It is difficult to know why babies suddenly decide that breastfeeding is not for them, but usually this is only a temporary glitch and breastfeeding returns back to normal within a few days. Whilst in most cases breast refusal takes mum by surprise, there are a few situations that can lead to nursing strike. Let’s look at the practicalities of managing breast refusal.

Firstly it is important for you to realise that your baby is not rejecting YOU. Many clients feel that they have done something wrong or that their baby doesn’t like them and whilst this may feel like personal rejection, it is more the method of feeding that your baby is not getting on with. When we can determine which element of breastfeeding your baby is not happy with, we can resolve it and breastfeeding will usually go back to normal.

Knowing that your baby is getting enough food is generally the primary concern when little ones go on nursing strike. If your baby is refusing to even latch onto the breast, you will need to express both breasts every 3 hours to maintain and protect your milk supply. Offer your baby expressed breast milk as frequently as he or she fed from the breast. I find the Medela Calma bottle to be the most suitable, as the baby still needs to create a sealed chamber of negative pressure to draw the milk out of the bottle. All other bottles will begin to drip milk when turned upside down, which makes milk transference easier than breastfeeding and can lead to further refusal.

As you are maintaining your supply by expressing, you can now focus on keeping your baby hydrated. Monitor your baby’s output. If your baby is older than 6 weeks, we won’t expect to see many dirty nappies, however the wet nappies should be heavy and clear.

Offer your baby the breast after a short bottle feed. Bottle feeding first will take the edge off your baby’s hunger and will take the pressure off you. Do as much skin to skin with your baby before and during the feed. Many mums find having a nice warm bath with baby, quite effective too.

What are some of the common causes of breast refusal and what can you do to rectify it?

Oversupply or fast let-down
If you can hear your baby gulping and spluttering at the breast at each feed, which usually leads to your baby pulling off the breast and struggling for breath, it would be reasonable to suspect that this could be a cause of breast refusal.
Feed lying down when possible, feed lying back with baby prone or on top of you facing down it is easier to manage when out. Block feed so that you only feed from one breast every 4-6 hours when baby needs a feed. This will allow your body to reduce milk production and flow.
If you are concerned about your supply but find the flow difficult to manage, you could try using nipple shields. These will break the stream of milk, making it easier for baby to manage.

Low milk supply or poor sucking reflex
When baby’s aren’t able to access the milk or find feeds exhausting, bottle feeds will seem like a far easier option and this may lead to breast refusal. There are many ways to boost and increase your supply, so explore some of these and see if feeds become less stressful. Also get some help to assess whether your baby is actually able to milk and drain the breast. Sometimes babies aren’t able to suckle properly and though they have been on the breast for hours, they have not even had a single drop. Speak to your breastfeeding specialist about alternative feeding options.

Reflux, ear infections, blocked noses
All of these and a whole lot more can lead to sudden and ‘unexplained’ breast refusal. Have your baby checked out by your GP, as with a little treatment, these can be easily resolved and breast feeds can resume as normal.

How do you know that your baby is getting milk when breastfeeding? Sure you can see him or her sucking, but are those sucks amounting to efficient milk transfer or just allowing your baby to swallow nothing more than fresh air. Let’s look at what research tells us.

Countless women have been shocked and upset to hear that their baby had lost more than the expected 10% of birth weight, when they had been reassured that baby was feeding well by health professionals. Often when I meet with mums who’s babies are failing to gain weight, I am surprised that a glaringly obvious clue has been overlooked by the ‘trained’ and ‘qualified’ eye.

I am referring to the collapse of baby’s cheeks with each swallow. So how is this relevant to milk transfer?

When a baby latches onto the breast, the tongue moves down the floor of the mouth and stretches over the lower gum, creating a degree of padding and increasing the availability of room for breast tissue inside baby’s mouth. The anterior part of the tongue holds and stabilises the breast as the nipple moves right to the back of the mouth where the hard and soft palate meet. The breast is held in place by the palate, the cheeks which are equipped with fat pads to ensure the oral cavity is snug and a grooved tongue.

The baby then laps the breast in a wave-like motion to create a sealed chamber at the back of baby’s mouth, around the nipple area. When the baby is ready to transfer milk, he will drop his jaw slightly, pulling the mid section of the tongue down and creating negative pressure. This negative pressure allows the milk to spray into the baby’s mouth before swallowing.

The purpose buccal pads (fat pads), is to increase the thickness of the cheek wall and prevent the collapse of cheeks when baby drops his jaw, in order to maintain an enlarged oral cavity and aid milk transfer. If a baby’s cheeks collapse during the feed, the oral cavity is reduced which leads to less negative pressure and undermines milk transfer. Ramsay & Hartmann conducted ultrasound studies in 2005 and found that negative pressure in the mouth was imperative to milk transfer.

If you are working with a mum and baby who are struggling to gain weight and you notice that baby’s cheeks are collapsing, check that baby has enough breast tissue in his mouth. Check that baby is close enough to mum. Use breast compression to aid milk transfer. Seek expert advice as soon as possible to get to the root of the problem.

We have all spoken to mums who sadly found that their breast milk supply suddenly seemed to dry up with no real explanation when their baby was around 3 months old. So why does this happen and what can you do to protect your milk supply long term?

Establishing a good breast milk supply in the early days is crucial to long term breastfeeding success. If you have heard this strap line once, I am sure you have heard it a hundred times – ‘The more you feed from the breast, the more breast milk you will produce’. BUT this is only true if your baby is effectively stripping the breast of milk at each feed.

If your baby is ‘feeding’ frequently but not actively transferring milk from the breast, your milk supply begin to decrease. Your baby has to actually drain milk off the breast at each feed, to ensure optimal and long term milk supply and production.

Think about putting petrol into your car. Parking the car next to the pump will not deliver fuel into your tank. Putting the nozzle into the petrol tank won’t deliver fuel into the tank. You HAVE to do both of the above and then pull the trigger on the nozzle and hold it down, to ensure the safe and effective delivery of fuel into your petrol tank. It really doesn’t matter how often you park your car next to the petrol pump or pop the nozzle into your tank – nothing of value is going to happen. The same can be said of breast feeding.

You see in the early days, your milk production is driven by both the efficient removal of milk and an efficient supply of milk producing hormones. If you have a strong let down or an abundant supply of milk in the early days, your baby will be grow well even if they are not able to effectively strip the breast of milk.

The hormone responsible for milk production in the early days and weeks, prolactin, significantly decreases in the first 3 months. Milk production is then determined by the amount of milk drained from the breast as hormonal levels only play a very small part in good milk supply.

So if you have fed well and you suddenly start to see that your little one is waking more frequently for feeds at might – is becoming fractious and difficult to settle – have your breast feeding assessed to ensure that he or she is actively draining the breast at each feed.

More often than not a sudden decrease of milk around the 3 month mark is as a result of undiagnosed poor milk transfer.

Whilst this sounds quite dramatic, you can increase your milk supply quite easily and enjoy a long and happy breastfeeding relationship with your baby.

What happens when all the ‘changes’ you are told to expect, just don’t seem to happen? Is is an indicator that something is not working the way it should, or that you are going to experience problems later on down the line? Well, apparently the absence of breast growth during pregnancy has been found to be unrelated to milk production post-partum.

So if this is true, why would so many professionals, including myself include this question as part of our case profile? The truth is that the breast is the last organ in the body to mature and only matures once a woman has been pregnant. During the first trimester, we expect to see that the breast size increases or changes shape as this is when milk producing tissue proliferates.

In my experience though, women who are already larger breasted don’t notice a significant increase, however smaller breasted mums do notice a varying degree of breast size increase. One study (Cox 1999) found that there was no conclusive link between breast growth and milk supply at one month post delivery. This is good news for many mums who are worrying that the lack of development in the bust area, spells problems ahead.

Another interesting point that I came across was that the breast growth continued in the first month after birth. This might not be such great news for mums who are already struggling to cope with their generous growth during pregnancy, but it is important to bear this in mind when buying nursing bras. Purchase a bra that will stretch as your breast changes to avoid tightness and possible onset of mastitis, especially when wearing breast pads or breast shields.

If you have had a baby, think back to how excited you were when you were told that you could go home with your new baby, that everything was going well, your baby was feeding well and off you went, merrily on your way!

For some mums, that is how their hospital story ends and whilst the first few weeks are not always smooth sailing, over time everything falls into place.

However, for many mums, this is just the start of a real rollercoaster ride and many mums end up back where they started for a number of reasons. I have seen 4 mums readmitted this week and I wonder whether this could have been prevented. I am not on a rant, as I know that everyone is doing their best for mums and new babies, but surely, having mums and babies brought back to hospital is not good from any point of view.

So what are the most common reasons mums and their babies find themselves back in hospital? You guessed it, breastfeeding related problems.

Either baby is not feeding well enough to gain weight, be settled after feeds or get rid of his/her jaundice. For mums, the affects of a baby who is not able to feed well, often leads to the development of mastitis or worse.

I am not sure why I am writing this, I definitely don’t want to scare anyone but I feel that maybe it is just this sort of thing which results in breastfeeding having to really bad reputation.

Mums often tell me that there are no clear answers when it comes to breastfeeding, they find it difficult to read situations correctly. Many mums who have revisited hospital feel less than confident that they will be able to breastfeed successfully and keep their baby well hydrated and gaining weight after such an experience.

If there are any expectant mums who are reading this, please be reassured that for many women breastfeeding is simple, easy and the most natural thing on earth. But…if you are in pain, if your baby is not settling don’t think it is just something that you are doing wrong, ask for help and don’t stop looking until you find clear answers to your questions – they are out there!

The next antenatal Breastfeeding Workshop is on Saturday 15th May and Wednesday 26th May Let’s Breastfeed Workshops

Come and see how different our workshops are, we have dropped the price to £49 for May workshops!

Dear Geraldine,

I hope you can help me! I am at my wits end and exhausted to say the least!

My baby is 5 weeks old and feeds all day!! Feeds usually last for an hour and a half (with lots of sleep time at the breast) but then he won’t let me put him down after feed, he starts crying (sometimes I feel like joining him!) and so I put him back onto the breast. SIGH!

I am feeding him from one breast so that he gets to the hind milk, but he goes to sleep after 15 minutes and I can’t keep him awake, even though I tickle is toes, blow on him and undress him completely! My health visitor has suggested that I give him formula after each feed as I may not have enough milk. I just don’t want to as I have worked so hard to get this far on breast milk alone. There has to be a better way of doing things!

Janet White London

Hi there Janet,

You have done well to get to 5 weeks and I agree that there has to be a better way! So let’s have a quick look at what we can do for you.

There are a few things to mention:

1. Your baby is 5 weeks old – he could be going through a growth spurt which does lead them to feed ‘all day’. This should only last for a few days though, but we will keep this in the back of our minds.
2. Your feeds are lasting for an hour and a half – WOW! Did you know that your baby’s tummy is practically empty an hour and a half from the beginning of the feed? This means that he will not go to sleep easily – on an empty tummy, so will need to feed again before you can put him down. This is quite likely why the feeds are running into each other! We need to get your feeds shorter and more efficient!
3. You are feeding him from one breast for roughly 15 minutes before he falls asleep.
4. You are thinking of introducing formula.

It seems to me that your little one IS hungry,  but not because you have a low milk supply issue.

Most 3 week old babies need to feed from both breasts at each feed. As your little boy is 5 weeks old – I definitely think he should be feeding from both at each feed.

We know that your baby is getting to the hind milk if his poos are yellow.If he was not getting enough hind milk, his poos would be spinach green.

Babies can drain the breast pretty quickly and effectively within minutes, so I would suggest that once your little boy has fed from the first breast, do a little breast massage or compression so see if you can encourage him to swallow a little more.

If he is asleep, take him off, wind him – nappy change him if needed and offer him the second breast.

When he goes to sleep on that side, take him off, wind him and offer the first side again. He will either take it or not depending on how hungry he is.

If he is nice and relaxed, put him DOWN QUICKLY, so that he can go to sleep with a full tummy. Offer him a feed every 3 hours – from the beginning of one feed to the beginning of the next, starting on the side you fed from last!

You want to see that your baby gains 20-30g each day. If he is gaining this and is still crying, we need to explore what else could be causing the crying spurts – as it won’t be hunger. I don’t think there is any need to introduce formula just yet.

• FEED 20minutes with compression throughout – or feed for longer if you can see him swallowing.
• Wind and nappy change to wake
• FEED from second breast for 20 minutes with compression. Small wind.
• BED

Follow this routine for a few days and then let me know how you are getting on.

Kind regards,

Geraldine

Over the last few years, I have met many mums with many different problems and challenges. The most feared problem an expectant or new mum have is the fear of low milk supply. How many mums have you spoken to who had to stop breastfeeding as they simply weren’t producing enough milk?

Unfortunately there are some mums who won’t produce enough milk and this is usually due to a medical complication. So if 97% of mothers are more than capable of producing enough milk for their babies, why do so many mums cite low milk supply the catalyst in the demise of breastfeeding? Are we missing something? Are mums being told they don’t have enough milk by mistake? Are mums simply imagining things or just too tired to breastfeed and want a ‘get out clause’?

In truth, it would be hard to rule out any of the above but I want to add in a new line of thought…one which I have used in my practice for many years – incompatible anatomy.

You have probably wondered how mums with different shaped breasts and nipples all seem to feed their new baby as effectively as each other, but what happens when a mum or baby’s anatomy is the cause of breastfeeding problems?

I often remind clients that they are part of a wonderful team and if breastfeeding is not working, we need to look how we can help both people in the team and not simply focus on the mother. Anatomy in one area I feel is often overlooked when assessing a new mum and baby. How many people have looked in your baby’s oral cavity before helping you position and attach your baby?

Sometimes a baby’s mouth/oral cavity can be small in relation to a mother’s nipple, or the mother’s nipple can be quite small in relation to the baby’s oral cavity. Naturally the positioning of the baby and the attachment technique will need to be adapted to accomodate the individuals anatomical make up, but with a little insight and skill, mum and baby can soon be enjoying a comfortable and effective feed.

If this has been overlooked, more often than not you will either experience soreness, engorgement or find that your baby is not feeding well and feeling satisfied at the end of the feed. In worse cases, you may even find that your baby is not gaining weight.

I do believe that most mums will be able to produce more than enough milk for their baby, however, if the baby is not able to drain the milk from the breast, supply will begin to dwindle and the baby may struggle to gain weight. With less milk drained from the breast, less will be produced and overtime, a mum who once had more than enough milk, will find she is running on empty.

As it is the start of a New Year, I want to do more to support mums experiencing this particular problem this year. I will be running special low milk supply clinics that mums can attend and be monitored and supported until the supply increases and baby begins to gain more weight.

If you are struggling or want to ensure that you don’t go down the slippery slope, get in touch with me for more information about the Low Milk Supply clinics you can attend lowmilksupplyclinic@letsbreastfeed.com

There is nothing worse than the thought of leaving your baby hungry and when mums are breastfeeding, it is even harder to establish just how much milk your baby has had, and if you are offering a top up, how much more your baby needs to feel full and satisfied.

It is important to remember that babies do cry for reasons other than hunger and being able to differentiate between the cries is invaluable when trying to cut down the amount of milk your baby receives as a top up. If you are breastfeeding and having to top your baby up, these are a few guide lines to follow to make the transition to exclusive breastfeeding less stressful.

• Have your baby weighed regularly, on the same set of scales. You want to see that your baby is gaining 20g-30g each day. If your baby is gaining more than this, you can start to decrease the amount of top ups slowly, keeping an eye on weight gain to ensure this does not decrease.
• Ensure that you are using both breasts effectively at each feed. You want your baby to work hard at the breast and finish the breast, as this will ensure that your milk production is maintained and that your baby is not relying on top ups to fill up. If your baby is sleepy, compress the breast to increase milk flow, switch nurse by feeding from alternate breasts during the feed for 10mins at a time, and use a nappy change to wake baby if he or she is very sleepy.
• Feed more frequently. If a baby needs 500ml in a day and you struggle to express 50ml, feed more frequently. By feeding 10times a day, your baby will still get the 500ml he or she needs, and your supply will be sufficient. If you try to only feed 5 times a day, your baby will take the 50ml you produce, but will then become reliant on having 50ml of formula at each feed too. This will make it harder to drop or cut back on top ups.
• Remember, the more formula top up your baby takes at each feed, the less hungry he or she will be and this will push your breastfeeds further apart. The less your baby feeds, the less you produce, so you will start to see your milk dwindle and your baby become more reliant on formula. If you can see this happening, you need to spend one day, just breastfeeding and only offer a top up as a last resort, when your baby is really unhappy and you simply can’t feed anymore. This will increase your supply and help your baby re-establish breastfeeding as a primary source of food and nutrition.

It is tough going but it will pay off and once you are breastfeeding without any top ups, you will look back at all the hard work you put into getting breastfeeding right, and you will feel proud, empowered and absolutely fantastic!

]]> http://www.letsbreastfeed.com/blog/cutting-down-on-top-ups/feed/ 0 http://www.letsbreastfeed.com/blog/tongue-tie-the-lasted-craze/ http://www.letsbreastfeed.com/blog/tongue-tie-the-lasted-craze/#comments Thu, 26 Nov 2009 13:09:57 +0000 Geraldine http://www.letsbreastfeed.com/?p=1544 Continue reading →]]>

It is so very annoying when some condition suddenly becomes ‘the’ problem. I am of course referring to the current craze of tongue ties! A couple of years ago, nobody knew what a tongue tie was. In the past, complete tongue ties where the tongue was pulled so tightly to the floor of the mouth the baby couldn’t even lift it, were often over looked or parents were simply told that it wouldn’t be a problem and if it was, to bottle feed.

That was incredibly frustrating and life was very difficult when trying help these mums resolve their problems.

Now things have gone to the other extreme and I am realising that it is a hundred times worse.

I have had so many clients take baby to have a tongue tie snipped, even though it hardly exsited and were very dissapointed when their problems didn’t magically dissappear. And now, nearly every potential client I speak to, has a tongue tie.

I am beginning to wonder what I missed! As a precaution, I now offer mums telephone numbers of specialists who can properly assess their baby’s tongue, just to be sure that another health professional doesn’t exclaim that the baby has a tongue tie that needs to be cut and cart mum off to an appointment tutting under her breath that I have missed it.

So mums, you are the vulnerable ones. Look into tongue ties a little before you are told that all your problems will be resolved with one simple snip. Many of us do have a small degree of tongue tie, but as long as your baby is able to push his or her tongue over the lower gum and you feel tugging during the feed, it is unlikely that a tongue tie is causing your breastfeeding problems or that the tie will need to be divided.

HOWEVER

If you are having problems breastfeeding such as sore nipples, accompanied with mastitis, a baby who is not gaining weight but feeding constantly and your baby has a tongue tie, you need to have it assessed properly, as it may well be causing you problems.

Come and see me if you are able to and if I can’t give you a definitive answer, as to whether or not it needs to be divided after we have corrected every aspect of breastfeeding, I will refer you to somebody who can!

I hope this helps.

Geraldine

]]> http://www.letsbreastfeed.com/blog/tongue-tie-the-lasted-craze/feed/ 0 http://www.letsbreastfeed.com/blog/bottle-feedingtoo-early-to-start/ http://www.letsbreastfeed.com/blog/bottle-feedingtoo-early-to-start/#comments Fri, 20 Nov 2009 07:45:28 +0000 Geraldine http://www.letsbreastfeed.com/?p=1540 Continue reading →]]>

I have been getting so many questions about bottle feeding young babies, I thought it would be helpful to have a few pointers.

There are a few things that need to be said first.

In my practice I find that some babies are more likely to have problems breastfeeding once they have had a few bottles. These babies are usually babies who are young and weak, not able to access and drain the milk from the breast even though mum is producing bucket loads, or where mum’s milk supply is just not enough to satisfy baby’s needs.

So if
1. your baby is very new and has not been able to latch onto the breast and feed from the breast resulting in low blood sugar levels
2. your baby is younger than 10 days, is jaundiced and not producing any poos
3. your baby is younger than 10 days, cries non stop, wants to feed non stop and your nipples are shredded
4. your baby is feeding non stop and is not gaining the 20-30g a day we expect
5. you lost a lot of blood a birth and your baby is struggling to regain birth weight and settle in between feeds

you are a candidate for introducing a bottle before the 3 week mark, regardless of whether it impacts on your breastfeeding. Naturally there are other feeding methods you can try before bottle feeding such as cup feedind or finger feeding. However, if you are experiencing any of the 5 combinations above, there is clearly a problem with either milk production (you) or milk transference (your baby) and this needs to addressed quickly so that your baby does not become reliant on supplements at each feed.

If your baby is older than 10days but is not gaining the expected 20-30g a day, is feeding non stop, is not producing any poos and wees are small and dark yellow, you may need to top up but find good breastfeeding support as well so that you can correct and eliminate any problems.

If your baby is feeding well, is gaining weight well and your nipples are not sore in the least, you can introduce a bottle with little risk of problems developing with breastfeeds. Remember, everyone is different and there is not guarentee that things won’t go pear shaped, however experience has shown me that this is relatively good time to introduce a bottle.

If you need more practical advice on how to avoid feeding problems from day one and to introduce a bottle feed into your day, have a look at the Beginners Guide.

If you are concerned about your supply, have a look at the Low Milk Supply Guide.

I hope this helps.

Much love,

Geraldine

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