This gradual reduction is important to baby, often from a psychological/emotional point of view (ie many can become very distressed when the breast is suddenly withheld) but also from a health perspective. As feeds are reduced, milk becomes "transitional" - becoming much more like colostrum and packed with extra antibodies to help protect the nursling. If cessation is sudden, the infant misses this valuable "boost".
- Early introduction of bottles or too many bottles - even more so if mum has reduced supply and slow flow at the breast. If you do decide to introduce one, get baby to suck a clean little finger for a few moments before getting milk, so they have to work for a few minutes as they would at the breast for letdown.
- Thrush or other oral discomfort
- New found independence eg they find a sippy cup is good fun and portable
- Negative association with feeding - perhaps baby has bitten and mum has inadvertently yelped or raised her voice.
- illness eg ear infection or cold/blocked nose which can both cause discomfort when feeding.
- Early introduction of bottles
- Return of menstruation (can make the milk very salty for a short time)
- A major disruption in your baby's routine, such as you returning to work*
- An unusually long separation from you*
Pamela Morrison IBCLC suggests sometimes the cause may not always be immediately obvious:
The cause of a nursing strike can be sometimes difficult to identify, at least initially. Perhaps baby has had to wait too long for breastfeeds or been left to cry - something got in the way of his close relationship with his mother. Anything can cause this and sometimes the mother doesn’t find out what it was until much later. I’ve known this happen from 3 months.Strikes can be very upsetting for mum; in a young baby there may be concern over milk intake and mums can feel as though it is a personal rejection of them as a parent. My own lil one had a strike aged around 18 months when a virus caused several tiny mouth blisters - feeding was quickly associated with pain and the strike lasted for around two weeks before feeding resumed.
What can you do to encourage baby to resume nursing?
Nursing strikes can last anything from a few hours or a few days, to a few weeks - staying calm, positive and relaxed is difficult yet it's importance is often underestimated. I noticed during our strike that the more I tried to encourage, the less interest - as soon as I backed off and became casual, interest resumed!
Pam's top tips:
1. Express or pump breastmilk to keep the breasts thoroughly and regularly drained. For a young baby rule number one is to ensure baby is sufficiently fed; depending upon the cause of the strike and the age of the baby, finger feeding, cup or if needs be bottle are all options. For the older nursling established on food, some mums use the expressed milk in smoothies, puddings or on cereal, if baby wont take from a cup.
2. Don’t force breastfeeds, keep baby happy and calm.
3. Where possible abandon all other responsibilities for several days and devote 24 hours/day to the baby. Hold him all the time, wear him all day, play with him a lot, bath with him, sleep with him, lots of skin to skin - attempt to get back “in touch” with the baby and regain his trust. If mother needs to draw the curtains and go around half-naked for most of the time, then that’s what it takes.Whilst I find the above tactic fantastic with younger babies and some older infants - I found with my child that alone, without distractions in a favourite nursing place- was actually the worst place to offer as it was clearly linked with an expectation to feed. More interest was shown when I was watching TV or reading ie without any focus on feeding - so this may be something else worth trying for the slightly older nursling.
4. Offer the breast a lot, but don’t force it. If baby starts to struggle/arch/cry; stop offering, smile and laugh, then when baby is happy and relaxed (in an hour or so), offer again. When offering breast, make sure there are no clothes in the way, mother and baby are alone (no distractions, TV, other children, etc) in a quiet darkened room (or in the bath), offer “favourite” breast first, in “favourite” position, in “favourite” place etc. Often offering the breast while standing and/or rocking the baby can help. Some babies become enraged if placed horizontal, so the mother needs to slide the baby down from her shoulder and offer the breast with the baby upright. Sometimes having the baby upright straddling her leg can also work. She can “play” at dabbing the baby’s lips with the nipple, taking it away, dabbing again, laughing, keeping everything light and happy, as if this is a big game ..
6. Mother to be charming, do all the things that baby likes and keep him very happy, treat him like Dresden china, keep offering the breast.
7. If the mother becomes distressed by baby’s refusal, she must try not to show it - put baby down somewhere safe, go outside and scream or kick something, but hide frustration from the baby (easier said that done, but she is bigger, cleverer, smarter than he is).
8. Keep offering breast. Eventually baby will try it out. May take one or two swigs and then come off. Mother is to “reward” baby with biiiig smiles and congratulations for even the smallest attempt, and let him call the shots, i.e. let him stop when he wants to, and offer again later. Tiny swigs may start to become longer. Eventually the baby is willing to breastfeed. When this happens the mother should offer the breast a lot, at every excuse, before she can start to relax and realize that the strike is over.
9. At this point, mothers often realise what went wrong in the first place, and become determined not to let it happen again - i.e. they become much more “careful” mothers of this quite sensitive baby.I’ve never known these measures to fail if the mother is willing to embrace them. Often the strike is over within hours, not days. But the longer it took to happen, the longer it is likely to take to resolve.