Expert: Sally Wendkos Olds - 4/13/2009

Question
hello. i have been nursing my 8 month old son and it has gone very well. in the last couple weeks though he has gotten so incredibly distracted and unable to nurse long at all. but it's now beyond distraction - he just simply will not nurse in my arms... the only way i can get him to nurse is lying down - and at that it is very quick - a couple minutes at the most. i have tried creating peaceful, quiet environments and being topless around the house whenever possible and creating as much skin to skin contact with him as possible but none of that is working. i am getting extremely concerned about my milk supply... i have been pumping at night to try to make a bit from the day and his lack of nursing... but it's becoming so frustrating and upsetting. i want to nurse for one year but another 4 months of this sounds so hard... any advice would be greatly appreciated.

Answer
Dear Molly,

First, congratulations for giving your son the best start in life by breastfeeding him!

He is at an age when nursing strikes are fairly common. It sounds as if you have been doing the right things to encourage him to stay at the breast, but maybe there are some new tricks you can try! I am attaching an excerpt from the manuscript of the new edition of my book (see below), and I hope that one of the suggestions here will help you.

Good luck!

Sally
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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.
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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
• Has your baby turned against the taste of your milk? It 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 new strenuous exercise program you’ve begun, a developing infection in your breast, or because you’re pregnant or have just resumed menstruating.
Explore these possibilities, one by one. Keep a log of what you eat and what your baby’s reaction is, so that 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.
• Is she teething? 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.)
• Is he wildly hungry? If he 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.
• Does she have a cold? She may be 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.
• Does he have thrush? This mouth infection, described earlier, can make nursing painful. If you suspect it, treat it immediately, both to relieve your baby and also since the infection can spread to you.
• Does she have an earache? If so, she may find nursing painful. Ask your doctor to evaluate her.
* Look at his symptoms and consider the possibility that he may be suffering from gastroesophageal reflux (GER – see page tk).
• Is your baby consistently refusing only one breast? If so, see your own doctor, since this may signal a medical problem that should be explored.
• Are you under tension? If you’re going through a particularly difficult time emotionally, your feelings may be coming across to your baby, who in turn becomes 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 tk.
END BOX