Breast Rejection 101
Does your baby scream or fight whenever you put them near your breast? Assuming nothing is medically wrong (such as a fractured collarbone making a certain position painful), this does not mean your baby hates you or your breasts. It’s natural to feel rejected, and even a little guilty that you are “making him” try to breastfeed when he seems to hate it.
This is not an uncommon scenario. You’re not being selfish by persevering, because you can still get to a place where nursing can be the relaxing, bonding experience you dreamed of. It will just require a different approach than the one that’s not currently working.
This is not your fault!
It is very common for babies to struggle with latching for a variety of causes, but before discussing those, it’s important to understand that you didn’t cause this. There is likely nothing wrong with your breasts or nipples (and if you do have a nipple or breast variance, you certainly didn’t choose that!). If anyone has blamed it on something you did or didn’t do (e.g., gave a pacifier, not enough skin to skin, gave one bottle), they’re frankly more interested in looking smart than in helping you figure out what to do.
Nor are you being selfish by prioritizing teaching your baby how to breastfeed when she doesn’t want to. She may not want to learn to tie her shoelaces either, but it’s still important—and so is breastfeeding.
Why do some babies not latch?
There are a number of reasons why a baby doesn’t latch. Let’s first talk about why they sometimes can’t latch, and then about babies than can do it but won’t. The main reasons why some babies can’t latch are:
Flat or inverted nipples
Disorganized sucking pattern
Severe tongue tie
Mouth too small for mother’s larger-than-average nipples
Breast tissue taut and inelastic (e.g., during engorgement)
Too tired or upset
Most of the above issues are mechanical in nature, and can almost always be solved with time, patience, persistence, and sometimes some expert help. A nipple shield is a quick and easy band-aid you can try to see if there’s immediate improvement, but it’s always important to address the root cause, and to be evaluated by an IBCLC when using a tool such as nipple shields.
Now let’s talk about babies who can latch, but won’t. They may have latched at birth, then seemingly forgotten how, may latch occasionally but not consistently, or may fight and cry when they even come near a breast. These can usually be addressed by working with a lactation consultant, or just by continuing to try every so often in a low-pressure way, until they get it. Fighting and crying when you bring your baby near the breast, however, requires a different approach. There are several causes of this behavior, and here are some:
Baby has experienced being treated forcefully during a breastfeeding attempt
Baby’s temperament is that they demand immediate gratification of their hunger
Baby has learned to associate the breast with hunger and the bottle with easy and immediate milk
In rare cases, there may be a physical reason for a baby crying when held in a particular position, such as a broken clavicle, so it’s important to bring this up with baby’s doctor.
The most important step in addressing this issue (aside from maintaining milk production) is to help your baby remember that the breast is a nice place to be. Start with just skin to skin cuddling in a reclined position, and only do that for a few days. Having baby on your chest in a laid back position may trigger their instincts to find and try latching themselves; but resist the urge to try to make it happen. Let your baby explore at their own pace.
The next step is to help baby learn to trust the breast…
…as a food source that will provide milk in a timely manner and until they are satisfied. Two great ways to accomplish this are:
Use a curved tip syringe or supplemental nursing system at the breast (see video and picture below) to provide immediate milk; wean off of it as your baby becomes more comfortable
Give the bottle first to take the edge off their hunger, and then put them to breast when they’re nice and relaxed (but still a little hungry); in other words, either a bottle appetizer and a breast meal, or a bottle meal and breast for dessert (instructions here).
This mother is using a homemade supplemental nursing system. It works by delivering milk in a tube to the baby as they suckle at the breast.
What is the difference between a bottle appetizer and a bottle meal?
Not much; whether you need to give an appetizer or a meal from the bottle just depends on your baby’s temperament and your how quickly your milk starts flowing (lets down) and the available quantity. If your baby just needs a little bit from the bottle and then is content to nurse off of a breast with ample milk that releases quickly, then weaning the baby from the bottle onto full breastfeeding is likely to be easy; if your supply is low, your baby acts like they’re starving the second they wake up, or your let down takes a few minutes, then it may be more challenging and take longer. In some cases, bottles may need to be part of your long-term feeding plan, but you are every bit as much of a breastfeeding mom as someone who is breastfeeding exclusively.
Over time, your baby will learn to trust and enjoy breastfeeding, and you can work on weaning from these strategies.