Wednesday, February 5, 2014

Why Won't My Baby Nurse?

As your baby gets older (over three months old), some aspects of breastfeeding get easier: Your baby learns to latch properly and can do most of the work herself. You get more practiced at arranging yourself and your baby to nurse comfortably. Your nipple pain subsides and any damage heals. Your milk supply balances out so you're not constantly engorged or spraying your baby in the face. Your baby becomes more efficient at extracting milk and can finish a feeding much more quickly. She may be taking in more at a feeding and can go longer between nursing sessions. You've figured out what positions are comfortable for you and your baby. Your confidence improves, and with it your ability to relax while nursing.

And then, suddenly, you're hit with a new set of frustrations!

As babies reach three and four months of age, they start to "wake up" to the world. Their lives are no longer just about sleeping, eating, and pooping. Now they're smiling at faces, staring at interesting patterns and objects, trying to reach out and grab things. They want to sit up and roll over. Life is fascinating, and nursing, while still comforting and necessary, sometimes becomes an interruption to their exploration, rather than their priority. They've also decided what's comfortable for them, which may not always be your first choice.

At this point, you may find that your once-eager nurser has to be convinced to eat, won't eat in certain positions or places, or flat out screams at you when you offer the breast. This can be discouraging and make you feel like you're suddenly doing something wrong, just when you finally had it all figured out.

Take my baby, for instance. On our recent road trip, he decided he didn't want to nurse in the cradle hold sitting down. Oh, no. I had to stand and bounce, or lean over his car seat, or wait until we could curl up in bed at the hotel. The other day, we spent several hours at the Social Security office and he got hungry, but would he nurse happily? Of course not! I had to convince him he was hungry and tired, and he finally fell asleep after being walked and rocked for a while.

I find he nurses best when we're both relaxed and in a calm zone. At home, I usually take him to my bed and lie down with him to nurse. When we're out and about, I try to sit as comfortably as I can so that I can relax. The more rushed or tense I feel about having to nurse him, the less likely he is to simply latch and feed. Often, he will calm down without nursing. When he does, I usually just try to get him to wait until we're in a more convenient place for him to nurse. If he's really not willing to wait, I'll do anything and everything to get him latched and eating, no matter where we are.

I figure that if he gets three or four really good feedings in throughout the day, the snacking or fussy popping-on-and-off that he does the rest of the time is fine. He's still getting enough to eat, even if it's frustrating.

I think the number one rule is to relax. This applies to a lot of things when it comes to breastfeeding. Relax, follow the baby's lead, and don't stress about it. You can't force a baby to nurse, but you can remind him that he's hungry. If he really just doesn't want to latch right now, see if you can find another way to calm him. Sometimes once he's calm, he'll be more content to feed.

Some tricks that work for me when my baby is reluctant, for whatever reason, to nurse:
  • Try a different position. If I'm sitting down and using a cradle hold and he's resisting, I'll try standing up and using cross cradle to get him latched. Sometimes I even need to rock or bounce him while he nurses. Alternatively, if I have him in the carrier upright, I'll try taking him out (if possible!).
  • Try the other side. Sometimes my baby just doesn't like one side for some reason but will happily latch and nurse on the other side. 
  • Have him suck on something else, first. I'll give him a pacifier or a finger to suck for a few minutes. Sometimes this calms him down and reminds him that he's upset because he's hungry. Then he'll take the breast and eat well.
  • Let him pop on and off enough times to get letdown. When I'm nursing in public, I don't love it when he's popping on and off because I feel like I'm flashing everyone, but often once he gets letdown, he'll eat happily. If I'm in a place, position, or situation where I can let him do this, I'll go with it.
  • Try to calm him and wait until we're somewhere else. Sometimes he just doesn't like the location. I'll rock or bounce him for a bit, or roll him back and forth in the stroller, or drive around for a few minutes. This will calm him enough that he'll fall asleep, or he'll be willing to try again in a new place. For some reason, he seems to like when I dangle my boob into his mouth while he's in the car seat (when the car is PARKED, of course), so if that's an option, I'll do it, when all else fails.

While you shouldn't generally try to delay feeds when your baby is a newborn, once breastfeeding is going well, your baby is growing, and your milk supply is healthy, delaying a feed by 20 or 30 minutes isn't really going to harm anybody. You may be uncomfortable, and your baby may be unhappy, but it's not going to cause any long-term damage, especially if it means that he gets in a good feeding once you have the opportunity. I don't advocate skipping or delaying much more than 30 to 45 minutes, but it's not always up to you! When the baby just won't eat, he just won't eat!

Some other reasons your baby may be refusing to nurse at certain times or in certain places or positions:
  • Teething. Yes, babies can start to teeth as early as 3 months, even if teeth don't show up for a couple of months. Sometimes the pressure of sucking can increase teething pain (while other times it offers relief!). Teething pain comes in spurts of a couple of hours, which is why he may refuse at some times and not others. Teething pain may also be felt in the ears, and laying on one side may be more painful than the other side. This is why switching sides may be helpful.
  • Ear infection. As with teething pain, the pressure of an ear infection is worse when lying down. If you can nurse with him more upright, that may help. Also, lying on the side that is affected will be more painful than lying on the other side, so, again, nursing on the less painful side may be more effective.
  • Stuffy nose. A stuffy nose can make nursing difficult-to-impossible. She can't breathe and eat at the same time if her nose is stuffy. Squirting saline or breastmilk up the nose to help loosen the mucus and then sucking the mucus out (I highly recommend the Nose Frida for this, rather than a bulb syringe) may help. You might also try nursing in a steamy bathroom or run a humidifier to moisten those nasal passages. Keeping baby more upright can make it easier for her to breathe, as well.
  • Reflux. The pain of stomach acid coming up into the esophagus may make a baby reluctant to nurse lying down, as well. With reflux, your best bet is to give small, frequent feeds and keep your baby upright or reclined as much as possible.
  • Gas. Maybe baby just needs to burp or pass gas, so his little tummy hurts. He feels hungry, but nursing isn't making him feel better. If you can help him move the gas bubbles out, he may settle down and nurse happily.
  • Unpleasant association. Did you have an especially strong letdown at some point that may have made your baby choke? Did you eat something unusual that might have bothered his stomach? Is the taste of your milk possibly different because of your period coming, something you ate or drank, or a breast infection? Maybe something upsetting happened while he was nursing that scared or hurt him, and now he associates nursing with that occurrence. Sometimes it takes a few days for your baby to get over a bad association with a particular nursing session. In this case, just keep offering, and especially offer when he's sleepy and/or relaxed. Once he has a good, comforting nursing session again, he should return to the breast more happily.
  • Your scent. Are you wearing a perfume you don't usually wear? Have you been around people wearing scents or smoking that your baby may not be used to? Did you change shower gels or laundry detergents? Babies have an excellent sense of smell and are used to your smelling a certain way. They seek out the scent of your milk to help them zero in on the breast. If you've done something to obscure the scent she's used to, she may be agitated or even bothered by the smell. See if changing clothes, washing hands, or changing locations helps.

Please remember, it is not normal for a baby under a year old to "self-wean." There is usually a reason they refuse the breast temporarily. If they're completely refusing to nurse, this is called a nursing strike, and these typically last just a couple of days. Nursing strikes are most common around 4 months and 10 months of age but may occur at any time. Keep offering the breast as often as you can, try some of the thoughts mentioned above, and spend time skin-to-skin in a quiet place with your baby. Babies won't let themselves starve! If you're really concerned, consult with a trained lactation consultant (IBCLC) to make sure there's not something else going on that can be corrected.

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