Why a Baby May Struggle to Feed: It’s Not “Laziness”

If a baby is struggling to latch to the breast or bottle, it is not because they are lazy, stubborn, or trying to be difficult. Babies are biologically designed to feed, so when feeding is hard, there is usually an underlying reason that needs to be understood. Feeding difficulty is a sign to look deeper, not a reason to blame the baby.

Parents are often told to “keep trying” or that their baby will “get there eventually,” but persistent feeding problems deserve proper assessment. Early support can help identify the cause, improve milk transfer, reduce pain, and protect breastfeeding confidence and supply and therefore longevity!

Tongue-Tie and Feeding

Tongue-tie, or ankyloglossia, is one possible cause of feeding difficulty. It can restrict tongue movement and interfere with latch, sucking, milk transfer, and maternal comfort. In a prospective observational study, Ghaheri and colleagues found that infants with tongue-tie had significant breastfeeding difficulties, and many improved after frenotomy.

A systematic review by Francis et al. found that frenotomy may reduce maternal nipple pain and improve some breastfeeding outcomes, although the overall evidence quality was limited and longer-term outcomes were less certain. Similarly, a systematic review and meta-analysis by O’Shea et al. concluded that frenotomy can improve breastfeeding difficulty scores and maternal pain in selected infants, but not every baby with tongue-tie requires treatment.

Other oral restrictions, such as upper lip-tie or buccal-tie, are sometimes discussed, but the evidence base is much less clear than it is for tongue-tie. A careful functional feeding assessment is more useful than looking at anatomy alone.

Causes of Feeding Difficulty

Breastfeeding and bottle-feeding problems can happen for many reasons, and oral dysfunction is only one part of the picture. Common contributors include the baby’s oral anatomy, muscle coordination, neurological maturity, positioning, maternal nipple or breast factors, and milk supply or flow issues.

Reasons a baby may struggle to feed include:

• Tongue-tie or other oral restrictions.

• Poor suck-swallow-breathe coordination or oral motor dysfunction.

• Prematurity or low birth weight, which can affect feeding stamina and coordination.

• Nasal congestion or illness, which can make breathing during feeds harder.

• Pain or discomfort such as oral thrush, reflux-related discomfort, or ear infection.

• Poor latch or positioning at the breast.

• Maternal nipple anatomy, including flat or inverted nipples.

• Breast engorgement, blocked ducts, mastitis, or low milk supply.

• Bottle flow mismatch, poor pacing, or feeding technique issues.

Signs to Watch For

Feeding problems can show up in different ways, and symptoms may be subtle at first. Common signs include nipple pain, clicking, shallow latch, prolonged feeds, unsettled behaviour at the breast, poor milk transfer, dribbling, coughing or choking, and slow or faltering weight gain.

In some families, the first sign is simply that feeding feels stressful or never seems to become easy. If feeding is consistently painful, inefficient, or exhausting, that is a strong reason to seek help.

Why Early Support Matters

Feeding difficulty affects more than milk transfer. It can lead to maternal pain, stress, frustration, reduced confidence, and strain on the parent-infant relationship. A recent systematic review found that mothers of babies with tongue-ties were at increased risk of breastfeeding complications, including nipple pain and emotional stress.

That is why early assessment matters. The sooner the cause is identified, the sooner a family can get the right support, whether that is breastfeeding help, oral-motor support, bottle-feeding adjustments, lactation support, or referral for tongue-tie assessment when appropriate.

When to See an IBCLC

An International Board Certified Lactation Consultant can assess feeding function, latch, positioning, milk transfer, oral anatomy, and feeding behaviour in a practical, baby-centred way. This is especially important when a baby is struggling at both breast and bottle, because that often points to a broader feeding issue rather than a single latch problem.

If you are worried that your baby cannot feed well, or if feeds are painful or stressful, do not wait and hope it will simply improve on its own. Babies are designed to feed, and when they cannot, there is a reason that deserves attention.

Reference List

• Ghaheri BA, Cole M, Fausel SC, Lin B, Holleman R, Muench C. Breastfeeding improvement following tongue-tie and lip-tie release: A prospective cohort study. Laryngoscope. 2017;127(5):1217-1223

• Francis DO, Krishnaswami S, McPheeters M. Treatment of ankyloglossia and breastfeeding outcomes: A systematic review. Pediatrics.  2015;135(6):e1458-e1466

• O’Shea JE, Foster JP, O’Donnell CPF, et al. Frenotomy for tongue-tie in newborn infants. Cochrane Database Sytemic Review. 2017;(3):CD011065

• Royal Women’s Hospital. Tongue-tie

• Royal Women’s Hospital. Breastfeeding problems

• National Health Service. Common breastfeeding problems