Breast refusal ('nursing strike') is a very distressing and worrying problem for mothers. In this article we will give you some reasons and some ideas to cope. More detailed information is available in our booklet Coping with Breast Refusal and also by talking to one of ABA's breastfeeding counsellors on the Breastfeeding Helpline.
A baby's refusal to suck at the breast is a most distressing problem to a breastfeeding mother. She cannot help feeling upset when her baby screams and turns away from her breast. She may feel that her baby is rejecting her as a mother and doesn't want her, need her, or even like her very much.
A baby may refuse the breast at some or all feedings, at any age, and his reasons for doing so will vary with his stage of development or even his health at the time. He may suck for a few minutes, then break away with signs of distress and refuse to continue. He may refuse even to begin sucking although he is obviously hungry.
Sometimes, a baby does not actually refuse but is very fussy and difficult to feed. He may be the kind of baby who seems to be very unwilling to start sucking and takes a long time to get going, but once he has started, feeds well. A fussy baby can seem to receive little satisfaction from feeding. He sucks for a short while and then breaks away, finishing his feed after a series of stops and starts. He may be easily distracted and restless during the feed, perhaps pushing away from his mother with his fists or his feet. He stops as soon as his hunger is satisfied and may remain restless and fidgety afterwards.
When managing a fussy feeder or a baby who is refusing to breastfeed, it is important to remain calm and patient, handling your baby gently. If you are both on edge, try taking deep breathes similar to that which you may have used during labour or when trying to calm or meditate. The deep breathing helps slow your own breathing and make it more regular which can help calm everyone, concentrate on staying relaxed, use soothing music, rock your baby gently or carry him around. This relaxation will help your milk flow readily so your baby will get milk once he latches on.
If your baby is quite unsettled, cross or crying or if you are feeling angry and upset, you may find it helps to try again when you are both feeling calmer. In the meantime a cuddle or a game may distract your baby or a walk outside may relax you both. This is the time when your partner (or a friend or relative) may be able to step in and give you both a break.
Is it breast refusal?
Think about the following questions - they may let you know that all is well and that even though your baby is refusing some feeds, she is contented and healthy and getting sufficient breastmilk for her needs. If you are still worried however, you may find it comforting to have your baby checked thoroughly by your medical adviser.
How many feeds is your baby completely refusing in 24 hours?
The number of feeds your baby needs changes as she grows older. A very young baby commonly needs eight to twelve breastfeeds in 24 hours, but there is a wide variation in the number of feeds an older baby needs. There is a big difference between a four-month-old who refuses one or two feeds in eight, and a baby of the same age who refuses four out of five feeds.
How many wet nappies does your baby have in 24 hours?
Regardless of the number of feeds she has, signs that your baby is getting enough breastmilk include if she has, over 24 hours, regular soft bowel motions, at least six to eight pale, very wet cloth nappies, or at least five heavy wet disposable nappies with pale, odourless urine. Check with your medical adviser if your baby's urine is dark and has a strong smell. She is being adequately nourished if she is reasonably contented, looks alert, has bright eyes and good skin colour and muscle tone and has some weight gains.
There are many, many reasons for babies to refuse the breast, whatever their age. Below are some of the main reasons that mothers have found for their babies' refusal - but sometimes no reason can be found. Just as suddenly as the baby started refusing, the whole episode is over and he is happily breastfeeding again as if nothing had happened.
- Attachment problems
- Baby confused by bottle feeds
- Baby refusing one breast
- Recent immunisation
- Illness, e.g. a cold or earache, sore throat
- Feeding pattern is changing
- Introduction of other foods
- Overuse of a dummy (or pacifier)
- The weather
- Discomfort associated with sucking
Milk Supply reasons
- Fast flow
- Low supply
- Slow let-down
- Overtired or overstressed
- Sick or taking prescribed or over the counter medications
- Unusual food in your diet
- You smell different for some reason- e.g., different perfume, deodorant, chlorine/ salt from swimming; visit to hairdresser, smoke
- Hormonal Changes
- Menstruation and pre-menstrual tension
- Oral contraceptives
Things to do… to get your baby on the breast
- Be as patient and calm as you can, even though you may be feeling frustrated or impatient. Forcing your baby to feed is likely to make the situation worse. If he has just been refusing the breast and is upset, distract him by doing something completely different - a walk outdoors, looking at toys, singing a nursery rhyme. When he has settled down he may be eased on to the breast, or he may be happier just being cuddled.
- Walk around with your baby in an upright position against your body with her head level with your nipple. Walk and feed simultaneously. You could try putting your baby in a baby sling but remember to have your bra undone so that her face is touching the skin of your breast and she can find your nipple. The sling will need to be worn lower than normal for this purpose.
- Try a completely different feeding position: your baby tucked under your arm (twin style); or lying down on a bed next to your baby with no body contact - this is especially good if it is very hot, or your baby is sensing your tension; or lying down with your baby cuddled in close next to you.
- Feeding your baby while you are both in the bath may help. You may want to have someone available to help you lift your baby in and out of the bath.
- Try breastfeeding baby after his bath when he is warm and relaxed (if he likes baths).
- You could try playing with your baby on the floor while you are bare from the waist up. After some time gradually offer your breast.
- Anticipate your baby's waking time and lift her to feed while still sleepy - you may slip in extra night feeds this way.
- Try to soothe baby with a dummy. Walking, singing and rocking while baby sucks the dummy may gradually soothe him so you can gently put your baby to the breast while removing the dummy. It may be necessary to start a very hungry baby sucking on a bottle with a small amount of expressed breastmilk, e.g. 30 ml, then gently replace it with the breast.
- Some mothers, whose babies have become accustomed to a bottle, have found that putting ice wrapped in a flannel on the nipple or tickling the nipple and areola makes it easier for the baby to grasp. Alternatively, you may use a nipple shield to begin a feed, slipping if off quickly and putting your baby back to the breast once the milk is flowing and she is sucking happily.
- Feed in a rocking chair.
- Express some milk into your baby's open mouth to encourage him.
- Spend five minutes or so before the feed massaging your baby's naked body to relax her, if she is receptive to this.
- Try singing to your baby - he probably won't mind if it is the same few lines over and over.
- Try playing some favourite relaxing background music.
- Once you get your baby on to the breast, it may help to provide an instant milk reward. This can be done with a breastfeeding supplementer. This allows baby to receive additional milk at the breast whilst stimulating your milk supply by his sucking. If your milk supply continues to be low or your let-down slow or your baby is a 'poor' sucker, you may like to discuss with an Australian Breastfeeding Association counsellor the possibility of using a supplementer.
Most breast refusal is temporary and in most cases it should not be too long before your baby is again breastfeeding happily. Sometimes you may never discover why he did refuse. However, there are some babies who cannot be persuaded to return to the breast. If that is the case for you, it is important to remember that your baby is not rejecting you and that you will soon find other ways of relating to each other.
If your baby is still refusing to suck after you have tried the suggestions here, read ABA's booklet, Coping with Breast Refusal, available from the Australian Breastfeeding Association by calling 03 9885 0855 or emailing firstname.lastname@example.org, or contact an Australian Breastfeeding Association counsellor to discuss your situation.
© Australian Breastfeeding Association Reviewed Novemeber 2015