by Debbi Donovan, IBCLC (see more from this expert)

Q

For the last couple weeks my three-month-old baby has been refusing to nurse. She will arch her back and scream when I put her to my breast. We took her to her doctor for a checkup and she ruled out illness, though she said she could be teething. I walk her around and rock her while I try to feed her or I will wait until she is sleepy. She seems to do better then. I am stressed out and frustrated I'm thinking about weaning her to a bottle. Is this just a stage she is going through?



A

It is very stressful when your baby seems unhappy at your breast. I have experienced this myself. Many moms feel a strong sense of rejection and dread nursing sessions. Refusal of the breast can be as "simple" as a nursing strike, or there may be other factors involved.

You mentioned that your baby had been seen by a physician to rule out conditions such as oral thrush, an ear infection or gastroesophageal reflux. That was a good idea. Sometimes thrush is present in the mother with no visible symptoms (yet) in the baby. Have you had any nipple soreness? Have you or your baby been treated with antibiotics? Did you have symptoms of a vaginal yeast infection during your pregnancy?

If you have had pinkness, burning, itching or shooting deep breast pain you may have candidiasis (thrush). If you suspect thrush is the culprit, talk with your health care provider. You and baby would require simultaneous treatment for at least two weeks with antifungal medications if thrush is present in either (Breastfeeding: A Guide For the Medical Profession, Ruth Lawrence, MD, 1994.) Thrush can cause a baby discomfort. A baby may start to nurse and then pull away from the breast, becoming fussy.

A baby whose mom has a very abundant milk supply may begin to refuse the breast. These babies often gag and choke as your milk is ejecting. They may appear to dislike breastfeeding, pulling away and crying soon after beginning to nurse. These babies may finish nursing quickly and are often prone to gassiness and spitting up. They are usually quite healthy babies with better than average weight gains. They may always seem hungry. Some moms with overabundant supplies actually think they don't produce enough milk to satisfy their baby! These moms often leak a lot in between feeds, and may be more prone to plugged ducts and breast infections.

If you suspect this may play a part in your baby's refusal to nurse, it may help to feed you baby at one breast per three to four hour period. Whether your baby nurses once or several times in that period, offer the same breast. Actually, frequent nursing keeps the milk flow more manageable for your baby. Over the first few days, you may need to express just enough from the "unused" breast to remain comfortable. After three or four hours, switch to the other side, and keep following this pattern. This allows your baby to access your rich hindmilk, which will help to keep her satisfied for longer periods of time, and may reduce the irritability she experiences. This will also help to reduce your milk supply so that it is more in sync with your baby's needs.

Maintaining proper positioning throughout the feed is crucial. Moms with very abundant supplies often have suffered from nipple trauma due to their babies sliding down onto the nipple as the feed progresses. If your baby slides down, gently break suction by inserting your finger between your baby's gums and allow her to latch on again, this time getting a full mouthful of your breast tissue. If your baby spits and chokes during a feed, try to feed in a more reclined or side-lying position. You can remove your baby from your breast as your milk ejects. This can occur more than once during a feed. Catch the milk in a diaper (or a cup). Calm your baby before putting her back to your breast. A fussing baby can not nurse well.


When your baby refuses to nurse, for whatever reason, there are some "tricks" to help bring her back to the breast:

  • Try breastfeeding before your baby gets too hungry. Watch for her cues, such as sucking on her fingers.
  • Feed your baby when she is drowsy. Babies who are drowsy often accept the breast easily and nurse well. Pull her into bed with you for those nighttime feeds.
  • Enjoy lots of skin-to-skin contact. Lots of holding, loving and cuddling often works wonders at getting a baby back to the breast.
  • Be patient.

If you are unable to persuade your daughter to nurse, it will be necessary to express your milk to help keep your supply intact, and to keep your breasts comfortable. I would recommend using a hospital-grade electric breastpump (rental). You will need to express your milk as often as your daughter would usually nurse.

It is important when making breastfeeding changes to monitor your baby's output. She should be having five to six good, wet diapers a day at this time (six to eight, if under six weeks of age) and a good sized bowel movement every day or so (two or more per day, if under six weeks). Weekly weight checks will help to reassure you that your baby's weight gain is within normal limits.

Most nursing strikes last from a few days to a couple of weeks. If these tips do not help, I would recommend working with an IBCLC (International Board Certified Lactation Consultant). You can contact the ILCA (International Lactation Consultant Association) office and you will be referred to three IBCLCs in your area. You can reach ILCA at 200 N. Michigan Ave, Suite 300,Chicago IL 60601; phone 312-541-1710 or fax 312-541-1271. ILCA can also be reached at ilca@erols.com. Hoping your baby is soon happily back at your breast!

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