Like many expectant mothers, Davida Dinerman of Massachusetts had every intention of breastfeeding her baby after delivery. She and her husband even went to breastfeeding classes while Davida was pregnant. But when daughter Abigail made her debut on the great stage of life, she just wouldn’t nurse.
“Consultants came and went,” Davida says. “We really gave it the old college try.” And, even with the aid of a slew of lactation consultants, a week went by with no progress.
According to some medical experts, what Davida and Abigail experienced is not all that uncommon.
“There are several possible reasons that infants may appear to reject the breast,” says Judy Hopkinson, Ph.D., a lactation physiologist at the USDA/ARS Children’s Nutrition Research Center at the Baylor College of Medicine. “In the newborn period, most infants experience transient difficulties with latch-on. Many new moms think they are refusing the breast, but in reality, they are just having difficulty latching on.”
Latch-on problems can be caused by the baby’s inability to open his mouth wide enough, the baby’s position during nursing or even the shape of the mother’s breast and nipples.
“Engorgement changes the contour of the breast,” says Denise Archambault, a registered nurse and lactation consultant at the Women and Infant’s Hospital of Rhode Island. “It’s like trying to palm a basketball and the baby [may have trouble] grasping the areola.” As a result, babies may actually turn away from the breast out of complete frustration. Other reasons for breast rejection, including low milk supply, traumatic injury to baby during delivery (which could cause pain when baby lays on one side), baby allergies or congestion, nipple confusion (which can be a culprit if artificial nipples or pacifiers are used excessively in the first few weeks), breast engorgement, forceful let-down reflex or even stress, can change as baby matures.
One common cause that is often overlooked is that baby simply doesn’t know what to do.
“He [may not] know what that thing is for,” says Constance L. Tierno, R.N., a certified lactation consultant who coordinates the Family Life Services program at Shore Memorial Hospital in New Jersey. “If he was unable to nurse for whatever reason during the first few hours of life when it is instinctive to nurse, he may not know to root and go for the breast.”
“Ever do a project with someone else and they didn’t hold up their end?” Archambault asks. “The suckle is instinctual, [but] breastfeeding is learned by mother and the baby.” A lactation consultant may be able to help baby learn how to root and latch-on effectively.
Breast Refusal in Older Infants
Sometimes, after baby has been nursing comfortably for several weeks, she may suddenly refuse to nurse at all. The reasons for the sudden loss of interest are varied, but can include mastitis (breast inflammation), a clogged duct or even the onset of mother’s period, any of which can make the milk taste different. Less common causes could include a new product that Mom is using on her body (a new lotion or deodorant), or a new food in her diet.
A baby with a stuffy nose or an ear infection (which make it more difficult to breathe while nursing) will often be uncomfortable while nursing and he may behave like he is refusing the breast. “But this passes with time and patience,” Hopkinson says.
If the baby is somehow startled while she is nursing, she may be afraid to nurse again. This can happen if Mom cries out when a teething baby bites her breast, especially if it happens repeatedly. “A firm ‘no!’ followed by gently placing the baby on the floor for a minute or two with his teething ring is a much more effective way to help the baby learn the difference between using a teething ring and nursing on Mom’s nipple,” Hopkinson says.
The force of Mom’s let-down reflex may even cause the baby to choke, which may make him struggle and arch away from the breast. To alleviate this, Tierno suggests that Mom increase the frequency of feedings, pump or hand-express until the initial let-down response has passed.
Babies who refuse to nurse are probably not spontaneously preparing themselves for life away from the breast, though. According to Archambault, it is rare for a baby who hasn’t yet seen a first birthday to wean herself. “A baby who suddenly refuses the breast when less than one year of age is unlikely to be naturally weaning,” she says.
Babies with a Preference
Some babies may not completely refuse to nurse but may just refuse to nurse on one breast. This often happens when baby develops a preference because one breast might have more milk ducts than the other or milk may flow from it more freely. “One nipple might be more erect than the other or there might even be a mole or hair that may bother baby,” Tierno says.
She suggests that once the problem has been identified, Mom can feed baby on the preferred breast first, then after the let-down, slide him to the other breast without changing positions. “For example, if she begins nursing on the preferred breast in a football hold, gently slide him to a transitional hold on the side he’s been refusing,” Tierno says. “Or, if he’s in a cradle hold on the preferred side, slide him to a football hold on the less-preferred side.”
“[But] forcing the baby to take the second breast by cutting back the time on the first is a bad idea,” Hopkinson cautions. “It takes away an important mechanism the baby uses to adjust his calorie intake to meet his needs.”
Keeping the Milk Supply Going
Since milk supply is a supply-and-demand set-up, how can a nursing mom keep the supply going while baby isn’t eating?
Tierno recommends pumping so that the breasts are thoroughly emptied a minimum of eight times a day. Expressed milk can be fed to baby by cup (which even a newborn can drink from) instead of bottle to avoid nipple confusion. If baby has a weak or ineffective suck, Mom can try “switch nursing” which involves moving baby to the other breast as soon as her sucking slows down and she begins to swallow less. “[You] may need to do this several times during a feeding,” Tierno says.
Bypassing the Breast
Parents who decide to breastfeed do so for many reasons, including the health benefits to baby. But you can still pass on all the benefits of mother’s milk even if your little one can’t nurse simply by expressing your milk, which is what Davida decided to do for her Abigail.
“I thought, ‘OK, it’s my first baby. I’m a bit stressed anyway. Why add more? I can pump [and] my baby can gain all the benefits of the breastmilk and her daddy can feed her and help me out as well,'” Davida says. She ended up expressing and freezing her milk so Abigail could nurse from a bottle with a nipple her mouth could more easily latch onto. She and her daughter had no difficulties bonding because of the experience. In fact, she says, she and Abigail are quite close.
“My main goal was to give her breastmilk, whatever it took,” Davida says. “Sure, it would have been nice to nurse, but I think [it is important to] realize the goal is to give the child natural breast milk.”
If Your Baby Refuses to Nurse
- Contact a lactation consultant immediately. She can help with almost any nursing difficulty you may be experiencing.
- Contact a pediatrician. A visit to the pediatrician may rule out illness or injury.
- Soothe the baby. Between feedings, skin-to-skin contact (especially chest-to-chest) may help baby feel less anxious about nursing.
- Offer the breast when baby is sleepy or offer expressed milk in a cup before offering the breast. Both may prevent frustratration because he may be less hungry and have more patience latching on.
- Ease the tension. Some babies can sense if Mom is very tense during breastfeeding and may refuse to nurse as a result. Do some deep-breathing or feed baby while lying on your side so he can’t feel the tension in your body.
- Avoid over-stimulation. Stress from visiting family, travel, moving and major schedule changes can cause some babies to be fussy at the breast or refuse to nurse.
- Cut the chaos. Some babies want Mom’s full attention while nursing. Try sitting in a quiet room alone with the baby and talk with him in soothing tones.