Huge, huge (((hugs))) to you both
I was going to ask the same as Tay - are you sure that the reflux is under control? Is he on meds? How long has he been on them? Is it possible that they need adjusting/changing? Is MPI/MSPI a possibility? Are you doing anything non-medical to control symptoms? (ie, elevating the head of the crib, holding upright for about 15m after feeds, etc.) Reflux aside, could anything else be causing him discomfort while nursing? An ear infection or sore throat for example? Have you tried different nursing positions to see if that helps at all?
Ok, some tips to get your lo back to breastfeeding
Here's some information from kellymom.com, a very reputable breastfeeding information site, on their page "Help - My Baby Won't Nurse!":
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. First choice for what to feed a non-nursing baby is mom's own milk, second choice is banked milk from another mom, third choice is infant formula.
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). (*from Vikki: have you tried hand expression rather than pumping?
http://babywhispererforums.com/index.php?topic=70304.0 *)
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.
* If your baby is tolerating it, then work on latching for up to 10 minutes or so. If baby is getting upset, then go with shorter sessions. It's not a good idea to keep trying for more than about 10 minutes - after this baby will be tired, latching will be harder, and there is a risk of baby developing an aversion to the breast if you persist too much.
* 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.
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). 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. (Read more about kangaroo care or take a look at the book.)
* 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 (see this information on safe co-sleeping). 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 are working to seduce your baby back to breast. Again, coax, don't force!
Working with a baby who is actively resisting nursing
Make sure that a physical problem is not causing baby to resist nursing. Could baby have a birth injury or other condition that makes positioning for nursing painful? Is baby having problems with breathing while nursing or coordinating sucking and swallowing? Does baby have an overactive gag reflex that makes nursing uncomfortable? Does baby have severe reflux that makes feeding painful? Does baby have a sore throat from suctioning or other medical interventions? These are just some of the things that might interfere with breastfeeding.
Sometimes a baby will aggressively refuse the breast for no discernable reason - this baby will often resist being held, and may also be easily overstimulated. These babies can be transitioned to breastfeeding, but it should be done very gently so that baby becomes comfortable with being at the breast.
La Leche League's Breastfeeding Answer Book lists the stages that these babies go through as they transition to breastfeeding:
* The baby aggressively fights the breast.
* The baby cries more while being held than when he's put down.
* The baby is willing to be held in some positions, even if not in a cradle hold.
* The baby tolerates being held in the cradle hold.
* The baby will attempt to root.
* The baby will lick at the milk on the nipple.
* The baby will attempt to suck, using and in-and-out movement.
* The baby will take milk at the breast.
* The baby nurses well, even before the let-down occurs.
Source: Mohrbacher N, Stock J. The Breastfeeding Answer Book, Third Revised Edition. Schaumburg, Illinois: La Leche League International, 2003, p. 136-137.
Some babies will become more resistant the more you press the issue of nursing. If you've been working hard to get baby to latch and baby is resisting nursing, it can be helpful to step back for a bit, take the pressure off both yourself and baby, and not try to latch baby at all for a few days. Then slowly and gently work on moving baby through the above stages.
* Start out by bottle feeding (or using whatever form of alternative feeding you prefer) in the feeding position you usually use, without trying to nurse. If baby resists being held in the beginning, it might be helpful to feed baby in an infant carrier or perhaps while holding baby so he is facing away from you.
* Work with baby until he becomes comfortable being held in any position, then being held in a nursing position.
* Once baby is comfortable being held in a nursing position, start trying more skin-to-skin contact. Don't actively try to get baby to latch before he is comfortable with skin-to-skin. You want baby to be able to trust being at the breast and cuddling at the breast without the stress of trying to latch.
* When baby is comfortable cuddling at the breast, try feeding (bottle, etc.) at the breast. You're working to get him comfortable with feeding in a breastfeeding position, skin-to-skin.
* Next step, start offering the breast for comfort when he's really relaxed and sleepy, or even asleep. Nursing in the side lying position might be helpful, as this positioning allows for less body contact. Some babies will take the breast after bottle-feeding or partway through a bottle-feeding.
* Once baby is willing to take the breast for comfort, begin to work toward full breastfeeding.
(This is not the whole article, there is more information at
http://www.kellymom.com/bf/concerns/baby/back-to-breast.html)
I hope something in this rambling is helpful. Please let us know how things are going
