by Anne Smith, IBCLC
You and your baby have been happily nursing for several months. You have overcome the common problems nursing couples have in the early weeks, such as sore nipples or engorgement, and things are progressing nicely. Suddenly, he begins refusing the breast and seems quite unhappy about it. Is he weaning? Is he sick? Is there something wrong with your milk?
This abrupt breast refusal, usually in a baby between three and eight months old, is called a "nursing strike". It is possible that a baby younger than one year will wean himself, but it is very unlikely unless he is at least nine months old. A baby who is weaning himself will usually do it gradually, and will not be unhappy about it.
Nursing strikes usually only last a few days, but may last for a week more. It is not always easy to discover what is causing the breast refusal, and sometimes the cause is never found. Many mothers choose to wean during a nursing strike, especially if their baby is older than six months, but most of the time, babies can be encouraged to return to breastfeeding within a few days. This requires patience and determination on your part, but is well worth the effort.
Nursing strikes are frustrating and upsetting for everyone involved -- mother, baby, dad, and siblings are all affected. Your baby will be unhappy and it may be difficult to calm him down. You may feel that he is rejecting you, and also may feel guilty, thinking that your baby's refusal to nurse is due to something you have done wrong. This is rarely the case.
You may also be uncomfortable physically. If your baby skips feedings, your breasts will fill up with milk, and you may become engorged and/or get plugged ducts. If your baby is only a few months old and not eating solids, you will also worry about whether he is getting enough to eat, and how to feed him if he continues to refuse the breast.
While your baby is on a nursing strike, you will need to express your milk as often as he had been nursing previously. If you are unable to use hand expression, don't own a good electric pump, and if the strike continues for more than a few days, you may want to consider renting a hospital-grade electric pump until he decides to nurse again. Expressing your milk regularly will help prevent problems with engorgement or plugged ducts, provide breastmilk for your baby during the strike, and maintain your supply so that when he does return to the breast, an ample quantity of milk will be there for him.
During the strike, you will need to decide how to give the milk you express to your baby. It may be easier to get him back on the breast if you avoid bottles and feed him via cup, syringe, dropper, SNS (Supplemental Nursing System -- a tube feeding system that attaches to your breast -- see Medela products), or finger feeding system (Hazelbaker feeding system -- see Medela products). These last two options are usually reserved for situations where nursing is postponed for long periods of time, which is not usually the case with the average nursing strike. Bottle-feeding with a rubber nipple may satisfy your baby's need to suck, making him less likely to want to nurse. This is especially true with younger babies. Believe it or not, even newborns can be cup-fed. Feeding with a syringe or dropper can be messy, but with a little practice, most babies will get the hang of it fairly quickly.
There are many causes for nursing strikes. These include:
• Mastitis Your milk supply may decrease after a breast infection, and the sodium levels may rise, making the milk taste salty. These are temporary problems, but your baby doesn't know that.
• Teething Some babies respond to the discomfort of teething by wanting to nurse more often, while others will refuse to nurse at all. See article on Teething and Biting for suggestions on how to handle teething pain.
• Illness If your baby has a stuffy nose, a cold sore, and ear infection, or thrush in his mouth, nursing may be uncomfortable for him. If he has an ear infection, lying on his infected ear may be uncomfortable. Try nursing him in an upright position or the football hold to avoid pressure on the affected ear. If his nose is congested , ask your doctor about ways to unclog it (usually saline drops, nasal aspirator, humidifier, or he may recommend medications to decrease the production of mucus). See article on Yeast Infections for detailed information on how to treat thrush in a baby's mouth. Anytime a baby's mouth is uncomfortable, whether the cause is teething or thrush, bottle-feeding is usually more comfortable for him. Don"t feel rejected if he will take a bottle, but refuses the breast. The mechanics of breast and bottle-feeding are quite different, and drinking from a bottle requires less effort and less mouth movement than nursing does. This is one reason that it is preferable to use another method to feed your expressed milk to your baby during a nursing strike, rather than bottles. However, if giving a bottle is the only way to get your baby to eat during a strike, don't stress about it too much. Most babies will go back to the breast after they feel better, even if they have had a few bottles.
• Reaction to stress Some babies will respond to negative stimuli by refusing to nurse. This stress may be due to siblings who vie for mother's attention during nursings, a change in environment (such as travel to a new place or moving to a new house), a mother's overreaction to being bitten (see article on Teething and Biting), or severe stress in your life (divorce, death in the family, etc.)
• Prolonged separation from mother Sometimes a baby will refuse to resume nursing after mom has left him for a weekend or longer.
• Low milk supply This can be caused by long intervals between nursings, overuse of bottles or pacifiers, or an illness in the mother. This can cause a "Catch 22" situation -- your supply is low, so your baby won't stay on the breast long enough to build it back up; because he doesn't nurse long enough, your supply doesn't increase. See article on Increasing Your Milk Supply for tips on building your supply back up.
• A change in the taste of the milk Applying creams or ointments (other than lanolin especially formulated for nursing mothers, which is odorless and tasteless), use of a new product such as shampoo or deodorant, and rarely, something in your diet (such as dairy products or excessive caffeine) can cause babies to refuse the breast.
When encouraging a baby to take the breast, you need to be patient and persistent. If you or your baby get frustrated during the process, it is best to stop and try an alternate feeding method. Try again later, because you don't want to set up a negative association with nursing. Many babies are very sensitive, and you want your baby to associate nursing with positive feelings.
• Give your baby lots and lots of attention and skin-to-skin contact. Use a sling or baby carrier to keep him close between feedings. Try getting in the tub together. Nurse without a bra, and undress your baby down to his diaper. Throw a blanket over him if the room is chilly.
• Try nursing when he is sleepy. You may be more successful in getting him to nurse if is drifting off to sleep or just starting to wake up. Tuck him in bed with you at night.
• Try to minimize distractions. Nurse in a quiet, dark room, or put on some soothing music.
• Try different nursing positions, and try nursing while in motion -- rock, bounce, or sway while nursing. Experiment, and find out what works for your individual baby. Some babies will nurse while rocking or walking, but not while you are sitting in a chair. Some will nurse while lying down, but not while sitting on the couch. Some will nurse in the cradle hold, but not in the football. You get the idea.
• Try getting your milk to let down before you attempt to nurse. This will encourage the let-down so that he doesn't have to wait for it once he starts nursing.
• Offer the breast frequently. Don't wait till he's really hungry. This seems logical ("if he's hungry enough, he'll nurse) but it can often backfire. A frantically hungry baby is less likely to be willing to take the breast. If he gets really upset while you are trying to get him to nurse, stop the feeding, give him a little milk (preferably not by bottle) just to take the edge off his hunger, then try again. Try dripping a little milk into his mouth with a dropper or syringe while he is at the breast to encourage him to nurse.
After discussing the causes of nursing strikes and strategies for getting babies back on the breast, it is important to discuss the difference between a baby who fusses at the breast and seems to be losing interest, and one who truly refuses the breast completely.
In my twenty plus years of experience of counseling nursing mothers, I have learned that the majority of calls from mothers occur during the newborn period (engorgement, nipple soreness, concerns about milk intake, etc.). A "honeymoon" period usually follows, from about two weeks to two months, when things seem to be going along smoothly. Then, at some point between two and four months, I get calls from concerned moms who say things like, "He will only nurse for ten minutes; He pulls off the breast and fusses in the middle of the feeding, then acts like I'm trying to poison him when I try to get him to latch on again; he wants to nurse constantly in the evenings and doesn't seem satisfied". This behavior is developmental in nature, and doesn't constitute a nursing strike. Usually these babies will nurse well first thing in the morning, as well as during the night. The afternoon and evening feedings are the most problematic.
There are a number of reasons for babies to become fussy at the breast after they have passed the newborn period (the first six weeks or so). One is that babies become much more social during this time. A newborn infant will blissfully nurse for an hour or more, totally oblivious to his surroundings. There could be a major earthquake, and a newborn would nurse right through it, because newborns love to suckle. They even suck their fingers in utero, just because it feels good. Once a baby learns to actively interact and smile at you, he becomes much more distractible. He wants to nurse, but he also wants to play and smile at you at the same time. He is very interested in his surroundings, and wants to look around the room if the TV is on or a sibling is playing in the corner. It is very difficult to stay attached to the breast and look around the room at the same time. This can be very frustrating to babies, and can cause them to fuss and pull off the breast.
Another factor is patience. Your milk lets down vigorously at the beginning of a feeding, then slows down to a trickle. If your baby keeps nursing, he will be rewarded with another let-down. While a newborn is perfectly willing to keep nursing while he waits for another let-down (remember, he doesn't have much else to do that's fun at that point), an older baby may get antsy after the initial flow of milk slows down, and may not be willing to continue nursing while he waits for another let-down.
Many older babies will get all the milk they need in less than fifteen minutes. Your let-down reflex is well established by this time, and babies become very efficient at nursing. The baby who pulls off the breast after a few minutes and refuses to take the second side may simply have gotten his fill. See the article on How To Tell If Your Baby is Getting Enough Milk if you're not sure if he is getting enough to eat.
Many older babies will also begin to fight sleep in the evenings. I have never understood this phenomenon, because sleeping is one of my favorite activities. Many babies will fight sleep even while their eyelids are drooping and you know for a fact that they are exhausted. A baby who is fussy at the breast in the evenings may not stay on long enough to get the fatty hindmilk that will help fill his tummy so he will sleep a longer stretch at night. If your baby is fussy in the evenings and wants to nurse frequently, offer him the same breast until he has nursed on that side for twenty minutes. Switching from side to side too often can cause him to take in more of the foremilk, which is higher in lactose and can cause gassiness.
Also, your milk supply is lowest in the evenings, and you are the most tired and stressed. This can be a very frustrating period for everyone involved.
The techniques used for encouraging a fussy baby to nurse are similar to those used for babies who are refusing the breast completely. Try the above techniques, but if nothing works, consider giving him a supplemental feeding (preferably breastmilk) during his fussy period if you can't get him to settle down enough to nurse. This may be a good time to introduce a bottle if he is older than three weeks. Dad can give him a little milk in the evening, and give you a break as well. You might even be able to take a hot bath -- ah, luxury!!!!
Whatever the cause of a baby's refusal to nurse, you can almost always convince him baby to continue nursing. It takes a lot of patience and persistence, but the benefits to both of you are well worth the effort.
Anne Smith, IBCLC has breastfed a total of six children (three boys, three girls). She feels that her first hand experience plus her more than twenty years experience of counseling nursing mothers are among her most important credentials. Anne has been a La Leche Leader since 1978 and IBCLC since 1990. As a nursing mother, LLL Leader, and IBCLC, Anne has worked in many areas over the years. She has led support group meetings, taught breastfeeding classes, trained breastfeeding peer counselors to work with low income mothers, worked one-on-one with mothers to solve breastfeeding problems, helped thousands of mothers with breastfeeding questions over the phone, held workshops for health professionals on various breastfeeding topics, taught OB, Pediatric, and Family Practice Residents breastfeeding at Bowman Gray School of Medicine, and run a breast pump rental station with over 100 pumps, scales, and nursing bras for the past eleven years. We invite you to visit Anne's website.
Copyright © Anne Smith. Permission to republish granted to Pregnancy.org, LLC.