Sometimes, a baby can become very fussy during breastfeeding or refuse the breast altogether. A baby may also refuse to nurse entirely after breastfeeding normally for a significant period of time, we call this a "nursing strike." At times, a baby may refuse the breast at some feedings but not others. Or, a baby may have difficulty with one particular breast or feeding position.
Baby's refusal to nurse can sometimes be quickly resolved. In other cases, it may take time and patience before you are breastfeeding smoothly again. There are also times when the cause is never found. Unless there's an obvious reason why baby refuses the breast or goes on a nursing strike, it's best to check with your pediatrician to make sure there is no medically related reason. Discomfort or pain from a medical condition may cause baby to refuse the breast completely or to nurse in one position only.
If your baby is very fussy, refuses the breast, or goes on a nursing strike, he or she may have one of the following conditions:
- Ear infection;
- Thrush, which is a yeast infection in the mouth;
- A preference for an artificial nipple;
- Developmental changes;
- Or, baby may be more distractible, overstimulated, upset or under stress.
The problem can also be caused by:
- Engorgement of your breast;
- Milk let-down that is too forceful, too slow or delayed;
- Another external cause.
If baby's face or head is touched during nursing or latching, the rooting reflex may cause him or her to turn away from the breast. Try to avoid touching baby in this way.
With congestion or an ear infection, it may help to keep baby in an upright position before and during breastfeeding. Short, frequent feedings may also make breastfeeding easier.
Thrush in baby's mouth will often cause pain and should be treated by your pediatrician. Teething can cause baby's gums to be swollen and sore, making feeding painful. Giving baby something cold to chew on before breastfeeding may help. Contact your pediatrician if you think baby needs medication to relieve pain.
If your breast is engorged, baby may refuse to nurse because he or she can't latch effectively. For help with this problem, see "Engorgement."
If baby prefers an artificial nipple, he or she may forget how to latch properly or suck effectively. You may need to wait until baby's mouth opens big and wide to encourage deep latching. For assistance with latching, make an appointment with a lactation consultant.
An infant who prefers an artificial nipple often expects an immediate and consistent flow of milk. Try expressing milk before feeding just until your milk lets down, and then, offer the breast. You can express the milk by hand, or massage, heat or a breast pump can also be helpful. To keep the flow going, you may want to continue massaging the breast as you feed.
You can also try a nursing supplementing system to keep a continuous flow and get baby back to the breast. This system needs to be used under the guidance of a professional. If you wish to try it, you should make an appointment with a lactation consultant.
Developmental changes that may cause baby to be less interested in breastfeeding include crawling, walking, increased socialization skills, and greater awareness of the environment. With these new skills, baby may have difficulty settling down to nurse or may be too preoccupied to nurse at the usual times. If this is a problem, try nursing in a quiet, dimly lit room.
Things that alter your smell, such as a new perfume, soap, deodorant, lotion or laundry detergent, may cause baby to refuse the breast. If you eat a new food or a food in a much larger quantity, or if you start a new medication, this may also cause baby to refuse. By avoiding or changing these external agents, you should be able to resolve the issue. Do not stop taking any prescribed medication without speaking to your physician.
A baby who has difficulty with forceful milk let-down may refuse or postpone feedings. In this case, baby may nurse well for a few minutes and then pull away in frustration, or pull off coughing and sputtering. For help with this problem, see "Overabundant Milk Supply."
If baby sucks rapidly but does not swallow deeply for a few minutes and then pulls away in frustration, this may indicate a slow or delayed let-down. For help, see "Low Milk Supply."
Babies will sometimes refuse the breast before or during your menstrual period, or after you have had mastitis. In these cases, the taste of your milk may change. This reaction is usually temporary, and baby will usually resume normal breastfeeding once the issue is resolved.
If baby refuses the breast when there is a change at home, such as a different routine or family visitors, he or she may be overstimulated, upset or stressed. Try to minimize these types of situations. If you can't avoid the change, see "Fussy Baby" for some suggestions on comforting techniques.
The key to persuading baby to take the breast is patience and persistence. Avoid battles at the breast. Take special care with good positioning and latch. Experiment with different nursing positions and environments.
Remember: No matter what the cause, when baby refuses the breast or goes on a nursing strike, he or she needs you more than ever. Give baby extra attention and increase skin-to-skin contact. Added touching and bonding will comfort you both. Try nursing baby during drowsy or asleep times. Offer the breast while rocking or walking with baby. Try to feed when baby is responsive but before hunger is overwhelming.
A baby who aggressively refuses the breast from birth will need lots of time and patience. This is a more complex situation and usually requires professional help. We recommend that you make an appointment with a lactation consultant.
During breast refusal or a nursing strike, you may be concerned about whether baby is drinking enough milk. Baby should have at least six to eight wet diapers and two to five bowel movements in each 24-hour period and should be gaining an appropriate amount of weight according to age.
The next concern is keeping up your milk supply. During breast refusal, you should express milk often to avoid discomfort. Try expressing as often as your baby would normally nurse. Be patient. Most babies return to nursing within two to four days.