Expert: Sally Wendkos Olds - 8/28/2007

Question
I have a 4 month old baby and have been having difficulty with nursing her. Lately she has been crying when I try to breast feed her and seems to only latch on when she become exhausted resulting in her falling asleep soon after. Just recently she has accepted a pacifier and now only wants to suck on the pacifier. I have had to give her the pacifier and then quickly take it from her and offer her the breast. Does this mean that she may be ready to start weaning? It seems that she does not enjoy nursing.

Answer
Dear Triena,

First, congratulations for giving your daughter the best start in life by breastfeeding her!

On the present situation, there are a number of possible explanations. I am attaching an excerpt from my book (see below), which may give you some idea of where the problem lies. Some babies do start to wean themselves -- but rarely before 8 or 9 months. I doubt very much that at four months, your baby is ready to start weaning. I hope my suggestions help.

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.
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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.


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 childrearing 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 Box 15-10 lists several possible causes, along with some specific solutions.
  * If you want to continue nursing, don't start to give bottles now. Doing that may make the problem worse, and 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. 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 in an eye dropper, a teaspoon, or a cup, 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.
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  BOX 15-10  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 may be pregnant. 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, as suggested in Chapter 7. If you feel a lump in your breast, first treat it as a clogged duct; if it has not healed in a couple of 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.
  * Is he wildly hungry? If he can't seem to wait for the milk to let down, try picking him up about 15 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 vaporizer in the room where she sleeps or ask your doctor whether nose drops would help.
  * Does he have thrush? This mouth infection, described earlier, can make nursing painful. If you suspect it, treat it immediately, first 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.
  * 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.
  * See the suggestions in the section "Helping the Older Baby Who Isn't Gaining."
  * 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.
  END OF BOX
  

If none of the possible reasons listed in Box 15-10 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 week she's still refusing to nurse, and if she's more than six months old, she may be signaling her readiness to be weaned. While some children want to nurse long after their mothers had thought they would, others surprise and disappoint a mother by wanting to give up the breast earlier than she wants to herself. For suggestions on making the weaning process as comfortable as possible, with the least amount of emotional upset for mother and baby, see Chapter 18.