Expert: Sally Wendkos Olds - 11/20/2009

Question
Hello.  I have an 8 month old baby girl who has started refusing the breast.  She still feeds well first thing in the morning (she sleeps through 11-12hrs) but the last few days it's been a battle to get her to stay on one side long enough to get a let down, then she refuses the second breast, getting agitated if i keep trying.  By the last feed of the day before bed she is refusing to feed at all.  She usually has 4-5 breastfeeds a day plus three meals of 1/2-1 cup of solids.  It has been quite hot here the last week so i've tried feeding her lying down so shes not pressed up against me but this hasn't worked. I've been giving her water when she has a short feed as i'm worried about how much fluid she's getting in this heat.  I've also been giving her formula to replace her bed time feed if she refuses to feed.  I'd really like to keep feeding her to 12 months or more and don't want to wean if i can avoid this.  Is this just a faze or is she trying to wean herself?  I've also been wondering if i should be pumping when she refuses a feed to keep up my supply or just hope she comes back to it soon enough to stop supply dropping. Thankyou for your time.

Answer
Dear Karlie,

First, congratulations for giving your daughter the best start in life by breastfeeding her! Yes, it's a good idea to pump at the times you would ordinarily be nursing her to keep up your milk supply. This kind of "nursing strike" is not uncommon. I'm attaching an excerpt from my book (see below) with some suggestions that have worked with other moms and babies. I hope you'll find them helpful. However, if you can't get your little girl back on the breast, you can know that you have already given her precious antibodies and nutrition in these past 8 months.

Good luck!

Sally
--------------------------------
Sally Wendkos Olds
Author, THE COMPLETE BOOK OF BREASTFEEDING: Eiger & Olds, 3rd edition 1999, published by Workman Publishing & Bantam Books, and available in most public libraries, bookstores & La Leche League chapters. Now in revision for a fourth edition, with pediatrician Laura M. Marks, M.D.
-----------------------------------
Temporary Rejection of the Breast (“Nursing Strike”)
There are two kinds of breast refusal—that by a newborn who does not even begin to nurse, and that by a baby who has been nursing well and then decides to go on strike and refuses to take the breast. In either case, you can almost always figure out why this is happening and help your baby nurse happily.
   In either case, if your baby consistently refuses only one breast, see your own doctor, since sometimes a medical problem will make the milk taste different to the baby. If your doctor says that everything is fine with you, don't worry about the fact that your baby is not nursing from that breast. If the “unpopular” breast  fills up with milk and becomes uncomfortable, hand-express a little milk, just to relieve the discomfort. Every now and then, offer this breast again to your baby. If he keeps refusing it, one breast may become larger than the other, so you may want to pad your bra on the smaller side so you'll look even on both sides. The size difference will go away after you wean your baby.

The Older Nursing Baby
Sometimes in the first few weeks after birth, but more often between four and ten months of age, a baby will nurse a couple of minutes, then arch his back and cry. Nothing the mother can do will induce him to go back, and yet it’s obvious that he wants something. What’s wrong? And what can you do about it? As with so many other child-rearing issues, you have to look closely at your own baby and see what is going on in his life. The following suggestions have worked in some situations, and the box below lists several possible causes, along with some specific solutions.
• If you want to continue nursing, don’t substitute bottle-feeding for the times you would ordinarily nurse. Doing that may make the problem worse. Chances are that this “nursing strike” may last only a day or two, and your baby will then go back to being an eager nurser.
• If your baby has begun to eat solid foods, increase her portions of these for a few days to tide her over. Also, add some of your pumped breast milk to her cereal. If she has been eating large amounts of solids, however, this may be causing the problem. She may be too full of food to be interested in nursing.
• Express or pump your milk and give it to him until he resumes taking the breast.
• Keep offering your breast. The most effective time to do this is to pick him up while he’s asleep or very sleepy; he won’t remember to reject the breast, and once he’s back in the routine of nursing, he may decide it’s pretty good, after all.
• Vary your nursing positions. Your baby might prefer one you haven’t used yet.
• Nurse in motion—in a rocking chair or walking around.
* Give your baby a bottle with just a small amount of milk (ideally your pumped breast milk) first -- and then put her to the breast.
* Consider the possibility that your baby may be suffering from GER (gastroesophageal reflux), especially if he shows symptoms like arching his back or pulling away from the breast after starting to nurse. See the discussion of GER on page tk.
  If none of the possible reasons listed in the box on page tk to explain why your baby might be refusing your breast seem to apply to your situation, if none of the suggested remedies work, if after a couple of weeks she’s still refusing to nurse, and if she’s more than six months old, you can pump your milk and feed it in a cup or a bottle. You may also want to contact a lactation consultant to try to persuade the baby to continue nursing a while longer. While some children want to nurse long after their mothers had thought they would, others surprise and disappoint a mom by wanting to give up the breast earlier than she wants to herself. For suggestions to make the weaning process as comfortable as possible, with the least amount of emotional upset for mother and baby, see Chapter 18.

BOX
When an Older Baby Refuses the Breast
Explore the following possibilities, one by one.
• The taste of your milk may have changed because of a cream you’re using on your breasts, a new food you’re eating, a new medicine you’re taking, a strenuous exercise program, a breast infection, or because you’re pregnant or have resumed menstruating.
Keep a log of what you eat and how your baby reacts, so you can identify and eliminate an offending food. Schedule nursing sessions before exercise sessions. If you feel a lump in your breast, first treat it as a clogged duct; if it has not healed in three days, see your obstetrician.
•  If her gums are tender from the pressure of new teeth coming in, it may hurt her to nurse. If she bit you, she may have been startled by your cry of pain and be afraid to nurse again. (See section about biting on page tk.)
•  If he’s wildly hungry and can’t seem to wait for the milk to let down, pick him up about fifteen minutes before you would ordinarily feed him, or express a little milk first to give your let-down a chance to work.
• If she has a cold and is having trouble breathing through her nose, use a humidifier in the room where she sleeps, ask your doctor whether nose drops would help, and use an aspirator (a syringe with a rubber bulb) to suction out mucus in her nose. Get careful directions on how to use the aspirator before using it on your baby.
• If you suspect thrush, call your doctor and treat it immediately, both to relieve your baby and to prevent the infection from spreading to you.
• Ask her doctor to evaluate her for a possible earache.
* Check your baby for signs of gastroesophageal reflux (GER – see page 000).
•  If you’re going through a particularly difficult time emotionally, your baby may sense your feelings and become too upset to nurse. Make a conscious effort to forget about your cares, at least while you’re nursing. You’ll enjoy these oases in your life and your baby may be calmer, too. See the suggestions to help you relax in the box on page 000.
END BOX