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.

New Edition of Kindle Book is Available!

Check out the new, updated Jessica on Babies Breastfeeding FAQ, available for Kindle from Amazon.com. Makes a great new-mom gift or a quick purchase just before (or just after) you have your own baby. At $1.99, you get Jessica's basic breastfeeding advice in the palm of your hand, accessible any time and anywhere you need it.

Some sample questions and answers from the book:

What is the most important piece of advice you would give a new mother about breastfeeding?

The first thing I would say to any new mother is, “Keep nursing!” The more you nurse, the easier it gets, and the more you nurse, the more milk you make. You’ll often hear “breastfeeding is normal” or “breastfeeding is natural,” which is true, but it’s important to remember that breastfeeding is a skill that must be learned and practiced, by both mother and baby. Just like with any skill, the more you do it, the better at it you get. When my first son was born, I was so convinced that breastfeeding was natural and instinctive that I was very discouraged by how complicated it all seemed. I felt like I needed three or four hands. When my second son was born, despite all the reading I had done, it still took several weeks for me to find comfortable positions and the easiest way to get him latched on and sucking as quickly as possible. As awkward as you may feel in the first few weeks, you’ll find it getting easier by the day if you just keep at it. The third time around, I knew things would get better, but the first three days or so were very hard; he would scream every time I unlatched him from my breast. I had to keep reminding myself that the more he nursed, the better things would get. Sure enough, by the end of the third day, he became a much more content baby, and I was able to settle into a more comfortable nursing routine.

The second basic piece of advice I always offer is, “Give it six weeks.” The first few days and weeks can be challenging, and even painful, as you adjust to having a new baby and all the new demands placed on you by this change in your life. If you persevere through the first six weeks, nursing on demand, getting used to the baby’s cues and needs, it only gets easier. I’ve seen new mothers go from “Why is this so hard? I don’t want to do this anymore!” to “Oh yeah, I think I’ll nurse for at least a year,” in the space of just those few weeks. There’s something about that six-week point after which everything starts to seem easier. Also, as the baby grows, breastfeeding gets easier just because the baby’s mouth gets bigger, his neck is stronger, and he is more able to support himself. If you stick it out for those first six weeks and put in the work at the beginning, you’ll be able to continue your breastfeeding relationship for as long as you and your child desire.

I heard that giving a bottle of formula before bed, or adding rice cereal to the bottle, will help my baby sleep better and longer. Should I try this?

It is not a good idea to offer anything but breastmilk to your baby before six months of age. Remember that your milk supply is governed by the baby’s demand. If you give a bottle or other food instead of nursing the baby from the breast, you are telling your body that your baby doesn’t need milk at that time. This can cause your milk supply to drop, requiring that you continue to give your baby a bottle, which can cause your milk supply to drop further. It’s a vicious cycle that is difficult to get out of. 

There is no evidence that giving a bottle of formula at bedtime will help your baby sleep better at night. There is mounting evidence that doing so may be harmful to your milk supply as well as possibly contributing to postpartum depression or other maternal health issues. Recent studies show that mothers who breastfeed exclusively in the early months feel happier and better rested than those who attempt to supplement with formula in order to get more sleep. My sons woke frequently to nurse, and it was much easier just to pull the baby to my breast and go back to sleep than it would have been to get up and prepare a bottle for him. My husband and I were both much more sleep-deprived with our first son, who was formula-fed, than we were with our breastfed babies.

As for adding rice cereal to a bottle, or giving any other kind of solid (non-breastmilk) food to a young baby, this is highly discouraged by the American Academy of Pediatrics, the World Health Organization, and many other groups. It is recommended that you do not feed any foods or liquids except breastmilk to an infant under six months of age, unless under a doctor’s direction for a medical reason. Putting rice cereal in a bottle is also a choking risk. 

Also, giving a bottle in the early weeks of life may have a negative effect on the baby’s desire to latch properly on your breast (see “Should I give my baby a bottle?” below for more on bottles).

My nipples are bleeding. What do I do?

For short-term care, squeeze a little milk from your breast after a feeding and apply it to the bleeding nipple. Breastmilk has healing properties that will help the nipple heal faster and prevent infection. You may also purchase pure lanolin (usually found under the brand name Lansinoh) to apply to your nipples after a feeding. Lanolin is safe to leave on when your baby is ready to eat again and will soothe your nipples and help them heal. However, bleeding nipples are typically a sign of a bad latch or other feeding problem, and you shouldn't hesitate to contact a lactation consultant if the problem doesn’t resolve within a few days.