When a Baby Won't Nurse
Carol Brussel, BA, IBCLC
Denver CO USA
From: NEW BEGINNINGS, Vol. 18 No. 4, July - August 2001, p. 136-138
A mother seeks help with
her infant, who, she says, "has never breastfed." She is pumping her
milk for her baby, and longs to be able to feed her baby at the breast
instead. When the mother lifts her shirt and exposes her breast and
brings her baby close to her, the baby begins crying loudly and pushes
at the mother's breast, frantic, until the mother moves the baby away
and covers her breast. Tears stream down her face as the baby, offered
the bottle, begins sucking contentedly. "He hates me," she declares.
A baby's refusal to breastfeed
is a clear example of oral aversion. An aversion is defined as "a tendency
to avoid a thing or situation and especially a usually pleasurable one
because it is or has been associated with a noxious stimulation." Oral
aversion in breastfed infants may be more clearly defined as a resistance
to or difficulty feeding from the breast that ranges from a mild disruption
of normal feeding patterns, to complete refusal of the breast. Dr. Jack
Newman, of the Hospital for Sick Children in Toronto, Ontario, Canada,
suggests that what is commonly called "nipple confusion" may be more
clearly defined as "nipple preference," and should be considered a form
of oral aversion.
Under normal circumstances,
breastfeeding is a pleasurable experience for both mother and baby.
Researcher E.J. Mobbs states "The mouth is the most sensitive organ
and the one over which the newborn infant has the most control" (Mobbs
1989). It is with his mouth that the infant comes to know his mother
and communicate with her. The mouth is his avenue for food and love,
communication and comfort. This sensitivity is the reason a baby is
so acutely affected by anything he experiences with his mouth. If his
mouth is hurt, especially before he establishes a secure breastfeeding
relationship with his mother, he may respond by refusing to breastfeed.
In addition to the loss of the breastfeeding relationship, the overall
mother-child relationship may be disrupted, even after oral aversion
ends (Klaus 1976).
When a baby who has breastfed
well for weeks or months suddenly begins refusing to breastfeed, this
is commonly called a "nursing strike." The causes may be obvious (a
startled response from the mother when a baby bites during nursing)
or unclear. Occasionally, a nursing strike is a signal from the baby
that the nursing relationship has been difficult from the beginning.
Feeding problems most commonly
associated with oral aversion are usually encountered at birth or immediately
thereafter. A newborn who refuses to nurse must first be evaluated to
rule out other causes, such as physical abnormalities or illness, the
lingering effect of medications used during the birth, birth trauma,
or the use of improper positioning or latch-on techniques. When a baby
with no other known problems refuses to breastfeed or has great difficulty
nursing, it is often the result of experiences from the earliest moments
and hours of the baby's life.
Factors in Oral Aversion
Some of the actions that
can contribute to oral aversion include suctioning of the newborn's
airway or stomach, naso- or orogastric feeding tubes, inappropriate
use of artificial nipples and bottle-feeding methods, incorrect placement
of fingers in the baby's mouth for finger feeding or suck assessment,
and aggressive attempts to alter the baby's sucking pattern. Some of
these interventions can be helpful as long as they are done gently and
slowly, paying attention to the baby's cues.
Airway suctioning is considered
necessary by some health care providers. In some communities, gastric
suctioning is commonly done "to promote hunger, as the baby will not
eat unless he is hungry, and he won't be hungry unless his stomach is
empty." This practice is based on the belief that mucus present in the
baby's stomach will suppress hunger pangs, preventing effective breastfeeding.
Interventions may become standard practice when health care providers
believe that they will prevent problems and that they are harmless.
Unfortunately, these interventions are neither harmless nor effective
in prevention problems.
Inappropriate use of artificial
nipples as a cause of oral aversion seems clear to even the most casual
observer. Introducing the nipple into the baby's mouth without waiting
for him to open his mouth can overwhelm him, and he is powerless to
refuse something forced into his mouth. Stimulating a faster or stronger
suck by rubbing the top of his mouth with the nipple, rotating the bottle,
and holding the bottle in his mouth despite indications of stress are
common techniques that can be invasive and overwhelm a baby's delicate
mouth.
Feeding tubes are sometimes
used in the place of artificial nipples in an effort to prevent breastfeeding
problems caused by nipple preference. However, when feeding tubes are
used in the forceful and overwhelming ways described above, they can
cause problems too.
Other situations in which
an aversion may be created are those in which fingers are introduced
into a baby's mouth for suck assessment or therapeutic purposes. Suck
assessment can reveal a great deal of information about a baby with
feeding problems in the hands of an experienced practitioner. It can
be a crucial step in determining how to help a baby breastfeed who is
having difficulty. Some practitioners teach various "suck training"
exercises to correct perceived problems. However, done incorrectly,
both assessment and treatment can create or worsen problems. The first
thing to enter a baby’s mouth after his birth should be his mother's
nipple.
Health care providers teach
various techniques to help initiate or alter a baby's sucking technique.
Often a mother is taught to latch the baby on by pushing the baby’s
chin down with her finger, and when the mouth is open, to push the back
of the baby's head until the open mouth is on the breast. This "forced
latch" technique is quite common, although there is very little support
for it in the standard lactation literature. However, many babies display
increased signs of oral aversion after repeated encounters with the
forced latch.
If your baby refuses to breastfeed
because he perceives it as unpleasant, what can be done to reestablish
the breastfeeding relationship? It is important to remember that your
baby loves you despite his refusal of the breast. Activities that encourage
a renewal of the physical bond between mother and child are crucial.
Skin-to-skin contact, kangaroo care techniques, baby-wearing, co-sleeping
and co-bathing are all ways to encourage your baby to experience pleasant
physical contact with you. Once he starts to feel comfort while being
close to you, he is more likely to go back to the breast. Mothers can
get support and information from La Leche League Leaders. Or a board-certified
lactation consultant (IBCLC), often in conjunction with the help of
an occupational therapist, can help you develop a plan to return to
breastfeeding.
Examine any feeding methods
you use. Your baby needs to be gentled back to the breast, not forced
back to the breast. Alternative feeding methods, usually avoiding the
use of artificial nipples, can be an effective means of decreasing the
stress associated with feeding. This may mean cup-feeding a baby in
order to allow a rest from intrusive oral feeding methods. A nipple
shield may allow a baby to make the shift from artificial nipples to
feeding from the breast, by providing some continuity in terms of the
feel and taste of the artificial nipple while transitioning to the breast.
In his new book, The Ultimate Breastfeeding Book of Answers (May be available from the LLLI Online Store.), Dr. Newman also recommends the use of "breast compression" to increase the flow of milk to the baby and so encourage him to nurse more.
Resolving an established
problem may be a short and simple task, or difficult and time-consuming.
Seek help from experienced and qualified breastfeeding support people.
It is vitally important that your baby receive adequate nourishment
at all times so that he will have enough energy to work at learning
to breastfeed. Your baby's primary health care provider needs to be
a partner in the treatment process, and be aware of your determination
to return to breastfeeding.
Prevention of oral aversion
is easier than fixing it once it has already happened. Encouraging hospitals
to become "Baby-Friendly" will help foster an atmosphere of breastfeeding
support that questions and discards unnecessary interventions. Mothers
can help assure breastfeeding goes smoothly by encouraging their babies
to breastfeed early and often, and by insisting that any necessary procedures
are performed gently. A mother who trusts her instincts about what is
and what is not an appropriate interaction with her baby is off to a
good start in establishing the loving, pleasurable relationship that
breastfeeding should be.
Tips for Getting Baby Back to the Breast
- Try nursing when your baby is asleep or very sleepy,
such as during the night or, while napping.
- Vary nursing positions.
(see illustrations.) Some babies will refuse to nurse in one position
but will take the breast in another.
- Nurse when in motion.
- Nurse in a quiet, darkened room or a place that is free from distractions.
- Give your baby extra attention
and skin-to-skin contact, which can be comforting for both of you.
- When offering the breast,
undress to the waist and clothe your baby in just a diaper when ever
possible. Use a shawl or blanket around you if the room is chilly.
- Use a baby sling or a
carrier to keep the baby close between attempts to nurse.
- Take warm baths together to soothe.
- Sleep together in order to provide closeness and more opportunities to nurse.
Adapted from
How to Handle a Nursing Strike (Published by LLLI, No. 290-17).
Asymetrical Latch
References
Mobbs, E. J. Human imprinting
and breastfeeding: Are the textbooks deficient? Proceedings, 16th
Annual Society for Psychosomatic Aspects of Reproductive Medicine,
Polkobin, South Wales, March 1989.
Klaus, M. G. and J. H. Kennell.
Maternal-Infant Bonding. St. Louis, MO. Mosby, 1976.
Newman, J. and Pittman, T. The Ultimate Breastfeeding Book of Answers.
Roseville, CA: Prima Publishing, 2001.
Last updated 12/24/06 by jlm.
Page last edited Sun Oct 14 09:30:51 UTC 2007.
