Causes of Clicking during Infant Feeding | An Indepth look at noisy breast or bottle feeding
Read time | 10 minutes
When I wrote on the causes of clicking during breastfeeding last year, I had no idea that it would quickly move to the first page of google.
I knew hearing clicking noises during feeding was a common occurrence for parents, but I couldn't have imagined that a short, poorly written post would become my highest performing post to date, with over 3,050 views since posting.
While my understanding of clicking during infant feeding hasn't changed much, my ability and desire to create easy to understand, in-depth blog posts has increased.
Therefore, I want to tackle this topic again, but in a manner that is true to me, resulting in an article that I don't shake my head and wonder, "Shondra, what were you thinking to post this unhelpful, pointless trash?"
What is Clicking?
In this context, clicking describes a short, sharp sound created from a baby's mouth. It sounds similar to a "tsk tsk" sound one makes if they're demonstrating disapproval (or "tut-tut" for my UK folks), though some might better relate to the ICONIC tongue popping sound popularized by the queen Alissa Edwards.
When it comes to baby, the clicking sound isn't as sharp or consistent as tongue pops made by adults, but once you're familiar with the general sound, identifying clicking variations during infant feeding becomes easy.
What causes clicking?
Clicking is caused whenever there is a loss of suction. This can happen both at the breast or on the bottle, and may or may not be seen in conjunction with more obvious signs of "breaking the seal" such as leaking.
How the clicking noises sound- sharp and bright or muffled- can depend on which part of the tongue loses suction, which also explains why for some, milk spilling from the baby's mouth accompanies the clicking, and for others, there's just the sound.
Note: There can be leaking without clicking too, which also provides useful information for troubleshooting feeding difficulties.
Is clicking a problem?
Though I would argue that clicking sounds aren't normal, I wouldn't say it's always a problem.
For example, if your baby makes the occasional clicking noise or if it's during a time of intense breast fullness, there's generally nothing to worry about.
Consistent clicking during feeding, however, especially in conjunction with other signs of feeding difficulties, such as nipple pain, slow weight gain, coughing, choking, gasping, panting, unlatching, grimacing, should be evaluated, even if it occurs during bottle-feeding.
Why is my baby making clicking noises?
There are many reasons possible causes for clicking.
Poor positioning/latch
A strong, forceful letdown
Engorgement
Poor tongue mobility/function (Such as tongue tie)
A weakness of the tongue
Inability to maintain a seal due to weak muscles or restricted lip (lip tie)
Body tension or physical limitations such as Torticollis
Hard Palate abnormalities
Submucosal cleft
Ear Infections
Thrush
Let's take a look at each case separately.
Poor latch & positioning
Oft, the phrases latch & position are used synonymously. Still, they describe two distinct steps- the latch refers to how your baby's mouth attaches to the breast or bottle and position relates to your baby's physical arrangement and orientation in space and in regards to the feeding parent.
To make it easy
Latch = mouth. Position = body. Latch =/= position.
A baby's position can, and often does, affect how effectively a baby latches and how well they can transfer milk ( a whole different & distinct step of feeding!)
An issue with the latch OR the position can cause clicking in some babies, in which case, mastering the latching technique and finding the right feeding position to support your baby's feeding ability may be all that's needed to achieve quiet feeding.
The act of mastering latching is many times easier said than done. Even after reading this excellent FREE 24-page latching guide, some parents will need additional latching support and troubleshooting.
Luckily, even if you live in an area short on IBCLC's, there are often many experienced lactation professionals who can help with latching basics and refer when necessary if tailored latching help doesn't resolve the issue.
A strong, forceful letdown
Just as some are "blessed" (or "cursed" depending on who you ask) with very robust milk supplies, some are "blessed" with an extraordinary rate of milk flow.
Though forceful letdowns & oversupply often go hand and hand, forceful letdowns (Overactive Milk Ejection Reflex [MER]) can happen in those with "typical" milk supplies. However, the underlying cause may be different. For example, full breasts often accompany oversupply, which may result in a forceful letdown due to the pressure build-up inside the mammary glands. The first letdown, and even the second, may be mighty as the breast releases the milk with a force that rivals Niagra Falls.
With Overactive MER, rather than the force stemming from milk volume, the power is due to an overachiever reaction on the part of the pituitary gland( which sends out the hormone that tells the 'milk sacs' to contract and send the milk out the breast).
As you may imagine, regardless of the cause, your baby can easily become overwhelmed with the rate of milk and release tongue suction to allow milk to spill from the sides of their mouth so they can breathe.
If the flow rate is the cause of the clicking, strategies tailored for managing overactive letdowns, along with more upright & laidback feeding positions, should resolve the clicking.
Engorgement
This cause is pretty simple: Full, taut breasts are hard to grasp on to, so during periods of intense engorgement or fullness, clicking may occur.
Resolve the swelling or reduce breast fullness, and the clicking should stop.
Poor tongue mobility/function (Such as tongue tie)
Poor tongue function is NOT always caused by tongue-tie, however, tongue-tie often causes poor tongue function thus impacting its range of motion (mobility).
There are many stages of the feeding and swallowing process, and a limited function of the tongue can impact each of the required steps.
The clicking sound associated with poor oral function due to tongue-tie can be broken down to this straightforward overview-
A tight frenulum doesn't allow your baby's tongue to raise to the proper placement for easy feeding OR the effort it takes your baby to overcome the resistance of a tight frenulum is such that they quickly get tired and start to lose suction.
Reduced tongue mobility is the most common cause of persistent clicking I see. There is such a strong association with clicking and tongue ties, that clicking alone is enough to prompt a tie suspicion even in the absence of "typical tongue-tie appearance."
A weakness of the tongue
The tongue is a group of muscles, and with any muscles, it can be or become weak. Weakness may be a byproduct, which is commonly seen with tongue-tie and explains the need for tongue strengthening exercises pre and post revision, but can be a stand-alone cause of clicking.
It takes an experienced and highly trained professional (such as IBCLCs who specialize in supporting tied babies) to be able to differentiate between limited tongue function caused by weakness vs. reduced tongue mobility caused by ties.
Inability to maintain a seal due to weak muscles or restricted lip (lip tie)
There is a profound link between tongue mobility and many other structures of the body (see below), to include the lips and surrounding oral muscles. Any weakness or limitation of any oral anatomy has the potential to impact tongue function.
Body tension or physical limitations such as Torticollis
See above. Insert body tension/physical limitation in place of muscle weakness/lip tie.
Hard palate abnormalities
The hard palate is the bony part of the roof of the mouth. We expect the palate to be intact with a gradual slope.
Sometimes there are abnormalities in the palate, be it due to congenital defects (such as cleft palates) or due to abnormal development caused by a lack of appropriate palate pressure in utero (ex: bubble palates).
During breastfeeding and bottle-feeding, the palate provides a platform for stabilizing the breast/teat in the oral cavity. Palatal abnormalities can impact stability, and clicking can result.
Submucosal clefts/ Velopharyngeal insufficiency (VPI)
Generally speaking, clicking sounds often come from the anterior portion of the mouth, and some may argue that clicking doesn't occur with submucosal clefts or VPI.
I wanted to add this category because how parents and providers interpret clicking is subjective. And because clicking noises already vary in sound and intensity, I don't think it's too much of a stretch to include sounds that may be loosely considered clicking.
Milk leaking from the nose during feeding is a classic symptom of submucosal clefts/VPI and will always require a referral for further evaluation. However, sometimes a soft puffy "clicking-esque" noise may be present due to loss of suction of the soft tissues near the throat and would also warrant a referral.
Ear Infections/ Thrush
Thrush & ear infections both can change the way your baby eats, and temporary clicking may occur. Once the thrush or ear infection resolves or the pain disappears, the clicking noises should stop as well.
I'll admit, I'm biased, but ff your baby suddenly starts to click and around the same time, you notice you're having some breast pain, it would be good practice to schedule a lactation consultation. During the consult, we will assess what's causing the pain and develop a care plan to reduce the discomfort.
As you may see, there are a lot of possibilities for your baby’s clicking. In many cases, when clicking persists despite position changes and after engorgement passes, the clicking is due to something structural.
I often find myself asking if there’s any clicking present during feeding when parents complain of pain, slow weight gain/weight loss (baby), and low supply.
The reason?
Babies need a proper seal to maintain vacuum pressure to transfer milk effectively and efficiently.
Many times parents are told that clicking is typical, or that there are no issues with their baby’s noisy eating, even though they sound similar to the baby below.
The baby in this clip is NOT feeding efficiently at all. Continued poor feeding is often very stressful for babies (and parents) and can lead to long term feeding aversions. Clicking may be the only noticeable sign of dysfunctional feeding, especially when babies are gaining weight or having appropriate diaper output.
If your baby is making clicking noises that persists or if they leak, gulp, gasp, pant, pop off or grimace and fuss while feeding (bottle or breast), please download this DIY Oral Assessment worksheet.
Once completed, you will have a better understanding of your baby’s oral strengths and weaknesses. The sooner we find solutions to make feeding easier for your baby, the better. You can book an appointment here.
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