Here you can download a sample practical skills review form for Positioning and attachment.

Positioning and Attachment revision checklist


Help to teach a mother to position and attach her baby by using a doll to show by example, especially useful for those mothers who learn better by visual stimuli. Helpful for the teacher who may find it hard to find the right words to describe the attachment and positioning.

NB: essential that the teacher does not contradict what she is saying by the way she is holding the doll. Make sure you do not hold the back of the dolls head even if it is just your finger resting on the it’s head.

When explaining correct positioning and attachment it is important that you explain to the mother why you are asking her to do certain things. This will help make sense of the instruction and therefore help the mother remember it.



Explanation to the mother why this is important

Position of baby


Hold the baby so his head and body are in a straight line

This is because it is very difficult for any of us to swallow if our head is twisted

Support the baby from the shoulder leaving the head free to tilt back

This is because we all need to be able to throw our heads back to swallow

Hold the baby’s body as close to the mother as possible

This is so the baby can get close enough to get as much of the breast tissue in his mouth

Position the baby so his nose is opposite the mother’s nipple

This is so that when the baby opens his mouth and throws his head back he will get as much of area underneath the nipple in his mouth and the nipple will be thrown to the back of the baby’s mouth

How the baby attaches to the breast


Stimulate the baby to gape if necessary by rubbing his top lip on the nipple, wait for a wide open gape and bring him to the breast as quickly as possible with his chin leading

Because the baby has been able to throw his head back he will come to the breast with his chin leading and the chin will sit as close to he breast as possible.

His bottom lip will be curled back and his tongue will sit over his bottom lip—This automatically happens as the baby throws his head back with his mouth wide open.

The bottom lip will touch the breast well away from the base of the nipple

The nipple will reach to the back of the baby’s mouth beyond the hard palette to the area of the soft palette.

The baby can use his lower jaw to access the parts of the breast tissue that contain the milk and use the action of his lower jaw to draw off the milk.

Because the nipple sits way beyond the hard palette it is not squashed by the tongue against the hard palette which causes damage to the nipple (sore and cracks)

Signs of good attachment


Wide open mouth

Remember that often the mother or the helper can not see this very easily once the baby has attached

More of the areola visible above the top lip than below the bottom lip

Important to say more areola visible above the top lip than just at the top as mothers can be holding the baby in a multitude of positions and have come to the breast from any direction

Round cheeks

No slurping and clicking sounds

Showing that the baby has a large mouthful of breast sitting securely in the baby’s mouth.

If the baby’s cheeks were sucked in then it would show that the baby was clinging on to the breast and slurping and clicking sounds as the breast slides in and out of the baby’s mouth because not enough breast tissue in the mouth.

Chin indenting the breast

Showing that the baby came to the breast leading with the chin, is as close to the breast as possible so can get as much breast tissue in his mouth

Rapid sucks changing to deep sucks with a suck swallow pattern

Rapid sucks as the baby stimulates the let down reflex but as the milk comes it changes to regular sucks and swallows. If the baby continues with rapid sucks means that he is not able to access the milk. He may however have few occasions during the feed when he returns to rapid sucks as there can be a few let down reflexes during the feed. As the milk gets creamier towards the end of the feed the sucks get slower

Baby should seem contented to stay at the breast.

There should be no pain for the mother

The baby should come off the breast himself once he has finished the feed, the nipple should be the same shape as before i.e.: not lip stick shaped

Position should be sustainable


The mother needs to be comfortable as she will be feeding for at least 30-40 mins

Help her become more comfortable

If she needs a cushion to help her support the baby this can be put in once the baby is correctly attached ---not before.

Leave mother with leaflet e.g. “Off to Best Start” to reinforce information to remind mother of info once member of staff has left.


Revision checklist for hand expression of breast milk


Using a model (knitted) breast helps demonstrate the actions needed for hand expression. It is important that explanations for the actions are given to ensure mothers understand why so she can remember better.



Explanation to the mother

Stimulate the breast with gentle massage and stroking of the breast and nipple rolling

This stimulates the release of the hormones i.e. the let down reflex.

The baby would do this himself by stroking the breast and using the rapid sucks to “call in the milk”

Feel down the breast or up the breast from the nipple until the texture of the breast changes. Some people describe this as feeling like peas.

This is the area where the milk collects and can be accessed. It  is the area where the baby would  place his lower lip

Using the fore finger and thumb in a C shape COMPRESS and RELEASE the breast in a steady rhythm

Do not allow fingers to slide along the skin

Milk may take a few minutes to flow so keep the compress and release action until the milk starts to flow.


When the milk eventually subsides from that area rotate the fingers around the breast and then start to compress and release in this area

This allows for each lobe of the breast to be drained

When all lobes have been accessed move onto the other breast

May need to advise the mother to stimulate her hormones again if the milk flow subsides

NB: Milk production is always better if the baby is present as his presence will be stimulating the lactation hormones. If not possible something to remind of the baby, smell, sound, picture etc.

Milk production better if mother relaxed, so advise on back massage etc.

 Leave mother with written information to remind her of instruction once staff member has left


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