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EAT => Breast Feeding => FAQ's - Frequently Asked Questions & Related Information - Breast => Topic started by: Erin (redstarfalling) on April 04, 2007, 11:52:50 am
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Is my baby weaning or is it a nursing strike?
A baby who refuses to breastfeed may not necessarily be ready to wean. When babies abruptly stop nursing, its more likely a nursing strike, not weaning - babies rarely self-wean before 18-24 months and its almost never abrupt.
A nursing strike is a baby's way of communicating that something is wrong, and most babies who go "on strike" are obviously unhappy about it. Some nursing strikes come on suddenly, others more gradually. But a nursing strike does not have to mean the end of breastfeeding. If a mother encourages her baby to return to breastfeeding, a nursing strike usually lasts between two and four days, although some last longer.
Nursing strikes can be incredibly frustrating and emotional for mothers too! Some mothers feel rejected or blame themselves unnecessarily, and many are scared that their baby will not have enough food during the strike. As important as it is to take care of your little one, you have to take care of yourself too. Many babies go through this at least once during their nursing lives - the Breastfeeding board is a great place for support. Try to relax and avoid blaming yourself. With lots of patience and persistence it is almost always possible to convince the baby to go back to nursing so that both mother and baby can continue to enjoy its benefits.
Some of the suggestions listed below may not fall completely in line with Babywhisperer practices and EASY (feeding while sleeping, frequently offering the breast, comfort nursing) remember that the goal is to get your baby nursing again. If you can do that within the BW/EASY framework, great, but if not, its always possible to get back on track with a baby who is now nursing well!
Possible Causes of a Nursing Strike
Sometimes the cause of a nursing strike is obvious, but other times the mother may never discover the reason. Some common causes for a baby to refuse to nurse include:
mouth pain from teething, an injury, a cold sore, or a fungus infection, such as thrush,
an ear infection, which may cause pressure or pain while nursing,
pain while being held in the nursing position, perhaps due to an immunization or an injury,
a cold or stuffy nose that makes breathing difficult while nursing,
too many bottles, overuse of a pacifier, or frequent thumbsucking, which may lead to a reduced milk supply,
regular distractions and interruptions while nursing,
an unusually long separation from mother.
There may be situations or actions on the mother's part that contribute to a baby's refusal to nurse:
a strong reaction to a baby's bite,
a major change in routine, such as moving or traveling,
limiting and/or rigidly scheduling feedings,
talking in a loud voice or arguing with other family members while nursing,
overstimulation, stress, or tension from an overly full schedule or an upset in the home,
repeatedly putting off the baby when she wants to nurse or letting her cry.
Other, less common causes of a nursing strike include sensitivity to a food or drug the mother or baby has ingested (including vitamin or mineral supplements, fluoride drops, dairy products, or caffeine), creams or ointments applied to the mother's nipples, change in the taste of the mother's milk due to a breast infection or change in mother's diet, or a reaction to a new product (such as a soap, shampoo, or laundry detergent) the mother has used on her body or clothing.
What can you do?
The two primary rules when you have a baby who is having problems nursing are:
1. Feed the baby. A baby who is getting the right amount of calories and nutrition is best able to learn how to nurse (expressed breast milk, or formula if necessary). Do not try to starve your baby into nursing. Your baby is not refusing to nurse just because he doesn't want to and is being stubborn, so ignore anyone who tells you that "baby will nurse when he gets hungry enough." In general, a baby who won't nurse, can't nurse. Your goal is to (hopefully) identify why baby can't nurse and either remedy the problem, work around the problem, and/or preserve your milk supply until the problem remedies itself (sometimes necessary for ill, small or premature infants).
2. Maintain milk supply. If mom's milk supply is being maintained with an appropriate frequency and amount of milk expression, more time is available for baby to learn to nurse, and baby's efforts will be better rewarded (with more milk). This means pumping or hand expression!
Suggestions for a typical nursing session
Very careful, supportive positioning can be very helpful when baby is having problems breastfeeding; for example, a cross-cradle hold or a modified football hold can be useful.
Don't continue trying to get baby to take the breast after major frustration (either mom's or baby's) sets in; stop for a bit and calm baby (and/or give mom a break) before continuing - let baby suck on a finger, or snuggle baby high up between mom's breasts, or hand baby to dad.
Sometimes it can be helpful to offer a little supplement at the beginning of a feeding; this can take the edge off baby's hunger so he has more patience to work on the breastfeeding. If you've been working on latching and hunger is getting in baby's way, go quickly to whatever alternative feeding you're using. If you're both totally frustrated, give a whole feed, but if you think your baby is up for it (and you are too), only offer enough supplement to calm him and go back to working on breastfeeding.
If baby does not latch or does not suck effectively (or won't sustain a suck for more than 3 sucks even with breast compressions), then either try supplementing at the breast (see below) or stop and offer baby a little supplement (1/2 ounce or so of expressed milk or formula), and then have another try at nursing. If the second try is unsuccessful, then go ahead and finish up the feed with whatever method of supplementation you are using.
Any time that baby does not nurse at all, or nurses but does not soften the breast well, pump after feeding baby. This will help to maintain your milk supply, plus you will have some "liquid gold" available the next time baby needs a supplement.
Coaxing baby to the breast - General tips
Your goal is to coax baby to the breast. Do not attempt to force your baby to breastfeed. Forcing baby to the breast does not work, stresses baby, and can result in baby forming an aversion to the breast. As baby gets better at nursing and is able to get more milk via nursing, he will grow to trust that breastfeeding works and will have more patience when latching.
Wear clothing that allows very easy access to the breasts. Baby may get very impatient in the split-second it takes for mom to lift the blouse and undo the bra. Spend time, if possible, in a warm place that allows both mom and baby to be naked from the waist up.
Lots of skin-to-skin contact can help your baby nurse better and even gain weight faster. Keep your baby with you as much as possible, and give him lots of opportunities to nurse (even if you're not successful). Get skin-to-skin with him, first when he is sleepy, right after a bottle feed (or however you're supplementing). Take a bath together. This way baby has the opportunity to sleep and wake up happily, skin to skin at mom's chest, and mom is right there to catch the earliest hunger cues. If baby moves toward the breast and then falls asleep before even mouthing the nipple, or after sucking twice, then these are positive baby steps, not failures.
Offer the breast often. Try breastfeeding in baby's favorite place, in his favorite position, in the bath, while walking around, while lying down, with baby upright, baby flat on his back, in his sleep, just as he is waking, any time baby looks as if he might be interested, or any other way you can think of, i.e. any time, anywhere.
Avoid pressuring baby to nurse. Offer in an ultra-casual way and pretend you don't mind if he refuses (easier said than done, but try not to show any frustration - your aim is to avoid pressuring baby to nurse). Don't hold the back of baby's head or push or hold baby to the breast. If baby pulls off the breast, then don't try to make him go back onto the breast at that time - simply try again later. If baby seems frustrated with your offering the breast, then turn the pressure down and simply make the breast available (lots of skin-to-skin!) without offering. It can be helpful to have lots of skin-to-skin time with baby where he is cuddled at the breast with no pressure to nurse - give control over to your baby, so that baby decides if and when to nurse and when to stop nursing.
Carry your baby close to you (a sling or other baby carrier can help with this). "Wear," carry, hold and cuddle your baby as much as possible; carry baby on your hip while doing other things, play with baby, and give baby lots of focused attention.
Sleep near your baby. If baby sleeps with you, you'll get more skin-to-skin contact, plus baby has more access to the breast (being sure to use safe co-sleeping techniques). If baby is not in the same bed, have baby's bed beside your bed or in the same room so that you can catch early feeding cues, breastfeed easier at night, and get more sleep.
Nipple shields can be helpful at times for transitioning baby to the breast. Talk to your lactation consultant about using this tool.
Comfort nursing is often the first to come, followed by nutritive nursing. Offer the breast for comfort any time you see a chance- at the end of a feeding when baby is not hungry, when baby is going to sleep or just waking up, when baby is asleep, and whenever he needs to comfort suck. If your baby is actively resisting nursing, then try encouraging comfort nursing after baby is comfortable with skin-to-skin contact. After baby is willing to nurse for comfort, you can then proceed to working on nursing for "meals" as well.
You also might try nursing when he is a little drowsy. Some babies are more willing to take the breast when they are semi-asleep than when fully awake. Try nursing as he is just beginning to wake up. Some mothers find that their babies will instinctively nurse well once completely asleep (dreamfeed).
Try different nursing positions. Nursing while lying down often helps minimize any distractions that may interfere with nursing. Nursing in a quiet, dark room may also be helpful.
"Instant Reward" techniques
For a newborn who is not latching or an older baby who does not want to wait for letdown, try these techniques that help to teach (or re-teach) your baby that nursing is a way to get milk:
Hand express or pump until let-down, just before trying to latch baby, so that baby gets an instant "reward" for latching on.
If you are using a nipple shield to transition to nursing, try filling the tip of the shield with expressed milk prior to applying the shield and latching, so that baby gets some milk first thing as he latches.
Drip expressed breastmilk (if you have it) or formula onto the tip of the nipple as you're latching (use an eyedropper or a bottle). You can continue this while you're breastfeeding: Just drip milk toward the center of baby's upper lip; let the drop start on the breast and roll down toward the center of the upper lip (12 o'clock position if you're using the football/clutch hold), one drop at a time. A curved tip syringe can also be used to drip milk into baby's mouth.
Use a nursing supplementer to increase milk flow at the breast.
If baby starts breastfeeding but stops sucking as soon as the milk flow slows, breast compressions can speed the flow of milk.
Bottles - yes or no?
Many experts suggest that baby not get bottles or pacifiers while he is learning to nurse correctly, with the idea that his need to suck will help the process along (nursing will satisfy the need to suck). Of course, if you're working with a baby who has nipple confusion, it's best to avoid bottles (when mom and baby are together, in particular) until nursing is going well again. If baby is not latching on at all, you do need to balance this with your baby's need to suck and comfort level.
Do consider giving your baby his feedings via an alternative feeding device other than a bottle, such as a nursing supplementer, feeding syringe, finger feeding setup, flexible cup, spoon, medicine/eye dropper, etc. A nursing supplementer can be a big help if baby is latching well: it will encourage your baby to continue nursing by giving him a constant flow of milk (expressed milk or formula) while he stimulates your body to produce more milk.
For some moms, using a bottle is easier and more familiar. If you feel that using a specialized feeding device (like a finger feeder or SNS) is simply too overwhelming and other methods (cup, dropper) are not working for you, using bottles may make it easier for you to continue working on the breastfeeding.
When using a bottle, encourage baby to open wide prior to giving the bottle. Stroke baby's lips from nose to chin with the bottle nipple, and wait until baby opens wide like a yawn. Allow your baby to accept the bottle into his mouth rather than poking it in. This will teach your baby to open wide for feedings, which is a good start to getting on the breast effectively.
References:
Is Baby Weaning or Is It a Nursing Strike? Nancy Mohrbacher
Mt. Prospect, Illinois USA, From: NEW BEGINNINGS, Vol. 9 No. 6, November-December 1992, pp. 173-4, 176
Surviving a Nursing Strike by Becky Flora, BSed IBCLC
www.kellymom.com