Help — My Baby Won’t Nurse!

By Kelly Bonyata, BS, IBCLC

Introduction

The following techniques have proven helpful for a wide range of problems with baby refusing the breast. Some of the babies who might benefit include:

• a newborn (or older adopted baby) trying to figure out how to breastfeed
• a previously-weaned baby whom you wish to breastfeed again
• a baby who seriously resists nursing (or even being placed in a nursing position)
• a baby with nipple confusion
• a baby who is a fussy nurser (but does not completely refuse the breast)
• a baby on a nursing strike

Even if you have a baby who adamantly resists nursing, getting your baby to breast is very possible but it will probably require time, patience, and kangaroo-style frequency. Expect “two steps forward and one step backward.”

If you have a newborn who is not latching on, do keep in mind that almost all reluctant nursers will start latching by four to eight weeks of life.

The Basics

Follow the Rules

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 frequncy 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).

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.
  

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• 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. See Establishing and maintaining milk supply when baby is not nursing.

Feed the Baby!

• 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 babies). A board-certified lactation consultant is a great partner to have in this process.
• Keep baby as full and happy as possible, i.e. continue to offer expressed mother’s milk, banked milk, formula or solids (if baby is old enough), but gradually get closer and closer to the nursing position, skin-to-skin, etc. Click here for tips for weaning from formula supplements.

Maintaining milk supply when baby is not nursing

It is important to express your milk to maintain milk supply while baby is transitioning to full breastfeeding. See Establishing and maintaining milk supply when baby is not nursing for more information.

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). 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!

“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. Another way to elicit let-down is by doing reverse pressure softening.
• 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. If this is not sufficient, the last two methods above can also be used.

Skin to Skin/Laid-Back Breastfeeding

Keeping baby skin to skin with mom and “laid-back” breastfeeding techniques can both be very helpful when encouraging baby to breastfeed. This video shows baby-led, mother-guided latching. One technique used to get babies to accept the breast has been called rebirthing, but this is essentially just laid-back breastfeeding in the bath. Mom gets into the bathtub, full of warm (not hot) water with baby. Place baby on mom’s tummy, in the water. Stroke baby, talk to baby. This may take time, but baby may begin to work his way up to the breast, search it out, and begin to suckle. It’s important to have a support person with mom when doing this, for the safety of the baby.

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.

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.

If you prefer to use a bottle for supplementing baby, it’s not the end of the world (or your breastfeeding relationship). 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. Although bottles can certainly have their disadvantages, a good lactation consultant should be able to help you to transition to breastfeeding with or without the bottles.

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.

Nursing Strikes

When babies abruptly stop nursing, it’s a nursing strike – not weaning. Babies rarely wean on their own before 18-24 months, and self-weaning is almost never abrupt.

Will baby nurse while asleep or just waking up? This is usually one of the best times to try. You also might try nursing lying down or while walking around. See also the tips at the top of this page for persuading baby to nurse.

As long as baby is not nursing as often as before, you’ll want to express milk to maintain your supply, stay comfortable, and reduce the risk of plugged ducts and mastitis.

Additional information

General

Useful info @

Nursing Strikes