Why all of a sudden is my baby refusing the breast/chest?
Why all of a sudden is baby refusing the breast/chest?
A nursing strike is a period (sometimes as short as 6 hours and sometimes as long as a couple of weeks) where baby suddenly halts consumption of milk at the breast/chest. It can be a full strike, where the infant refuses all feeds at the breast/chest or it can be a partial strike where the infant will only feed at the breast during certain narrow windows of time—displaying a sharp reduction in feeds (<4 per 24hr period). During a partial strike some parents find their child switches to a pattern where will only eat actively at the breast/chest if they are asleep or very sleepy.
These “strikes” can be extremely stressful because parents:
are concerned about their infant’s nutritional intake
may feel rejected
are concerned about their milk supply
very confused as to wtf is going on
Nursing strikes undermine parents’ confidence in their ability to feed and in their body’s processes. Many worry that this is the end of their breast/chestfeeding journey (spoiler alert: it’s very likely not!)
First off, you always want to rule out illness when there is a drastic change in nutritional intake. Check their temperature and reflect over the past few days to consider if any signs of illness are or have been present, as well as note if anyone in the household is or has recently been ill. If in addition to refusal of feeds your infant has started to cry and is inconsolable (truly inconsolable crying for long periods with almost no breaks, sometimes with a shriller cry—very different from increased “fussiness”) then I would head to the hospital. Another thing to examine is whether a decreased level of consciousness or energy is present. This would be displayed a harder to rouse infant and/or sleeping much more than usual while refusing intake. Change in level of consciousness or marked lethargy in tandem with dramatically decreased intake would be another reason to seek medical attention ASAP to rule out illness or disease process.
OK back to nursing strikes…
Why do nursing strikes happen? Here are some typical culprits:
Baby is teething and in pain. The act of latching and active feeding may be causing your infant discomfort.
Baby is going through a cognitive “leap” or growth spurt. Despite a typical increase in caloric demand at these times, infants are sometimes poorer feeders during these periods of cognitive evolution and physical growth. Their hunger and cerebral changes can be overwhelming, and it can make the skill of organizing the skill of latch/suck/swallow more challenging for them. Their patience is often thin during these periods (which often last just a few days to a week).
Around 2-3 months a parent’s milk supply often declines to a level that is near exactly what baby needs, rather than more ample than baby needs (as is often but not always the case during the first couple months postpartum when you would likely get very full between feeds). Because of the “tailoring” of one’s supply to baby’s needs, there may be a notable reduction in easy flow for baby. Think before with ample flow, baby had access to more of a faucet—this type of flow may not have required an optimized latch to be able to meet baby’s needs. But now, with a reduced supply (still can’t meet baby’s needs but may = less flow), the breast is more like a sucky water bottle vs. a faucet—it’s just not pouring out anymore. If you previously had a very strong flow and baby had a mediocre latch, at this point in time they may not be sure how to use their latch to achieve the flow that they’ve become accustomed to. They’re likely still getting milk but the change in flow rate might be confusing and upsetting to them. Because of this potential reduction in flow, baby’s latch becomes more vital to help them receive the flow they’re used to. Sometimes infants get extremely frustrated by this and protest by refusing to feed, pounding on their parents chest, pulling at the nipple, coming on and off, crying at the chest etc.
You may have a temporary reduction in supply from ovulation or pregnancy and this is frustrating baby.
Baby has oral thrush and feeding at the breast/chest is causing oral discomfort.
Baby has hit 3-4 months and they are SUPER distractible. These kids may feed very infrequently throughout the day, which appears to be a “strike” but feed many times overnight (up to 5+), may feed well when being put down for a nap or when in a low stimulation environment. This is less of a “strike” and more of a “I don’t have time to feed mom/dad/parent, I am too busy looking at the cat” type of situations. It likely does not indicate an issue with flow or supply. These infants will continue to gain weight daily and have ample output (6+ pees and sufficient stool diapers for their age and stooling pattern).
Baby has been doing lots of bottle feeds with a fast, constant flowing stream of milk and is getting frustrated by the natural ebbs and flows of the breast/chest and the work that is required to achieve a good flow rate.
What to do
Breathe. This will get better. It might not happen overnight, but it more than likely will resolve. If you have the resources, call up an IBCLC—you don’t have to go through this alone. You’ve worked hard to breast/chestfeed this child and you deserve to feel supported at stressful times where the feeding relationship feels threatened. Hit me up for a virtual or in home visit!
Offer expressed milk by cup, spoon or bottle every few hours. Utilize paced bottle-feeding methods. Check out my reel on it on my Instagram feed or give it a google.
Protect your supply by pumping every 2-4hrs for approximately 15 minutes using a “hands on” pumping method (see my Instagram post about maximizing pumping sessions).
Try alternating positions, or even feeding baby while in motion (feeding them while you walk around the house, feeding them in a sling, feeding them while bouncing on a ball, etc.)
Take the pressure off a bit. If baby is pushing back, away from the breast and you are trying to push them on because it’s been hours and hours since they last ate and you’re stressing out, take a pause… try your best to keep things neutral and positive at the breast/chest. Don’t force it. Instead, head to bed topless with baby in a diaper and just hang out with them, without pressuring them to feed. Do this for as many hours a day as you can budget. Hang out, skin to skin, low pressure, happy vibes—we want to keep the chest a positive zone and decrease the chance of negative associations. If they feed great, if they don’t that’s OK too (or pretend it is! Play it cool). This can work VERY well to reset things. They can hang out beside you, on you, or upright on your chest and you can just watch a show, read, listen to a podcast or just zone out. Try to spend as much time as possible like that throughout the day(s). These days won’t be “productive” on paper, but in doing very little you may be doing a lot to help reset things. This would be a good time to ask your partner to call in sick to help do things around the house while you focus on reconnecting, or you may want to consider ordering in food or asking someone in your circle of support to help you around the house so you can focus on this reset.
If you suspect teething (red cheeks, drool, hand chewing, swollen gums, maybe flashes of teeth seen through the gum ridge) let baby chew on a teething ring that’s cold prior to feeds to help numb the area or talk to your doc about using acetaminophen (Tylenol) or a similar pain reliever about 30min before the feeds that seem the most challenging.
Feed baby when they’re in a “twilight state” –when they’re kind of between sleep and alertness, such when they are falling asleep, while asleep, right when they are coming out of a nap. Do this in the dark with minimal stimulation. During nursing strikes you might find that baby will feed more overnight when they are less conscious which isn’t the most awesome for the parent, but might be a temporary way for them to get their caloric needs met while they work out what is going on with their daytime feeds.
Low stimulation feeds for distractible babies. Super distractible babies need minimal stimulation feeds in low-lit, quiet (or white noise) environments. Side lying position works well to help them stay focused (harder to look around the room and is calming). Try to do as many daytime feeds as possible in dark, quiet spots laying down.
Consider supplementing a bit before feeds with your milk (or formula if you don’t have expressed human milk) to decrease the “hangry” state baby is probably in prior to feeds (if they haven’t recently had any milk) and then try them at the breast.
If you think baby may be frustrated with flow you may want to initiate a letdown prior to baby coming onto the breast/chest. You can do this by using warmth, massage, and a few minutes of hand expression on the first breast/side of chest offered prior to all feeds, until baby learns to get that flow going themselves.
If you know me, you know that I feel that feeding baby in a bath can be another amazing way to “reset.” I believe it is because baby is so engaged with sensory input (warm temperature on their skin, sound of the water, feel of the water) that they enter a bit of a different mind-state. Try offering a feed in a low-pressure way in the bath. If they refuse, just hang out with them on your chest or near your body without putting any pressure on them to feed.
Do not feed baby on a schedule. Give baby lots and lots of opportunities throughout the day to feed. If they indicate interest to feed, bring them on. If after bringing them to the chest they get upset, you can try a tactic like changing positions or feeding in motion. If that doesn’t work, offer some cuddles then offer milk in an alternative way such as a cup or bottle.
If you think baby’s latch is the culprit, make an appointment with an experienced IBCLC. I work with lots of babies who are older and need a latch “review.” It can make a world of difference re: them getting the flow they desire at the breast/chest and increasing efficiency of feeds.
If you’re worried about your own supply and think you have a true dip in supply, that is less than can meet baby’s needs, consider meeting with an IBCLC to uncover the culprit for that and work on a sustainable plan to increase supply to aid with flow and transfer at the breast/chest.
Sometimes the issue may be more perceived than actual. This is the case when baby has become a super-efficient eater and only needs brief periods at the breast/chest to complete a feed (sometimes as short as 4 minutes). Because parents are often thrown off by the brief feeding window, parents often continue to try to bring baby to the breast/chest to “complete” the already completed feed and baby refuses. The parent may bring them back multiple times between true feeds and be met by refusal as the infant was recently satiated from their earlier feed. Because parents aren’t aware that some infants have these super rapid feeds, or the pattern is new and misunderstood, many of their attempts to feed baby are refused so they believe there is a true refusal/strike issue at play. These infants show no reduction in weight gain or out output (pees and poos). Most prenatal classes spend minimal time discussing infant feeding at the breast/chest/bottle so it makes sense that efficient feeders would surprise parents, especially when many MDs communicate to parents to offer each breast/side of chest for 15 minutes.
Good luck feeders.