, the breast
Milk Transfer (ILCA)
Observe infant for signs of milk transfer:
  • Sustained rhythmic suck/swallow patterns with occasional pauses
  • Audible swallowing
  • Relaxed arms and hands
  • Moist mouth
  • Satisfied after feedings

Observe mother for signs of milk transfer:

  • Strong tugging which is not painful
  • Thirst
  • Uterine contractions or increased lochia flow during or after feeding for the first 3-5 days
  • Milk leaking from the opposite breast while feeding
  • Relaxation or drowsiness
  • Breast softening while feeding
  • Nipple elongated after feeding but not pinched or abraded
Infant Behaviours (AWHONN)
Infant feeding cues:
  • Rooting
  • Hand-to-mouth movements
  • Sucking movements/sounds
  • Sucking of fingers or hands
  • Opening of mouth in response to tactile stimulation

Transition between behaviour states
(sleep to drowsy and quietly alert)

Infant satisfaction/satiety cues including the following:

  • During the feeding, a gradual decrease in number of sucks
  • Pursed lips, pulling away from the breast and releasing the nipple
  • Body relaxed
  • Legs extended
  • Absence of hunger cues
  • Sleep, contented state
  • Small amount of milk seen in mouth
Frequency and duration (ILCA)
Frequency and duration of feedings:
  • Expect a minimum of 8-12 feedings in 24 hours
  • Some infants will breastfeed every 3 hours day and night, others will cluster-feed,
  • feeding every hour for 4-6 feeds then sleeping 4-6 hours
  • Expect to feed 15-20 minutes on the first breast and 10-15 minutes on the second but do not be concerned if the infant is satisfied after one breast
  • If necessary, wake a sleepy infant for feedings until an appropriate weight gain pattern is established
  • Expect feeding frequency to decrease as the infant gets older