Why is my baby rejecting breast for a bottle at the end of the day?

[Aussiemum1]

I have a tough one and I will worship the person who can work this one out? Sorry - it's long but I don't know how else to explain this! Firstly I have a great supply and a fairly steady flow. However, my 4 month old DS has just started to refuse my breast in the evening for a bottle and I'm wondering if it's because he has worked out the routine I use to get him to sleep? Until recently he used to go down for his naps and night time sleep quite well. However, last night that all changed.

Last night we did the usual bath time routine - bath followed by breast feed - but when it was time to breast feed he wouldn't latch on? He became really distressed each time I tried to put him to my breast, so we gave him a bottle of EBM (which he guzzled no problems) and then it took us 3 hours to settle him to sleep. In the end he cried himself to sleep on my shoulder. I was quite upset that he refused my breast for a bottle and started to wonder if it was a supply issue? But I managed to express 7 ounces!

Tonight the same thing happened, but now I'm wondering if we have a clever little boy on our hands. We again started the usual bed time routine - bath followed by breast feed. However after his bath when it was time to breast feed he again refused to latch on, despite having no issues with his feeds during the day. I have a nice full breast so supply is not an issue. He had napped well in the afternoon so he wasn't overtired. I kept trying to latch him on and he kept refusing and began to cry. So, we pulled out the bottle of expressed milk and he guzzled it back - all 8 ounces. He then continued to scream each time we put him in his cot so we gave him another 4 ounces. Fearing he might be teething we gave him teething granules and calpol...but he continued to scream. We put him in his cot and left him to cry and then when we returned to the room to reassure him he would stop crying and smile, until he realised we weren't going to pick him up and then he would become hysterical.

So, I'm starting to wonder if he has just worked out that the bath means it's time for bed soon, so he refuses to breastfeed afterwards because he doesn't want to go to bed??? But can a baby at 4 months be that switched on?? Tomorrow night I'm going to try and trick him by not bathing him, but I can't do that forever! I think we are going to have to go down the controlled crying route if we are confident he isn't teething, but he gets so worked up. We tried it tonight and in the end he was so distraught he sobbed himself to sleep on my shoulder. Has anyone ever experienced anything like this? I'm gutted that my baby is choosing a bottle over my breast.

[RachelC]

Hi and welcome to the boards.

I am so sorry you are having a tough time.

Can you post your whole day's routine, including feed times, nap times, etc.  Are you following EASY?

Perhaps doing the breastfeed prior to bath time?  Please keep in mind that many babies will drink from a bottle and drink more than they need because it is easy for them.  Make sure you use the slowest nipple flow you can get, so at least he does have to work for it.

Please, please do not go the controlled crying route.  Tracy Hogg (who created this site and wrote the Baby Whisperer books) was totally against it.  There is an extensive explanation here: https://babywhispererforums.com/index.php?topic=63839.0

Seeing your whole routine will help.  I will ask some sleep mods to check out this thread as well.

Again, welcome to the boards.

[momofclaire]

Hi, and like Rachel said, welcome to the boards. 

If you could, post back with the info that Rachel requested.  Also, are you still feeding overnight, and if so how often? 
If he is teething, he may be more inclined to take the bottle.  When babies suck, blood rushes to their gums and this can be painful if teething. 
I think you are probably having a sleep issue more than a bf issue, but either way, rest assured that someone will be able to help.  I would also advise against CC. Please read the link Rachel posted.
Post back and we will try to help you figure this out.
Myia

[meltown]

I was thinking nursing strike.  could this happen with one feed only Rach?? I had a friend that had this problem when she started taking PPD meds.  but I think her's was more of a supply issue.  but that may be something to look at if you are taking meds. maybe it makes something different depending on when you take it.  Also your routine would be great, like Rachel asked for.

[Samuel's mum]

My hunch would be that he is simply tired - it's a common reason for refusal or difficulties with the last feed. If you are tired a bottle feed is so so much easier than a breastfeed as it requires hardly any effort or energy. Routine would be very helpful to see if he is overtired. A good nap in the afternoon may not solve an issue if he had a particularly long A time or other nap issues. But it might not be 'overtiredness'. He may be overstimulated and tired after the bath and now that he's older and more aware of the world he's taking in more stimulus.

I don't think a 4 month old would be consciously avoiding bedtime if they are no negative associations (and even if he was avoiding bedtime it's quite a stretch for him to have that understanding of consequence and effect) - actually that's one of the reasons we at baby whisperer really urge people not to go down the controlled crying route. It can start negative associations that are often the reasons people first come to these boards. Please do investigate other methods first and our sleep boards can support you.

But I would have thought your first bet is looking at your routine. Or could he be overhungry - what are your intervals? Have you seen any signs of a growth spurt?

Then I would agree with the Rachel to switch bath and bed. Then perhaps offer the bf in another room or in a different position. If you suspect teething pain (which he may be particularly aware of when tired) you could offer pain meds 30 minutes before the feed is due.

[Aussiemum1]

Firstly - thanks so much for showing interest so quickly! It's a relief to see people wanting to help out!

Ok - I first have to confess to loosely following the Gina Ford Contented Baby routine. My husband bought this book before DS was born and once he arrived I just didn't seem to have time to try and read anything else. I have heard about Baby Whisperer but have not read the book. I saw many people referring to it on discussion boards so needless to say I think it's time to get a copy!

The routine we loosely follow is this:

6.30/7am - feed for about 40 mins then play for about an hour
8.30/9am - nap for about 45 mins
10/10.30am - feed again for 30-40 mins then play again
12/12.30 - nap. Now this can sometimes go for two hours or one hour - so the rest of the day tends to be dictated by how well he naps now

If he sleeps at lunch for 2 hours:
2/2.30 - feed for about 30 mins then play
4.30 - I take him for a walk or a drive and sometimes he naps, sometimes he doesn't! He's very curious. If he doesn't nap I bring forward his bed time
5pm - bath time
5.45 pm - feed for as long as I can. Usually he drops off at the end of this sleep and I put him in his cot. He used to just stir then go back to sleep on his own before entering this phase. In fact - this used to be the one nap of the day that I was guaranteed and easy time! My how that's changed!!

If he sleeps at lunch for only an hour
1/1.30 - feed followed by a play
3/4pm - I try and get him to nap for an hour
Bathtime and final feed the same time

I'm actually quite paranoid about him becoming overtired and watch him like a hawk for any tired signs - yawning, grumbling and as soon as I see them I take him to his darkened room and start settling him. I try and get him sleepy with a little rock on his chair or a quiet read of a book.

The checklist I have gone through includes:
- milk supply, which isn't a issue because when I express there is milk there and my breasts aren't too engorged either
- stimulation, I try to keep things as calm as possible in the lead up to bed
- teething, I have him on granules and bonjela incase it's this

The only other thing I can think of is when I express I notice occassionally my let down will stop for a few minutes but then pick back up once the machine as stimulated my nipple. Could DS be too lazy at the end of the day now he has been exposed to bottles and is becoming impatient when there isn't instant let down? However he has had the odd bottle since the day he was born so it's not as though the bottle is a new concept to him. We did recently have a break of month recently when I travelled to Australia and he had no bottle. This probelm has started to happen since it was reintroduced at 10.30pm.

Oh the mysteries of babies!  Speaking of overtired babies...I think my DS needs bed time now!

[RachelC]

Sorry if this is quick, I've been running up and down the stairs trying to keep dd2 content until 7am 

Here is a link to EASY routines for ages 3-6 months:
https://babywhispererforums.com/index.php?topic=10385.0

At 4 months you want to aim for 3-3.5-4 hours between feeds.  At 4 months, I don't believe he should be taking 40 minutes to feed.  Do you hear clear swallowing sounds for the entire 40 minutes?  Listen for when the swallowing slows, as it sounds like he may be comfort feeding.

Also, I would start putting him down for a nap about 1/2 hour earlier.  At 4 months, most babies can handle about 1.5 hours of awake time.

What time is bedtime?  You want to aim for a 12 hour day, so up at 6:30am, bedtime 6:30pm.  Does he wake for the 10:30 feed, or is it a dreamfeed?  https://babywhispererforums.com/index.php?topic=65750.0  Does he go to sleep on his own? 

[Aussiemum1]

Thanks RachelC.

Answers to your questions:

Re 40 minute feeds - I think he might be comforting. I do hear swallows initially but towards the end he always gets a bit sleepy. I struggle to keep him going but perhaps I'm trying to keep him on too long? How long should it be at this stage. This morning he fed in about 25 minutes and I worried that it was too quick? His weight is average, and in fact in the last few weeks he has dropped a little on his chart - but not enough to worry the public health nurse.

Bedtime is usually 6.30pm and he usually gets up at 6.30am. However the last few nights he cries non-stop until we get him settled at about 8-8.30pm. He used to go down SO easily - most times I could put him into his cot very sleepy from his feed but awake, and he would have a little chat then drift off quite happily on his own. I felt so lucky that I had a baby that did that for most of his sleeps - so this is all a rude shock to me now!

We have only just introduced the dream feed a week ago - coincidently the same time this unsettled period seemed to start. For the first couple he would wake up because he would badly need a nappy change (I try and avoid this as much as possible). The last few dream feeds we have managed to keep him asleep - although last night he woke up when I tried to take the bottle away and had a cry. I managed to sooth him pretty quickly though. Previously I used to put him to bed at 6.30pm and then feed him whenever he woke up naturally at about 3-5am. That was the only night feed required. Now that we do the dream feed he doesn't wake for any other night feeds.

We just had another screaming session to get him down for his lunch time nap. It took about 20 minutes to calm him down. At the moment there is no way we can put him in his cot and try and sooth him. He gets too hysterical. We have to let him cry to sleep on our shoulders and then sneak him into his cot. When we try and sooth him in his cot without picking him up it can go on for hours and hours. The other night it lasted 3 hours and then we just had to pick him up.

It's such a mystery because he was so easy previously. We have introduced a few new things recently - blackout blinds to darken his room. I thought that he may have been afraid of the dark so we have tried to settle him without the blind and it's no better. A mobile above his cot - I thought that this was keeping him awake so I took it away again - but again it has made no difference.

Thanks again...

[Aussiemum1]

Well another night of the same...he had napped really well during the day (despite not wanting to go down), we didn't have a bath...and he just wouldn't latch. He was also a little fidgety with his other feeds today. So, I jumped on the internet and did some research and found this article. I think it's either his teeth bugging him (he is chewing and drooling like mad - so much he now has chin rash) or it's the developmental phase mentioned at the end of the article. Looks like I have to ride it out for a few more days and maybe it will pass? I'm glad it's not the bath because I love bath time with him.
http://www.storknet.com/cubbies/breast/AS-nursingstrike.htm

[RachelC]

25 minutes is plenty!  My girls would down a breast in less than 10.

I truly think this is an overtired issue.

[Aussiemum1]

Yeah - I was convinced it was too, but now i'm not so sure.

Yesterday he napped really well and I made sure to get him to bed 1.5 hours after he last woke. He still didn't want to go down or take my breast. The only other reason why I question if it is him being overtired is that he has followed this routine since he was 6 weeks old and in the past he hasn't had an afternoon nap at all and has still fed and gone down with no problems at all.

I'm just hoping that it will pass soon. It's also unusually warm here at the moment (I live in Ireland and we are having a great summer) so I'm wondering if this could be a factor? The day is at its warmest when I do his last feed. I did strip him down and take off some clothes myself and moved to another room and didn't work - but he was upset by then so it was hard to cool him down.

He has fed really really well today so I'm hoping for some kind of improvement this evening. It's so hard not to get overly stressed!

On another note...with the whole over tired thing...I get so paranoid about this that I often find myself chained to the house reluctant to go out for fear that I will overstimulate him. He is not great at just falling asleep while we are out and about - he's a curious little fellow. How do other people manage getting out?? My husband thinks I'm doing more damage to both my son and myself by staying couped up in the house. Today we popped out really quick to have a coffee with a friend but I was stressed the whole time about getting him home before he became overtired. My friend's baby just fell asleep in her buggy while we were out. My DS just wanted to play!

[Erin (redstarfalling)]

I usually get everything ready when my lo is asleep then as soon as she wakes, I feed her (and I agree that 25 min is probably plenty - are you doing breast compression when the flow slows down?) then we rush out.  About 15-20 min before I want her to go down for a nap, I make sure we're home to relax (you might have to do it longer).  WHen she was younger, it made for short outings, but saved my sanity!

The fussiness at breastfeeding in the evenings sounds EXACTLY like what my dd does when she's overtired.  I think if you stick to a routine with slightly shorter awake times (1.5 hrs sounds good to me too!), as long naps as you can get him to do (1.5 hrs would be ideal, obviously!), and maybe move the last bf to before the bath so he's not overtired.

As for teething, if you're comfortable with meds, I found some Tylenol really helped.

Let us know how things go!