Breast or bottle refusal can be a distressing occurrence for both mother and baby.
Often the baby has previously fed happily, then for some reason, begins to refuse a feed. Causes may be apparent such as: an alert baby being easily distracted, over-feeding or force-feeding, gastric reflux, illness in the infant or if breastfeeding, oral or nipple thrush, mastitis, medications and hormonal changes (e.g. ovulation, menstruation), or mother becoming ill. There may also be issues relating to mother’s milk supply, such as: low supply, or slow let-down reflex (thus baby becomes frustrated), or the milk flowing too quickly and baby needs a breather.
Usually, after a few days the baby begins feeding again as though there had never been a problem. If the cause can be located it can be treated, e.g. thrush, gastric reflux.
I have seen older babies who literally refuse their feeds even after only having 30-50 mls or 5 -10 mins on the breast. These babies usually come off crying and refuse further attempts to get them to feed. This is very stressful for mums and bubs. Many of these babies have a degree of reflux and even though they may be on medication, the medication may not be working as well as it should be to prevent discomfort while feeding. Adjusting their medication will improve baby’s feeding so have a chat to your doctor. If the situation is ignored it usually becomes worse.
It is also important not to feed baby too soon after the last feed as he/she will not feed well and you will only be setting up a bad habit of snack feeding and cat napping. Normally when your milk has come in (usually by the fourth day) baby should be able to go three and a half to four hours between feeds unless you have a low supply. If baby has reflux, feeding small more frequent feeds use to be encouraged but most babies prefer to have a full feed and not fed to frequently. Feeding a reflux baby small more frequent feeds is like adding fuel to the fire, increasing the stomach content which aggravates the heart burn.
Overfeeding also makes baby feel very uncomfortable as it does us. Baby will feed better if fed less than three and a half hours from the last feed with a good sleep (not a 45 min nap between feeds). A baby that sleeps well will be rested and will feed well. See article on When Does Your Baby Have a Sleep Problem?
Some things to remember:
Do not overfeed baby - this leads to discomfort and aggravates reflux
Don't underfeed baby - this will lead to hungry, irritable bab.
Make sure your baby is happy & content after a feed.
Check baby is putting on weight and has good wet nappies every 4 hrs.
If you have a low supply - express after every day feed and top baby up after the breastfeed where needed.
Assist in baby's selfsettling - good sleep habits will encourage better feeding.
If baby is on reflux medication - check with your doctor re increasing or changing the medication.
If baby is being distracted - move to a quieter room to feed.
Check baby doesn't have thrush.
If baby continues to fuss at the breast you must express after each day feed to keep up your supply and if necessary top up with bottle of expressed milk (from the morning when you supply is the fullest) or with formula.