Baby nursing strike

Baby nursing strike also known as baby’s breast refusal or breastfeeding strike, is a baby’s refusal to suck at the breast is a most distressing problem and worrying problem for breastfeeding mothers ¹. Some mothers might take nursing strike personally and believe her child is refusing her and not the breast milk. She might also think that there is something missing from her milk and it’s insufficient for her child ². In fact a common reason for cessation of nursing is infant’s refusal to breastfeed. But this problem can often be overcome ³. A baby may refuse the breast at some or all feedings, at any age, and his reasons for doing so will vary with his stage of development or even his health at the time. He may suck for a few minutes, then break away with signs of distress and refuse to continue. He may refuse even to begin sucking although he is obviously hungry.

Most breast refusal is temporary and in most cases it should not be too long before your baby is again breastfeeding happily. Sometimes you may never discover why he did refuse. However, there are some babies who cannot be persuaded to return to the breast. If that is the case for you, it is important to remember that your baby is not rejecting you and that you will soon find other ways of relating to each other.

Sometimes, a baby does not actually refuse but is very fussy and difficult to feed. He may be the kind of baby who seems to be very unwilling to start sucking and takes a long time to get going, but once he has started, feeds well. A fussy baby can seem to receive little satisfaction from feeding. He sucks for a short while and then breaks away, finishing his feed after a series of stops and starts. He may be easily distracted and restless during the feed, perhaps pushing away from his mother with his fists or his feet. He stops as soon as his hunger is satisfied and may remain restless and fidgety afterwards.

When managing a picky feeder or a baby who is refusing to breastfeed, it is important to remain calm and patient, handling your baby gently. If you are both on edge, try taking deep breathes similar to that which you may have used during labor or when trying to calm or meditate. The deep breathing helps slow your own breathing and make it more regular which can help calm everyone, concentrate on staying relaxed, use soothing music, rock your baby gently or carry him around. This relaxation will help your milk flow readily so your baby will get milk once he latches on.

If your baby is quite unsettled, cross or crying or if you are feeling angry and upset, you may find it helps to try again when you are both feeling calmer. In the meantime a cuddle or a game may distract your baby or a walk outside may relax you both. This is the time when your partner (or a friend or relative) may be able to step in and give you both a break.

Normal nursing strike is defined as a baby who is contented and healthy and getting sufficient breastmilk for her/his needs. However, if you are still worried, you may find it comforting to have your baby checked thoroughly by your doctor.

Mother-to-mother breastfeeding support

Search the internet for a breastfeeding center near you. These centers may offer support groups. Some resources include:

• Nursing Mothers Advisory Council (https://nursingmoms.net)
• Breastfeeding USA (https://breastfeedingusa.org)
• La Leche League International (https://www.llli.org) to find a local La Leche League International support group.
• International Board Certified Lactation Consultants (https://ilca.org). International Board Certified Lactation Consultants are certified breastfeeding professionals with the highest level of knowledge and skill in breastfeeding support. International Board Certified Lactation Consultants help with a wide range of breastfeeding concerns. To earn the International Board Certified Lactation Consultant certification, candidates must have a medical or health-related education and breastfeeding-specific education and experience. They must also pass a challenging exam.

How many feeds does my baby need in 24 hours?

The number of feeds your baby needs changes as she/he grows older. A very young baby commonly needs eight to twelve breastfeeds in 24 hours, but there is a wide variation in the number of feeds an older baby needs. There is a big difference between a four-month-old who refuses one or two feeds in eight, and a baby of the same age who refuses four out of five feeds.

Regardless of the number of feeds she has, signs that your baby is getting enough breastmilk include if she has, over 24 hours, regular soft bowel motions, at least six to eight pale, very wet cloth nappies, or at least five heavy wet disposable nappies with pale, odorless urine. Check with your medical adviser if your baby’s urine is dark and has a strong smell. She is being adequately nourished if she is reasonably contented, looks alert, has bright eyes and good skin color and muscle tone and has some weight gains.

How do I know if my baby is getting enough breastmilk?

If your baby shows the following signs then it is likely that you do have enough milk:

• At least 6 very wet cloth nappies or at least 5 very wet disposable nappies in 24 hours. The urine should be odorless and clear/very pale in color. Strong, dark urine suggest that the baby needs more breastmilk and you should seek medical advice.
• A young baby will usually have 3 or more soft or runny bowel movements each day for several weeks. An older baby is likely to have fewer bowel movements than this. Formed bowel motions suggest that the baby needs more breastmilk and you should seek medical advice.
• Some weight gain and growth in length and head circumference.
• Good skin color and muscle tone. Does she look like she fits her skin? If you gently ‘pinch’ her skin, it should spring back into place.
• Your baby is alert and reasonably contented and does not want to feed constantly. It is however normal for babies to have times when they feed more frequently. It is also normal for babies to wake for night feeds. Some babies sleep through the night at an early age while others wake during the night for some time.

A newborn’s nappies

Wide variation exists in what is seen in a newborn’s nappies. The following gives a general guide as to what might be seen.

The first bowel motions a baby has are black and sticky. This is from the meconium present in the baby’s digestive tract before birth. By day 2, the bowel motions should be softer but still dark in colour. Over the next few days, the bowel motions change to a greenish-brown and then to a mustard-yellow. As the colour changes they become less sticky and larger in volume.

A baby should have at least 1 wet nappy on day one, at least 2 on day two, at least 3 on day three, at least 4 on day four and at least 5 on day five. From day 5 onwards, the information above is relevant.

Over the first few days, salts of uric acid in your baby’s wee may leave a rusty, orange-red stain on the nappy. This is normal during this time. If you see this after day 4, consult your doctor.

My baby is suddenly refusing to nurse. Does that mean it’s time to wean?

A baby who is truly ready to wean will almost always do so gradually, over a period of weeks or months. If your baby or toddler has been breastfeeding well and suddenly refuses to nurse, it is probably what is called a “nursing strike,” rather than a signal that it’s time to wean. Nursing strikes can be frightening and upsetting to both you and your baby, but they are almost always temporary. Most nursing strikes are over, with the baby back to breastfeeding, within two to four days.

First thing to remember is to feed the baby. The other important thing is to protect your supply.

Nursing strikes happen for many reasons. They are almost always a temporary reaction to an external factor, although sometimes their cause is never determined. Here are some of the most common triggers of nursing strikes:

• You changed your deodorant, soap, perfume, lotion, etc. and you smell “different” to your baby.
• You have been under stress (such as having extra company, returning to work, traveling, moving, dealing with a family crisis).
• Your baby or toddler has an illness or injury that makes nursing uncomfortable (an ear infection, a stuffy nose, thrush, a cut in the mouth).
• Your baby has sore gums from teething.
• You recently changed your nursing patterns (started a new job, left the baby with a sitter more than usual, put off nursing because of being busy, etc.).
• You reacted strongly when your baby bit you, and the baby was frightened.
• You are newly pregnant and your milk supply may be reduced.
• You are ovulating and your milk supply may be temporarily reduced.
• You have been pumping less time or with less frequency when away from baby.
• You have been sick and/or taking a medication (including some methods of birth control), which can have a negative impact on your supply.

One additional consideration is a strong or overactive letdown, where your milk comes in so fast and sprays hard that baby can’t control it well and closes his mouth, refusing the breast.

Only you know for certain which, if any, of the above factors apply in your current situation. No matter what the cause, a nursing strike is upsetting for everyone. The baby may be difficult to calm and unhappy. You might feel frustrated and upset. Remember your baby isn’t rejecting you. Breastfeeding will almost always get back to normal with a little time.

Getting over the nursing strike and getting your baby back to the breast takes patience and persistence. Get medical attention if an illness or injury seems to have caused the strike. See if you can get some extra help with your household chores and any older children so that you can spent lots of time with the baby.

Try to relax and concentrate on making breastfeeding a pleasant experience. Stop and comfort your baby if he or she gets upset when you try to nurse. Extra cuddling, stroking, and skin-to-skin contact with the baby can help you re-establish closeness.

Additionally, these time-tested suggestions have helped many nursing parents overcome a nursing strike. They are best to try before a baby’s normal feeding times, to assure that baby is not hungry and likely more resistant at the breast.

• Try not to stress about it. (So easy to say, not to do.) The baby will pick up on stress. Play calming music, lower lights in the house, go skin to skin as much as possible.
• Nurse the baby as he is asleep, just awakening, or is very drowsy. As we drift to sleep or awaken, we are in a more primitive state of mind and since breastfeeding is a survival behavior for babies, sometimes they revert to feeding well at this time.
• Vary nursing positions.
• Nurse when in motion. In this case, a sling or cloth carrier can be useful.
• Give the baby extra attention and skin to skin contact.
• Hold the baby in a sling or baby carrier between attempts to nurse to increase bonding.
• Lay in bed to play with baby while you are topless, with no pressure to nurse. Just the open invitation if baby searches for the breast.
• Nurse in a quiet, darkened room free of distractions.
• Stimulate your let-down and get your milk flowing before offering the breast so the baby gets an immediate reward.
• Take a warm bath together with lots of skin to skin snuggling and no pressure to nurse.
• Sleep together, giving baby easy access to the breast while sleeping.
• Spend time around other nursing babies and toddlers. Sometimes peer pressure can be a good thing. Playgroups or busy store nursing rooms can also be helpful.

While you are trying to persuade your baby back to the breast, you’ll want to make sure baby gets enough milk to sustain him and you keep your milk supply flowing.

You may consider feeding by cup, spoon, eyedropper, or syringe while you work on getting him back to the breast. You might feed baby by bottle, making sure to practice paced bottle feeding. Tilting a bottle or using fast-flow nipples can sometimes confuse baby and bring on a nursing strike. You may find that his need to suck will encourage him to nurse instead of “just eating” by the other methods. Try to keep in mind, this could all be over in a day or two.

While baby is refusing breast, you need to extract your milk as often as baby has been nursing. Some moms find hand expression to be effective, while others rely on pumping. Not only does this practice protect your supply, it also saves you from potential clogged ducts or mastitis.

Take one hour at a time. Be gentle with yourself.

Finally, if this strike goes on and days turn into weeks, this may signal the end of your nursing journey. Please recognize what a gift you have given your child. It can be an emotional time, especially when your “plan” was to nurse longer. Not to mention hormonal changes as your milk supply diminishes. Take care of yourself and manage the weaning carefully to avoid clogged ducts or mastitis.

Nursing strike causes

There are many, many reasons for babies to refuse the breast, whatever their age. Below are some of the main reasons that mothers have found for their babies’ refusal – but sometimes no reason can be found. Just as suddenly as the baby started refusing, the whole episode is over and he is happily breastfeeding again as if nothing had happened.

Baby-centered reasons

• Attachment problems
• Baby confused by bottle feeds
• Overtiredness/overstimulation
• Baby refusing one breast
• Recent immunization
• Illness, e.g. a cold or earache, sore throat
• Feeding pattern is changing
• Distractions
• Introduction of other foods
• Teething
• Biting
• Overuse of a dummy (or pacifier)
• The weather
• Discomfort associated with sucking
• Weaning
• Respiratory, infectious
• Gastro-esophageal reflux
• Nasal obstruction
• Cerebral injuries and pain ⁴.

Milk supply reasons

• Fast flow
• Low supply
• Slow let-down

Mother-centered reasons

• Overtired or overstressed
• Sick or taking prescribed or over the counter medications
• Unusual food in your diet
• You smell different for some reason- e.g., different perfume, deodorant, chlorine/ salt from swimming; visit to hairdresser, smoke
• Hormonal changes
• Menstruation and pre-menstrual tension
• Ovulation
• Pregnancy
• Oral contraceptives
• Mastitis
• Drugs

Nursing strike treatment

Here are some things you can do to get your baby on your breast:

• Be as patient and calm as you can, even though you may be feeling frustrated or impatient. Forcing your baby to feed is likely to make the situation worse. If he has just been refusing the breast and is upset, distract him by doing something completely different – a walk outdoors, looking at toys, singing a nursery rhyme. When he has settled down he may be eased on to the breast, or he may be happier just being cuddled.
• Walk around with your baby in an upright position against your body with her head level with your nipple. Walk and feed simultaneously. You could try putting your baby in a baby sling but remember to have your bra undone so that her face is touching the skin of your breast and she can find your nipple. The sling will need to be worn lower than normal for this purpose.
• Try a completely different feeding position: your baby tucked under your arm (twin style); or lying down on a bed next to your baby with no body contact – this is especially good if it is very hot, or your baby is sensing your tension; or lying down with your baby cuddled in close next to you.
• Feeding your baby while you are both in the bath may help. You may want to have someone available to help you lift your baby in and out of the bath.
• Try breastfeeding baby after his bath when he is warm and relaxed (if he likes baths).
• You could try playing with your baby on the floor while you are bare from the waist up. After some time gradually offer your breast.
• Anticipate your baby’s waking time and lift her to feed while still sleepy – you may slip in extra night feeds this way.
• Try to soothe baby with a pacifier (dummy). Walking, singing and rocking while baby sucks the dummy may gradually soothe him so you can gently put your baby to the breast while removing the dummy. It may be necessary to start a very hungry baby sucking on a bottle with a small amount of expressed breastmilk, e.g. 30 ml, then gently replace it with the breast.
• Some mothers, whose babies have become accustomed to a bottle, have found that putting ice wrapped in a flannel on the nipple or tickling the nipple and areola makes it easier for the baby to grasp. Alternatively, you may use a nipple shield to begin a feed, slipping if off quickly and putting your baby back to the breast once the milk is flowing and she is sucking happily.
• Feed in a rocking chair.
• Express some milk into your baby’s open mouth to encourage him.
• Spend five minutes or so before the feed massaging your baby’s naked body to relax her, if she is receptive to this.
• Try singing to your baby – he probably won’t mind if it is the same few lines over and over.
• Try playing some favorite relaxing background music.
• Once you get your baby on to the breast, it may help to provide an instant milk reward. This can be done with a breastfeeding supplementer. This allows baby to receive additional milk at the breast whilst stimulating your milk supply by his sucking. If your milk supply continues to be low or your let-down slow or your baby is a ‘poor’ sucker, you may like to discuss with a Breastfeeding Association counselor the possibility of using a supplementer.

Figure 1. Breastfeeding supplementer (Supplemental Nursing System)

Breastfeeding supplementer

Breastfeeding supplementer also known as Supplemental Nursing System (SNS), is a device that allows a baby to receive extra milk at the breast rather than by bottle and teat. There are two types of breastfeeding supplementer, one the is Medela Supplemental Nursing System that uses a hard sided container for the supplement and the ‘Lactaid’ uses a soft bag to hold the supplement. Each has its own advantages and disadvantages. It is also possible to make a homemade version. Breastfeeding supplementer consists of a container that is worn on a cord around the mother’s neck. Fine tubing carries expressed breastmilk or formula from the container to the nipple. When the baby sucks at the breast, milk is drawn through the tubing into his mouth, along with any milk from the breast.

When extra milk is needed for medical reasons it is better to give it through a breastfeeding supplementer than by bottle:

• Milk given in this way rewards the baby’s efforts at sucking and he is more likely to be happy to feed from the breast and stay there for a longer time.
• Since the amount of milk a mother makes depends on how much her baby sucks and takes milk from her breasts, this extra sucking will increase her milk supply.
• Use of the mother’s own expressed breastmilk in the supplementer helps a weak or easily tired baby to get more milk with the same amount of sucking.
• The sucking action required during breastfeeding differs from that used with a bottle. Some babies find it hard to do both, or reject the breast in favor of the different bottle.
• The mother is able to provide milk at the breast and this helps with both the hormonal and physical aspects of breastfeeding.

Guide to storing fresh breastmilk for use with healthy, full-term babies

By following recommended storage and preparation techniques, nursing mothers and caretakers of breastfed infants and children can maintain the safety and quality of expressed breast milk for the health of the baby.

These are general guidelines for storing human milk at different temperatures. Various factors (milk volume, room temperature when milk is expressed, temperature fluctuations in the refrigerator and freezer, and cleanliness of the environment) can affect how long human milk can be stored safely.

Guide to storing fresh breastmilk for use with healthy, full-term babies
Place	Temperature	How long	Things to know
Countertop, table	Room temperature (up to 77 °F [25 °C])	Up to 4 hours	Containers should be covered and kept as cool as possible. Covering the container with a clean cool towel may keep milk cooler. Throw out any leftover milk within 2 hours after the baby is finished feeding.
Refrigerator	40 °F (4 °C)	Up to 4 days	Store milk in the back of the refrigerator. When at work, it’s OK to put breastmilk in a shared refrigerator. Be sure to label the container clearly.
Freezer	0°F (minus 18 °C) or colder	Within 6 months is best. Up to 12 months is acceptable.	Store milk toward the back of the freezer where the temperature is most constant. Milk stored at 0°F or colder is safe for longer durations, but the quality of the milk might not be as high.

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When a breastfeeding supplementer might be useful

A supplementer can be a useful tool in starting and being able to maintain breastfeeding. The baby may be premature or sick and unable to suck well; some mothers have problems due to the shape of their nipples or previous breast surgery. In rare cases, mothers may not have enough milk-making tissue in their breasts to be able to make a full supply of milk for their baby. Babies and their mothers may have had a difficult birth, causing a setback to the start of breastfeeding. Other mothers who may find a breastfeeding supplementer useful include those with a very low supply that they are trying to increase, mothers who have weaned and are trying to relactate, as well as mothers who are building a milk supply for an adopted baby. They might use the supplementer for only a short while or long term. A breastfeeding supplementer allows a mother to fully breastfeed while giving her baby extra milk, which could be her own expressed breastmilk, donor human milk or formula. Breastfeeding supplementers may be fiddly to use at the start but they become easier to use with practice.

When a breastfeeding supplementer is not likely to be useful

Most mothers who have problems getting breastfeeding started will solve them without using a breastfeeding supplementer. Often all some mothers need is information and support. Talking the problem over with someone who understands and supports your wish to breastfeed and who knows a lot about breastfeeding can help you work through any problems. Often they will be able to suggest new ideas to try. Sometimes, you can solve your own problems by learning more about how breastfeeding works. It can help give you confidence if you have the support of your medical adviser, child health nurse, lactation consultant or Breastfeeding Association counselor.

It is important that the baby is able to suck well at the breast, even if he tires easily, in order for the breastfeeding supplementer to work. A baby with a poor or abnormal suck may not be able to get the milk through the tubing any better than from the breast itself.

A Breastfeeding Association counselor will be happy to talk things over with you. She will help you look at the problem and will suggest options so that you decide what you want to do about it. Every mother and baby pair is unique. Other people can give you the information you need, but only you can decide what will work in your own family situation.

Here are some ideas that you may like to think about and perhaps discuss with a counselor, a lactation consultant or your medical adviser:

• Sometimes mothers feel that their milk supply is low when it is really quite normal. An unhappy baby is not always a hungry baby — nor are low weight gains always due to low milk supply.
• If a baby breastfeeds often, looks healthy, alert and active, has plenty of wet nappies (at least 5 disposable or 6–8 cloth nappies in 24 hours), regular soft bowel motions and gains some weight, she is usually getting enough breastmilk.
• If a mother’s milk supply is low, frequent feeding over several days (perhaps 10–12 times in 24 hours) will usually increase it. Unless your medical adviser feels that there is an urgent need for your baby to have extra milk, it is worth trying extra breastfeeds for a few days before adding in any other milk. Giving extra milk will reduce your baby’s hunger and the amount she takes from the breast. This is more likely to cause a decrease in your breastmilk supply than an increase.
• Is your baby facing you and tucked in close while feeding? Is she attached well, not hurting your nipples and can you hear her swallowing milk well? A good feeding position and being able to suck well helps your baby get your milk easily.
• If extra feeds are needed, but only at some feeds or in small amounts, it may be easier to give them from a cup or syringe.

How do I get a breastfeeding supplementer?

A breastfeeding supplementer may be bought online from some breastfeeding retailers. Some hospitals and pharmacies also sell them. Based on the experiences of many mothers, it is best if you have your own support while you are using a breastfeeding supplementer. This can be from an Breastfeeding Association counselor or a health professional who knows a lot about its use. Breastfeeding Association counselors are not medically trained. They are mothers who have breastfed at least one baby and who have completed a training course that includes information about breastfeeding and counseling breastfeeding mothers. This training is conducted according to Registered Training Organization guidelines. Counselors offer friendship and counseling on a mother-to-mother basis to women who wish to breastfeed and who ask for their help. If there are medical problems, mothers are referred to their doctor or child health nurse.

References

1. Schnler RJ. Breastfeeding continuity. In: Schnler R J, editor. Breastfeeding Handbook for Physicians, American Academy of Pediatrics. 2nd edition. USA: Publisher, American Academy of Pediatrics; 2006. 106 pp.
2. Breast refusal. https://www.breastfeeding.asn.au/bf-info/breast-refusal
3. Breastfeeding Counselling: A training course. WHO/CDR/ 93.4; UNICEF/NUT/93.2. https://www.who.int/nutrition/publications/infantfeeding/bf_counselling_trainers_guide4.pdf
4. Breastfeeding Promotion Society Commissioned the Ministry of Health. Treatment and Medical Education in collaboration with the United Nations children’s fund (UNICEF) Tehran: Training set of promotion of breastfeeding education; 2009. pp. 228–32.
5. Proper Storage and Preparation of Breast Milk. https://www.cdc.gov/breastfeeding/recommendations/handling_breastmilk.htm