When Baby Won't Breastfeed - Breast Refusal, Nursing Strike or Weaning?

Here you are, dripping milk, all ready for your baby to feed – but he won’t!

If you have a newborn, there is every chance you will be ‘woman handled’ as somebody tries to get your baby to latch by grabbing baby and boob and shoving them together (if this happens, put your hand up in a stop sign and ask, ‘please can you guide me, I would like to try myself’).

Or, if your baby is older and has been happily breastfeeding until now, you are probably wondering, ‘is he weaning?’

Whatever the reasons for your baby’s breast refusal, your baby isn’t ‘refusing’ to breastfeed because he is being stubborn, and forcing him won’t help.

For newborns, generally if your baby won’t breastfeed it is because he can’t right now, but it doesn’t mean you won’t be able to breastfeed at all – although you will need to be patient, with the right help, most babies will ‘catch on’ and latch on. Reasons for your newborn not being able to breastfeed in the early days may include being affected by drugs that you have taken during labour – being able to latch on and coordinate sucking, swallowing and breathing isn’t easy when your central nervous system is ‘hung over’ by drugs such as pethidine which pass through the placenta to your baby, staying in their body for several days or longer. Some drugs given by epidural have been found to affect breastfeeding for up to four weeks.

Early feeding attempts can also be affected by a difficult birth. For instance, babies who have had a forceps delivery may have some pain when they feed, others could be in pain in particular positions if, for instance, they have a sore shoulder or clavicle after birth. These babies often benefit from some gentle adjustments by a paediatric osteopath or chiropractor (it is important that any practitioner is trained to treat infants).

Other babies may have difficulty latching on due to problems with their oral anatomy such as a high palate (which can be helped by careful breastfeeding positioning) or a tongue tie (get an IBCLC Lactation Consultant to check). Some babies seem to develop an ‘aversion’ to breastfeeding after being ‘forced’ to breastfeed (your baby has a natural reflex to resist if his head is pushed forwards – don’t ever push your baby’s head against the breast). Another possible reason for ‘breast refusal’ could be 'nipple confusion': bottles and dummies require a completely different sucking action to the breast and babies can become ineffective at breastfeeding if they are given bottles in the early days.

If your newborn is having difficulty feeding at the breast, it is better to offer supplements by spoon or a syringe, or you could use a ‘nursing supplementer’, a device with fine tubing that slides into baby’s mouth, so he gets milk while he is at the breast. If you do have to temporarily offer some feeds from bottles, please don’t feel ‘this is the end’. With patience and persistence, and some help and support from a professional such as an IBCLC Lactation Consultant, even though it may take a few weeks, it is possible to gradually encourage your baby to breastfeed.

 Is baby unwell?

After the early days, even babies who have been feeding beautifully can refuse to breastfeed or seem to struggle at the breast.

A baby who has oral thrush may find it uncomfortable to breastfeed and a baby who has gastro oesophageal reflux can squirm and pull off the breast if feeding is causing discomfort. A baby with reflux may find it more comfortable to feed ‘sitting up’ perhaps straddled across your leg to feed. Babies with allergies can also seem restless during feeds or may reject the breast.  Although your baby is NEVER allergic to your milk, if he is sensitive to something in your own diet, a bit of detective work and eliminating the culprit food can make all the difference.

Is your baby weaning or is this a ‘nursing strike’?

Older babies can seem to be rejecting the breast as they become more efficient feeders so feed more quickly and are also easily distracted (these babies will often feed better when they are sleepy or at night when there are fewer distractions); painful teething can see babies ‘go on strike’; babies who have been given bottles can almost suddenly seem to ‘prefer’ drinking from a bottle and other babies can quite suddenly refuse the breast for reasons that aren’t at all obvious.

If your baby is less than a year old, it is very unlikely that he will be self-weaning, so generally this refusal to breastfeed will be a temporary 'nursing strike'. With patience and persistence, you will usually be able to bring your baby back to the breast and he will once again enjoy the comfort and nourishment of breastfeeding.

What can you do?

Whatever the reasons for your baby refusing to breastfeed, the most important considerations are to feed your baby (please don’t EVER try to ‘starve’ him into taking the breast), and to maintain your milk supply, by expressing so that when your baby does attempt to feed, his efforts will be rewarded by good milk flow.

Offer lots of skin to skin contact – wear clothes with quick access to the breast and cuddle your baby with your top off, allowing him to fall asleep on you. Wear, cuddle and carry baby lots and sleep with or close to him, so you can offer the breast at his very first hunger cues.

Try feeding in different positions and at different times –with an older baby who is refusing to breastfeed, try nursing lying down, standing or walking, or in the bath.

Offer a 'Dream feed' - Try offering the breast as your baby is just waking, as he is falling asleep or when he is asleep but stirring slightly – many babies who are temporarily refusing to breastfeed will ‘dream feed’. This can help maintain your supply until your baby accepts 'wide awake' breastfeeding again.

Don’t try to pressure your baby to feed. Stay calm (not always easy!) and avoid making your baby frustrated. If he is becoming stressed, feed him however you have been and try again later (the first rule is always 'feed the baby'). If baby is having bottles, he may try the breast after he has had a little drink, rather than when he is very hungry.

Be patient. It can take time for new-borns to learn to feed effectively or for a baby who is on a ‘nursing strike’ to return to breastfeeding, but this can happen more quickly with expert personalised help from a lactation consultant who can help you trouble shoot what may be happening, and support you and your baby through these challenges.