8.2 Assessing and Correcting the Latch
Key Takeaways
- The LATCH tool scores five components — Latch, Audible swallowing, Type of nipple, Comfort, and Hold/help needed — each 0 to 2, for a composite of 0 to 10; scores below about 7 flag a dyad needing more support.
- Suction must be broken safely before unlatching: insert a clean finger into the corner of the infant's mouth to break the seal rather than pulling the baby straight off, which injures the nipple.
- A shallow or painful latch is corrected by re-aligning the dyad, waiting for a wide gape, and re-latching chin-first — not by enduring the feed.
- Suck assessment (digital exam of palate, tongue movement, and seal) distinguishes a positioning problem from an oral-motor problem such as ankyloglossia.
- Persistent poor transfer and maternal trauma despite an optimized latch are the trigger to suspect tongue-tie or another structural issue and to refer, since diagnosis and frenotomy are outside the IBCLC scope.
From Impression to Documented Assessment
The IBCLC exam's Clinical Skills and Techniques domains reward structured, repeatable assessment over gut feeling. A standardized tool lets two clinicians describe the same feed the same way, supports objective documentation, and shows change over time. The most widely tested charting system is the LATCH tool.
The LATCH Scoring Tool
LATCH is an acronym in which each letter is scored 0, 1, or 2, for a composite 0 to 10. Higher is better.
| Letter | Component | 0 (concern) | 2 (ideal) |
|---|---|---|---|
| L | Latch | Too sleepy/will not latch | Grasps breast, tongue down, lips flanged, rhythmic suck |
| A | Audible swallowing | None | Spontaneous and intermittent (older newborn: frequent) |
| T | Type of nipple | Inverted | Everted after stimulation |
| C | Comfort (breast/nipple) | Cracked, bleeding, severe pain | Soft, non-tender |
| H | Hold (help needed) | Full staff assist to hold to breast | No assist; parent positions independently |
A total below roughly 7 is a practical cue that the dyad needs more support and follow-up. The score is a communication and triage tool, not a pass/fail grade — an exam item may ask you to identify the lowest-scoring component as the focus of your care plan.
Recognizing a Shallow or Painful Latch
Signs that a latch is shallow or ineffective include: pain that persists through the feed; a creased, pinched, or lipstick-shaped nipple afterward; clicking or smacking sounds (lost seal); cheeks that dimple inward; lips tucked in; little or no audible swallowing; and an infant who slips off or feeds for very long stretches without satiety. Any one of these warrants re-assessment.
Breaking Suction and Re-Latching Safely
Never pull a latched infant straight off the breast — the vacuum can tear nipple tissue. The correct sequence:
- Break the seal first — slide a clean finger into the corner of the infant's mouth between the gums until you feel the suction release.
- Gently remove the breast once the seal is broken.
- Re-set positioning — return to the four principles: align, face, support, baby-to-breast.
- Wait for a wide gape, then re-latch chin-first for an asymmetric latch.
- Re-confirm the signs of an effective latch before continuing.
Example: An IBCLC scores a feed: Latch 1 (shallow, frequent slipping), Audible 1, Type 2, Comfort 0 (cracked, bleeding, pain throughout), Hold 1 — total 5/10. Comfort and Latch are the lowest. She breaks suction with a finger in the corner of the mouth, re-aligns the dyad chest-to-chest, waits for the gape, and re-latches chin-first. The next feed scores Latch 2, Comfort 1 — total 8/10 — and she documents the change plus a 48-hour follow-up. The rising score shows the intervention worked.
The Role of Suck Assessment
When a latch will not deepen with positioning alone, a digital (finger) suck assessment helps locate the problem. With a clean gloved finger, pad up, the clinician evaluates palate integrity and shape, tongue extension and elevation, the strength and rhythm of the suck, and whether the infant maintains a seal and peristaltic (wave-like) tongue motion. A disorganized, weak, or non-peristaltic suck, or a tongue that cannot extend past the gum or elevate to the mid-mouth, points toward an oral-motor cause rather than simple positioning.
When Poor Latch Signals a Structural Problem
If transfer stays poor and the parent has ongoing nipple trauma despite a fully optimized latch and position, suspect a structural cause such as ankyloglossia (tongue-tie), high-arched or cleft palate, or retrognathia (a small, set-back lower jaw). The clinical principle is the same as for tongue-tie elsewhere in this guide: act on function, not appearance.
A visible frenulum or a slightly recessed chin is not, by itself, a problem; what matters is whether the infant can extend and elevate the tongue, maintain a seal, and transfer milk. So the workup is sequential — rule out and fix positioning first, because the great majority of shallow latches resolve with deeper attachment alone.
When the latch is genuinely optimized and the problem persists, the IBCLC's job is to assess function, optimize what is in scope, document intake (weights and output), and refer to a physician, dentist, or surgeon for evaluation. Remember the scope boundary: an IBCLC does not diagnose tongue-tie or perform frenotomy — a frequent distractor on exam items.
The right answer pairs a referral with continued lactation support: keep protecting supply (express if transfer is poor), keep the baby fed (supplement with expressed milk if needed), and keep working the latch while the referral is pending. Abandoning support, or leaping to surgery the IBCLC cannot order, are both wrong.
Match each letter of the LATCH tool to what it assesses.
Match each item on the left with the correct item on the right
A mother needs to remove her newborn from the breast because the latch is shallow and painful. What is the safest technique?
After fully optimizing positioning and latch over several feeds, a newborn still transfers poorly, slips off repeatedly, and the mother has worsening nipple trauma. A digital suck assessment shows the tongue cannot extend past the gum or elevate to the mid-mouth. What is the most appropriate next step?
On the LATCH tool, each of the five components is scored from 0 to 2, giving a maximum composite score of ___.
Type your answer below