An issue the admin team for the NWL Facebook groups and I have noticed coming up regularly is breastfed babies who are used to having a bottle or two of expressed milk a day, suddenly starting to refuse the breast, even if their parents have been very careful about practising paced bottle feeding:

https://www.youtube.com/watch?v=GNMm4Twhvbs

A typical age for this to happen is around 3-4 months; here are the reasons why:

In the early weeks, most babies will spend hours and hours on the breast because being in their mother’s arms and sucking at the breast provides the closeness and comfort that is essential for human newborns, who are born very immature compared to most mammals, and who are more easily able to regulate their body temperature, heart rate and breathing when being held, especially in skin-to-skin. A beneficial side effect of this behaviour is that frequent feeding is excellent for building up milk supply.

By 3-4 months, many babies have become much more efficient at the breast, and their mother’s milk supply will have become very well established, meaning the baby can get all the milk they need very fast. In addition, at this age, babies start to become aware of, and fascinated by, the world around them, and in many cases, almost overnight go from happily taking the breast whenever it’s offered and spending hours feeding, to only wanting to breastfeed for hunger and thirst, especially during the day. They also become very distractible while feeding, and many will only feed somewhere quiet and with very few distractions.

Mothers who have been used to their baby feeding very regularly and for long periods, may become worried and confused when their baby no longer wants to feed nearly as often, and is only spending a few minutes on the breast at each feed. They therefore continue to offer the breast as frequently as before, and if the baby comes off after a shorter than usual time, they keep trying to get the baby to go back on the breast, resulting in a grumpy, annoyed baby. (Imagine if you were having dinner with friends and they kept trying to get you to eat and eat even when you were full to the gills). In some cases, this can result in a baby starting to reject the breast.

Parents might resort to offering a bottle in their desperation to get milk into the baby, and this can make the situation even trickier, because unfortunately, it’s much easier to persuade a baby to drink from a bottle than from the breast, even if they aren’t particularly hungry. Parents can then find themselves giving more and more bottles and the baby starting to show a distinct bottle preference.

Here are two articles with very good suggestions on what to do if your baby is fussing at the breast and has become very distractible during feeds:

https://kellymom.com/ages/older-infant/distractible-baby/

and

https://www.sdbfc.com/blog/2015/4/8/breastfeeding-at-3-4-months-it-can-look-very-different?fbclid=IwAR0b-B0Ua-297d264yK6HBsgZiMqmCyWVk7uD-_k2yAt4xSQSBNi_MGQfmA

Here is a post from NWL Breastfeeding by Nicole, a member who experienced her baby rejecting the breast as described above:

Nicole:

I have an exclusively breastfed 12-week-old that prior to this week has been feeding really well from me with no problems. At night-time he can often become unsettled just before bed and refuse the breast so I will often give him a bottle of expressed milk which normally settles him.

Since this Monday he has been refusing the breast more and more in the daytime to the point where now I’m having to give him expressed milk in the bottle (or even formula now as I don’t have milk to hand) as every time he goes near the breast he screams hysterically.

I’ve tried not trying to give in to giving him the bottle thinking if he is hungry then surely he will feed from me but it gets to the point where he gets overtired and really upset.

In the night and first thing in the morning though he feeds off me perfectly so I’m just so confused.

It exhausting me because I’m now having to give him a bottle and express to 1.relieve my very full breasts and 2. to replenish the milk the milk so I don’t run out. I’m home alone during the day so finding the time to do this whilst also occupying him is difficult especially if I go out in the day.

What do I do about this breast refusal? I am worried that I will have to give up breast feeding completely. I wondered whether he is being like this because of a developmental leap at 12 weeks but I’m not sure.

Also it’s worth mentioning that it seemed to start on Monday with him only feeding for a bit then getting distracted and refusing to go back on and now it has just got worse and worse.

Cordelia Uys:

I’m so sorry to hear this has happened to you. Unfortunately, this is quite a common occurrence at around 3 months. At this stage babies often change their feeding patterns. Unfortunately when mothers start to offer bottles when this happens, it can often lead to breast refusal.

My first suggestion is to be extremely careful to make sure whoever is giving the bottle is always practising paced bottle feeding: https://youtu.be/GNMm4Twhvbs 

Here are the recommendations for nursing strikes: https://www.laleche.org.uk/nursing-strikes/

Once your baby goes back to the breast, I would be extremely cautious about offering a bottle if he doesn’t seem interested in breastfeeding. Instead I would just leave things and wait until he is showing obvious feeding cues.

Nicole:

Thank you Cordelia, all really helpful advice. I think like you said, once he goes back on, hopefully this evening, I’ll just have to avoid giving him the bottle and then hope for the best! Good to know that it is likely a developmental sign!

Hanna:

Hi Nicole! This is really typical at this age! As the world has suddenly got more interesting day feeds become a chore (baby will make up for it at night!).

Key things are: trust your baby to take what he needs. He won’t starve himself!

There is no need to introduce a bottle and doing so could interfere with breastfeeding because the pace of the flow could be something baby becomes used to, and if the top-up is with formula, and pumping isn’t done to replace the feed, it could impact supply. 

I know it’s so wild and bizarre because they used to love to boob all day but this sounds so typical at this point.

You can try to breastfeed in a dark room with white noise to limit distractions if at home, but while out and about I’d not worry about offering the breast unless baby is keen. Offering upon waking from a nap might also be a good time. But if not, no worries!

The very first message I ever posted in this group was about precisely this, so I know exactly what it’s like! It’ll pass in a couple of months max - just go with baby’s flow! You’ve got this.

Nicole:

 Thanks Hanna, I just worry that he won’t have enough food especially when he is hysterically crying, but yes I guess he won’t starve himself!! Just getting use to a new routine with him feeding which seems to be affecting his sleep routine too, hopefully it will pass and he will be back at the breast all the time!

Cordelia Uys:

Can I just ask: do you always offer both breasts? And are you breastfeeding responsively or to a schedule?

Nicole:

Yes, I always offer both breasts and offer on demand, but I was noticing patterns forming eg he would often have a longer nap at lunchtime and be more fussy later in the day, but now he’s just fussy all the time and not napping for very long periods.

Maree:

Hi Nicole, this is such a tough age, so hang in there!

I started feeding my second one in the sling when he started to get to get distracted during the day and it was a massive game changer for me! Have you tried it? I used to carry on whatever I was doing whilst I fed him, and he loved it. Might be worth giving it a go?!

Farah:

Just to say both mine went through a similar phase which started around the 10-week mark. With my youngest son most recently it started with the bedtime feed. He would go hysterical every time I put him on the breast but was not happy or settled otherwise either. Side lying worked for us and this lasted for several weeks.

He then became unsettled in the mid morning feed but that didn’t last as long luckily - maybe only a couple of weeks but was incredibly tiring and frustrating. Be patient and know that it’s very common and will pass. Nursing whilst rocking or having him look out of the window helped. I also used to put a toy for him to look at on my shoulder.

He’s now 5 months old and feeds normally but will often pause and come off to look around, have a smile and “chat” then latch back on. Good luck!

Jess:

Apparently this is very common at this age due to babies feeding more efficiently and getting distracted. I went through a similar ‘nursing strike’ when my (now 7month old) baby was 3 months too. It was upsetting! She got annoyed / fussy when I offered the boob which in turn put me off feeding her in public. I made the mistake of offering the bottle as an alternative (we usually only use bottle once daily), thinking thy she’d be hungry otherwise. She would drink it, hence not then needing the next breastfeed, so I was actually making the whole situation worse! I got some great advice from Cordelia Uys and we got through the strike after a week or so. I cut out the bottle completely for a short while and found the following suggestions helpful: standing up or moving around while latching on, skin-to-skin, feeding in the bath, staying home for a few days to feed easily on demand. We are still happily breastfeeding now. I hope that helps and good luck!

Rebecca:

Great advice above - and yes definitely avoid bottles . Also my baby got very fussy about this age also fighting at the breast during feeds etc - swopping boobs a lot during feeds really helped - rather than doing one then the other. There’s also a way of putting one of their arms under the boob as they feed which helps. Trying different positions good too. Also they may be teething (I totally wasn’t expecting this so early and my daughter was being disturbed/crying a lot and fussing - then a friend noticed she had a tooth coming through). My period also came back about three months and that caused a couple of disturbed days and nights that again I didn’t understand - just keep offering boob and it will pass.

The sling was also a godsend; I think my daughter started feeding in the sling about this age. I had a close caboo and an ergo baby.

Nicole:

Thank you all so much for the advice I managed to persevere and didn’t give into the bottle today! He was very fussy at the start of the day at times only feeding for literally two minutes, but gradually his feeds became longer. Walking around the house whilst feeding him really seemed to help when he was really fussy- although my arm was starting to ache!! We will see how tomorrow goes but hopefully it continues in the right direction.

Cordelia Uys:

Thanks for the update Nicole. Do bear in mind that at this stage, 2 minutes may be enough for your baby to transfer all the milk he needs. Please see this article by Emma Pickett IBCLC: https://www.emmapickettbreastfeedingsupport.com/twitter-and-blog/do-minutes-matter

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