by Jack Newman, MD, FRCPC
There are many reasons a baby might refuse to take the breast. Often there is a combination of reasons. For example, a baby might latch on even with a tight frenulum if no other factors come into play, but if, for example, he is also given bottles early on, or if the mother's nipples and areolas are swollen from fluid from the fluids she received during the labour and birth, this may very well change the situation from "good enough," to "not working at all."
However, one of the most common causes of babies' refusing to latch on arises from the misguided belief that babies in the first few days must breastfeed every 2 hours, or 3, or on some other aberrant sort of schedule. Babies were not meant to feed by the clock even during the first days. Belief in the schedule and trying to stick to a schedule results in anxiety on the part of the staff when a baby has not fed, for example, for three hours after birth, which then results, frequently, in babies being forced to the breast when they are not yet ready to feed. When the baby is forced into the breast, and kept there by force, especially when the baby is not interested or ready, we should not be surprised that some babies develop an aversion to the breast. If this misguided approach then results in panic, and "the baby must be fed," alternative feeding methods (the worst of which is the bottle) are then used, resulting in worsening of the situation and the beginning of a vicious circle.