I use two strategies to help babies keep their hands out of the way when 
learning to latch. First, I have mom just let the baby eat his or her 
hand, until the baby realizes that there's no milk there. Babies are 
smart, and learn rapidly from the consequences of their actions if we 
let them! Then, I have mom bring the baby much closer to her trunk. If 
the baby's belly is on mom's ribcage, the chest is on the breast, and 
the chin is touching outside the areola, there is no room for the hands 
to get in the way! I think a lot of the hand flailing has two roots: 
insecurity because the baby's movement is suddenly free after being 
constrained by the uterus (think being wrapped tightly in trampoline 
rubber) and they are unstable because of that; and they are looking for 
the breast in a tactile manner (babies who are self-attaching use their 
hands on the breast first to locate the nipple, then press on the breast 
to make the nipple area stand up where their mouth can grasp it). If we 
give them great postural stability by "plastering" them to mom's trunk 
and give them tactile input by letting their chin touch the breast and 
the nipple touch their philtrum (the little ridge between nose and 
mouth), the flailing stops and their motor activity becomes very 
directed and purposeful. Since I've discovered this, I've been able to 
help older and older babies to attach to the breast. I have wonderful 
video tape of a one month old baby who had never successfully latched 
before crying and struggling, then going right onto the breast as soon 
as his chin touched. I use a little snippet of it in some of my 
presentations...

This is not to say that I never swaddle babies, and sometimes if mom has 
relatively large breasts, we trap the babies lower arm in mom's cleavage 
to keep it out of the way. Just most of the time, I find that the above 
works and I don't have to swaddle or stress about the hands.
Catherine Watson Genna, IBCLC  NYC

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