Breastfeeding essentials: Assessing latch and milk transfer

Assessing breastfeeding effectiveness requires more than observing whether an infant is attached to the breast, according to Jessica Nash, MD, IBCLC, who emphasized the importance of evaluating maternal comfort, milk transfer, and infant feeding cues during routine pediatric visits.

Nash, a pediatrician at Children's National Hospital in Washington, DC, discussed breastfeeding assessment, early parental education, and continuity of lactation support at the American Academy of Pediatrics (AAP) 2026 National Conference & Exhibition.

She encouraged pediatricians to develop practical skills for evaluating breastfeeding and identifying when families need additional support.

What should pediatricians look for when assessing latch?

Nash emphasized that pediatricians should be comfortable directly observing breastfeeding and evaluating whether an infant has an effective latch.

Important considerations include appropriate positioning of the infant's lips, maternal comfort, and whether feeding causes pain.

"One of my goals during my lecture on breastfeeding essentials is to make sure pediatricians understand that really looking and assessing a latch is one of the things that they should be able to do and be able to do effectively," Nash said.

Although observing a feeding during an office visit provides only a snapshot of breastfeeding at home, it can reveal problems with positioning or milk transfer.

Nash explained that prefeeding and postfeeding weights can help estimate how much milk an infant receives during a feeding.

Pediatricians should also observe rhythmic sucking, audible or visible swallowing, and whether the infant appears comfortable throughout the feeding.

When does breastfeeding pain indicate a problem?

Persistent pain during breastfeeding should prompt additional evaluation, according to Nash.

Although some discomfort may occur, effective latch and milk transfer should generally involve minimal pain.

Nash emphasized that clinicians should investigate whether discomfort results from ineffective positioning, poor latch, or another anatomical concern.

"If a baby is effectively latching and transferring milk, the pain should be minimal," she said.

Beyond the feeding itself, pediatricians should assess whether the infant appears relaxed and satisfied afterward.

Urine and stool output provide additional information about feeding adequacy and are practical measures families can monitor at home.

These observations can help pediatricians identify concerns while giving parents greater confidence in evaluating breastfeeding between appointments.

How can early education improve breastfeeding success?

Nash emphasized that breastfeeding education should begin before delivery rather than waiting until families encounter feeding difficulties.

Prenatal counseling can prepare parents for common early challenges, including breast engorgement, latch discomfort, and concerns about milk production.

She noted that families may misunderstand how much milk newborns require, particularly during the first days of life.

Nash used comparisons of newborn stomach size to explain why small amounts of colostrum may be appropriate early in feeding.

She encouraged pediatricians to discuss normal feeding expectations and reassure families that milk production changes during the early postpartum period.

Frequent feeding, approximately every 2 to 3 hours, combined with monitoring infant satisfaction and urine and stool output, can help families assess feeding effectiveness.

Providing this information before problems arise may reduce uncertainty and help parents recognize when additional assistance is necessary.

How can pediatricians strengthen continuity of lactation care?

Nash described continuity of lactation care as an essential responsibility beginning in the hospital and extending into outpatient pediatric practice.

Discharge planning should identify the infant's community pediatrician and available lactation resources, particularly when feeding concerns are already present.

However, not every pediatric practice has access to an on-site lactation consultant.

Nash recommended identifying a clinician within the practice who has additional breastfeeding training or experience.

When internal resources are unavailable, pediatricians should establish relationships with community lactation specialists.

State AAP breastfeeding coordinators and breastfeeding coalitions can help practices identify International Board Certified Lactation Consultants and other local resources.

Nash emphasized that pediatricians should know where to refer families when breastfeeding concerns exceed their available expertise.

For pediatricians, her recommendations reinforce the importance of direct feeding assessment, anticipatory education, and coordinated lactation support to help families navigate breastfeeding challenges.

Reference

Nash J. Breastfeeding Essentials. Presented at: American Academy of Pediatrics 2026 National Conference & Exhibition; October 5, 2026; San Diego, CA.