Questions to Ask Lactation Consultant
Twenty questions for a consultation with a lactation consultant, covering what they observe at the latch, weight and intake, pain, supply, pumping, and the plan for the days after the visit.
The questions
Open any question for the note
What are you seeing in the latch, and can you show me the change on this feed?
Why ask it
Ask for the adjustment in your hands rather than a description of it. A visit that ends with an explanation but no successful feed leaves you with information you cannot reproduce at two in the morning.
Is the baby getting enough, and what are you basing that on?
Why ask it
The basis is the part that matters: a weighed feed, output over the last day, or the weight trend. Reassurance offered without any of those is an opinion, and it is worth knowing which you have been given.
How does the weight compare with birth weight, and is that expected at this age?
Why ask it
Weight is read against days of life and against the lowest point, not against the birth figure alone. Ask for the numbers to be written down, since this is the measure any doctor you see next will ask about first.
Is anything physical making this harder, in the mouth, jaw or neck?
Why ask it
Tongue movement, palate shape, jaw position and neck tightness all affect feeding, and some need referral rather than technique. Ask directly what they can assess and what they would send you elsewhere for, so you know the limits of this visit.
Which positions should I use, given my size and the baby's?
Why ask it
General position advice is where most feeding guidance stops being useful. Ask for the two that suit your body and this baby, and have them photographed on your phone before the consultant leaves the room.
What is causing the pain, and what will change it?
Why ask it
Nipple pain has several distinct causes, and shallow latch, damage, thrush and vasospasm are managed differently. A plan that treats pain as something to endure until it passes is not a plan.
How often should I be feeding right now, and should I wake the baby?
Why ask it
The answer depends on age, weight trend and whether jaundice is a factor, so this is the question where generic advice does the most harm. Ask what changes the answer, since it is likely to change within a week.
How long should a feed take at this stage, and when should I stop trying?
Why ask it
Without a limit, many parents end up feeding for an hour, then pumping, then bottle feeding, around the clock. Ask for a time to stop and what to do instead, because that boundary is often what makes the rest sustainable.
If I need to give extra milk, how much, using what, and how do I protect supply?
Why ask it
Supplementing is a specific instruction with an amount, a method and a plan to reduce it, not a yes or no. Ask what would let you cut it back and how you will know when that point has arrived.
How can we tell whether my supply is low or the baby is not transferring well?
Why ask it
These two situations look identical from the outside and need almost opposite responses. Ask what would distinguish them in your case, because getting this the wrong way round costs weeks of unnecessary pumping or unnecessary worry.
If I pump, how often, for how long, and is my flange the right size?
Why ask it
Flange sizing is one of the most common practical problems and it causes both pain and poor output. Bring your pump and parts so this can be checked rather than guessed at.
How should I store and use what I express?
Why ask it
Handling rules differ depending on whether milk goes in the refrigerator, the freezer, or straight into a bottle, and on whether the baby is premature or unwell. Ask for the version that applies to your baby rather than the general one.
What should make me call a doctor rather than you?
Why ask it
This draws the line between a feeding problem and a medical one, and it is the most useful boundary a consultant can give you. Ask for the specific signs in both you and the baby, and who to call outside office hours.
What is the plan for the next two days, in writing?
Why ask it
A plan with numbers and times can be followed at three in the morning by an exhausted person; encouragement cannot. Ask for it before the visit ends, since almost nobody recalls it accurately afterwards.
When should we speak again, and what would make you want to see us sooner?
Why ask it
Early feeding changes quickly, so a single visit rarely settles it. The sooner list also tells you which parts of the plan they are least confident about.
Will you send a note to my doctor and the baby's doctor?
Why ask it
Feeding sits between two clinicians who often do not hear from each other. A short written summary going to both prevents you having to relay a plan you are still learning yourself.
What is your qualification, and how does the billing work?
Why ask it
Titles in this field vary considerably in training, and so does whether a visit is covered or reimbursed. Ask what documentation you will be given for a claim, since that is easier to request at the visit than afterwards.
If I decide to combination feed, or to stop, will you still help me?
Why ask it
The answer tells you whether the rest of the support will come with pressure attached. A consultant who can plan a reduction or a transition calmly is more useful than one who treats any change as a failure.
What would count as a good outcome here?
Why ask it
Asking this aloud stops you and the consultant working toward different goals for a month. Say what you want as well, because a workable plan for someone returning to work in three weeks looks nothing like one for someone at home.
If this does not improve, what are the other options and when should I consider them?
Why ask it
Knowing the next step in advance removes the sense that everything rests on this attempt. Ask for a date to reassess, since an open-ended plan tends to continue long after it stopped working.
Getting the Most from a Feeding Consultation
Practical guidance for the conversation itself
Before the appointment
Bring a short log, not a full diary
Times of feeds, roughly how long, output, and any amounts given by bottle over the past day or two. Two days of accurate notes is more use than a week of estimates.
Bring the equipment
The pump with its parts, any bottles and teats you use, and a nipple shield if you have one. Sizing and assembly problems are common and can only be checked in person.
Time the visit so the baby will feed
The consultation is built around watching a feed, so a baby who has just finished one leaves little to observe. Ask when booking how they would like you to time it.
Have another adult there if you can
One person holds the baby and one writes things down. Very little of a first consultation is remembered accurately by the person who is feeding.
Write your three questions on your phone
Visits run out of time and the practical questions about supplementing, pumping and follow-up are the ones most often left unasked. Put them in order of what you would regret missing.
During and after the visit
- Ask them to watch a whole feed, not the first two minutes, since problems with transfer often appear later in it
- Photograph or film the position that worked, from the angle you will see it from yourself
- Get the numbers on paper: weight, amounts, how often, for how long, and for how many days
- Repeat the plan back in your own words before they leave, which is when misunderstandings surface
- Ask what to do if the plan is not working by tomorrow, rather than waiting for the next appointment
- Ask for a copy of anything sent to your doctor or the baby's doctor
Where this stops being a feeding question
Signs that need medical care
Fever, spreading redness or a hard painful area in the breast, a baby who is feeding much less than usual or is difficult to rouse, or jaundice that seems to be increasing. Ask your consultant for their own list at the first visit and keep it where you can find it at night.
A lactation consultant is not a prescriber
Suspected infection, tongue-tie division and medication questions go to a doctor, dentist or midwife depending on where you are. Good consultants say so plainly and will tell you who to see.
Your own health is part of the picture
Pain, exhaustion and low mood affect feeding and are treatable in their own right. If you are struggling, say so at the visit rather than waiting for the six week appointment.
Be careful with guarantees and product lists
Nobody can promise a particular feeding outcome, and a consultation that ends mainly in purchases has drifted. Supplements marketed for supply are not a substitute for working out whether the milk is being removed effectively.