Breast refusal/breast aversion: how to resolve it
Breast aversion or breast refusal is deeply distressing. It feels like your baby is rejecting you or doesn’t like breastfeeding. My first baby was like this. I persisted for months trying to breastfeed and eventually I accepted that I was going to be exclusively pumping. So I personally understand how devastating it can be when a baby doesn’t breastfeed. In retrospect, I wish I’d known all of the information in this blog. I think our breastfeeding experience would have been very different!
In this blog I talk about 3 common ages when you may see breast aversion or breast refusal. It is quite common in newborns, again at 6-8 weeks, and may appear at any point over the age of four months. Of course it can happen at any stage, but these are the times I’ve seen it most often.
I’ll discuss common causes for breast refusal/aversion, and also some tips that should help you get your baby back to the breast. In a nutshell you want to: CALM your baby before attempting to feed and don’t persist with trying to get them to breastfeed. It’s completely understandable that you might feel panicked or pressured to make your baby breastfeed. However, the more you pressure your baby to feed, the more likely they are to develop breast aversion.
NB: Please note that breast aversion is not the same as breastfeeding aversion. Breastfeeding aversion is where the breastfeeding parent experiences agitation, anger or discomfort when breastfeeding. If you have clicked on this link because you are experiencing breastfeeding aversion, you can find out more about it here.
How do aversive babies behave?
With breast refusal/aversion, babies react in one of two ways:
- They scream and arch away when the breast is offered. In this scenario, the baby’s fight/flight mechanism kicks in. Your baby experiences something stressful and their sympathetic nervous system becomes activated.
- They close their eyes and appear to be sleeping. Believe it or not, this is often also breast aversion/refusal. In this scenario, your baby is going into the “freeze” state. This is also a nervous system response, mediated by the dorsal vagal pathway of their nervous system. Your baby still feels stressed, but their response in this situation is to shut down, rather than to become agitated. Of course, sometimes babies DO fall asleep at the breast! What I describe here is an obviously hungry and otherwise alert baby that is placed near the breast, doesn’t latch and instead appears to fall asleep.
It is important to understand that when a newborn isn’t able to breastfeed easily, it is not a sign that they don’t want to feed. It means they CAN’T feed. Remember that babies are primed to breastfeed. Their very survival depends on it. This means that when your baby is agitated at the breast, it’s not that they don’t want to feed. They desperately want to feed, but they can’t work out how to do it. Repeated attempts to breastfeed are stressful, and eventually every time they go to the breast it triggers that nervous system reaction.
Let’s look at some of the reasons why a newborn may not be able to breastfeed:
They may have been pressured to breastfeed
Often, the approach adopted by midwives and other well meaning health care professionals trying to help a baby latch is to force the baby onto the breast. They grab a boob, grab a baby by the back of the head and shove the two together! Some babies are ok with this approach and will latch reasonably well. Other babies find this massively stressful. It’s similar to someone tying your hands behind your back then shoving your face down to your plate of food. I’m guessing you wouldn’t enjoy your meal no matter how tasty it is! This experience triggers that nervous system response that I mentioned before – either fight/flight or freeze.
Babies need to be able to tip their head back, open their mouth wide and stick their tongue out past their bottom lip to latch on well. If they feel a bit bruised, tight around their neck or shoulders, or if they’ve been born via forceps or vacuum, then it’s not uncommon for these babies to struggle to latch properly. Most babies recover in the first couple of weeks and find it easier to latch as time goes on.
They can’t relax at the breast
Some babies need to feel really relaxed and comfortable at the breast. When they don’t feel stable it can trigger what Dr Pamela Douglas refers to “conditioned dialling up”. Laid back positions for breastfeed can be really helpful. Babies can lie completely supported on mums body, self-attach with a deep latch and feel completely stable. Then they often relax into the feed and feed really well. Some babies just need lots of support to feel comfortable and stable, and repeated instances of not feeling stable are stressful for them. Their nervous system starts to “dial up” every time they go to the breast.
Around 10% of all babies will have a tongue tie. This means that they can’t bring their tongue forward properly to latch onto the breast and hold the breast. If you use a laid back position and your baby still can’t latch onto the breast, it’s worth getting your baby checked for tongue tie.
Early introduction of a bottle
Often you have no choice about this as some babies are slow to feed, have low blood sugars, or you are unable to breastfeed straight away. My first baby was sleepy and slow to breastfeed with low blood sugars. I’m sure that the early introduction of a bottle was one of the reasons why she never breastfed.
We can push a bottle into a baby’s mouth without them “latching” onto it. This won’t work for breastfeeding! Babies need to tip their head back and open their mouth to latch onto the breast. If they learn they can get milk without latching, it becomes harder for them to breastfeed.
Bottles can also impact on breastfeeding because a baby can used to the much firmer teat of a bottle touching the roof of their mouth. When they try to breastfeed, there is something missing in that whole process for them, as the breast tissue is much softer. They need that hyper-stimulus from the bottle teat. Repeated attempts to latch become frustrating, and then this just triggers that aversion response.
These symptoms won’t be present from birth but may develop at around 3 weeks. It is also rare for babies to become aversive and stop feeding completely due to an allergy but it does happen. In this scenario, babies react to proteins in mum’s milk. This triggers a response in baby’s system, usually in the form of painful reflux. As the baby starts to associate feeding with pain, they become more and more reluctant to feed.
Skip to the end of this article to read about solutions for getting a newborn baby to breastfeed.
Six - eight weeks
At 6-8 weeks, your baby may become fussy and cry when you try to feed them. This can be a bit of a shock if breastfeeding got off to a good start and if they fed really well as a newborn. Common reasons why this often happens around this age:
Your baby may just not want to feed
You may see this behaviour at around 8 weeks, when your baby loses their sucking reflex. They can now choose whether to feed or not! Up until this point, any time you’ve put your baby to the breast the reflex has taken over and they latch on and feed! If they have been latching on easily up till now, it’s 100% ok and you haven’t done anything wrong in the past. They may just not want to feed as frequently as when they were newborns. Mums often get quite anxious about their milk supply if their babies feed less often and can try to pressure their babies to feed as frequently as before. Then that cycle of being pressured to feed/nervous system activation happens.
They may be more efficient with feeding
As a newborn, you were maybe used to long feeds, and as an older baby they maybe finish up in around 5 minutes. They just become more efficient with time! When you persist with putting them back on the breast, they start to get annoyed about it. Cue nervous system activation and breast refusal/aversion.
I often find that as babies get older, their position at the breast changes and makes it harder to latch. They often end up too far up in the crook of your arm for feeding. When this happens their head is tipped down, their nose is buried in the breast and the chin isn’t touching the breast. Some babies feed ok like this, but some babies really need a deep latch. If you find that the latch is uncomfortable or they can’t hold the breast properly and keep slipping off, it helps to reposition them. Otherwise they just start to get frustrated at the breast, and some babies end up refusing to feed altogether.
Go back to basics. Move them towards their feet and pull their chest and hips in closer to you. It will help them tip their head back and get a better latch. This article may be helpful.
It’s not massively common, but if your baby suddenly starts crying and refusing to feed, it’s worth checking for thrush. This will look like a thick, cottage cheese-like coating on their tongue, cheeks and lips. If you see this, then you need to get treatment as soon as possible. You can find more information here.
If you’ve been giving your baby a lot of bottles (even if it’s breastmilk), then some babies develop a bottle preference. If you do give bottles then make sure that you use a paced bottle feeding technique as this will reduce the likelihood of a bottle preference developing.
It’s not uncommon for babies to have 10-15 colds a year. This often results in viral ear infections as well, which make babies feel very uncomfortable especially if they are lying flat, or on one side. You may notice that they feed from one breast ok, but if one ear is sore they’ll refuse to feed from one breast.
Most of us have one breast that produces more milk than the other. This may occasionally lead to babies feeding from one side and refusing the other.
Torticollis tends to affect babies feeding from one breast or in one position. Babies often have a bit of tightness on one side of their neck because they are curled up in utero. This tightness usually resolves quickly in the first few weeks. However, if your baby has developed a preference for always facing over one shoulder, or their head tilts over to one side, then the muscles on that side of their neck get tighter and tighter. This means that they find it harder to feed on one breast (or both!)
I say this cautiously, as I do think that it’s uncommon for allergies to start to play a significant role in breast aversion with a baby of this age. Usually, you see the signs earlier. However, I have had a couple of clients with fussy babies at around the 6-8 week mark, who then had a very strong reaction to egg at 6 months when solids were started.
Four months and older
Sometimes babies breastfeed very easily as newborns and as young babies but may develop aversive behaviour when they get older. This can be deeply upsetting, especially if you base a lot of your parenting around breastfeeding. Some of these will be similar to issues for younger babies so I haven’t repeated the information!
See above under babies 6-8 weeks.
Some babies become very uncomfortable when they are teething. You may find that for a day or two they really don’t feed very much at all until their teeth erupt. Usually helping them with the discomfort helps, for example, letting them chew on a frozen cloth or teether, and giving them some pain relief. This is one of the best articles I’ve found on teething: Teething – is it as bad as the horror stories? – Holistic Sleep Coaching
See above under babies 6-8 weeks.
See above under babies 6-8 weeks.
Babies hit a certain age and the fear of missing out is real! They can’t see what’s going on when they’re snuggled in to feed. So they refuse to feed when they are out and about, or if you’re watching tv, or even having a conversation with someone! Often taking them to a dark quiet room helps, or they may also reverse cycle and just feed more at night time. While not true breast aversion, it certainly is breast refusal!
Being scared after biting
It’s not uncommon as teeth are coming in, and babies experiment, for them to clamp down on the breast. If you reacted by shouting or screaming (a very understandable response!) then sometimes babies are scared or startled. They may not understand cause and effect. In other words, they may not realize that biting you led to being startled, but just that they were scared while feeding. This can trigger that fight/flight response when they come to the breast.
Enjoying food too much
Some babies take to solids really well and start to refuse to breastfeed. This is more common in babies where solids are started early, which is one of the main reasons we don’t recommend starting solids until six months!
Not enough pleasant breastfeeding associations to maintain breastfeeding
As babies get older, they need a lot of associations to keep them breastfeeding. If they breastfeed for comfort, feed to sleep, and feed as a way to reconnect with mum, then they are more likely to feed into toddlerhood. If you reduce these associations too much, eg not feeding to sleep, offering a dummy instead of a cuddle, or cuddling instead of breastfeeding, you reduce all those opportunities to use breastfeeding as a parenting tool. When babies don’t have lots of positive associations with breastfeeding, they may reduce their feeds and stop sooner than you’d like. While true weaning under the age of a year is uncommon, it may still happen in these circumstances.
Solutions to breast refusal/breast aversion
Keep your baby as chilled out as possible
This is the most important step. Essentially, you want to keep their nervous system regulated. If they start to fuss or cry, you want to stop and try something else for a little while – maybe rock or bounce them, or let them just chill out on your chest for a few minutes. With an older baby, you may want to get up and entertain them with something else for 20-30 minutes and then offer the breast again. It’s ok to offer once or twice, but persistently trying to latch your baby on when they are upset will be counter-productive. This will increase the risk of them developing a persistent and long lasting breast aversion.
If they are hungry, feed them by whichever means possible – even 15-20 mls via a bottle can be enough to calm them down and take the edge off their hunger (just remember to used a paced feeding technique). If your baby is gaining weight well and maintaining their growth along a centile line, then there is less pressure to get them to feed. Practice some mindfulness or relaxation to help you with your own stress levels! Tell yourself your baby knows how to regulate their appetite and will get enough milk.
If your baby isn’t maintaining their growth along a centile line, then getting skilled support from an IBCLC or dietician would be really beneficial.
Other measures to try:
- Fix any underlying issues eg tongue tie, thrush, torticollis, sore ears, teething pain, allergies etc.
- Skin to skin – this can be a real game changer, no matter what age your baby is! Just let them lie on your chest with no pressure to feed. It usually calms babies down. This position often triggers those feeding reflexes and babies will latch on much easier.
- Laid back positions – tied in with skin to skin is using a reclined position to feed. Very young babies are able to organise themselves better and use their reflexes to self-attach. These positions also help to keep babies stable and comfortable for feeding.
- Offer a feed any time your baby is calm. However, have a very low threshold for abandoning the attempt. Always work on calming your baby down again if they become upset when you offer a boob.
- Nipple shields. For babies that have a strong bottle preference, using a nipple shield can be a great way to transition babies back to the breast. With time, it usually becomes possible to remove the nipple shield and feed directly from the breast.
- Feeding when sleepy. Your baby’s nervous system is already chilled out, which is why it works so well! You could perhaps let a baby nap on your chest and then feed them as soon as they start to stir. Alternatively, a lot of mums find that safe co-sleeping means that babies feed frequently and calmly at night.
- Add in some movement. Again, this helps to soothe their nervous system! Feeding in a sling, or when bouncing on a gym ball can help babies to calm and then feed more easily.
Need some support?
I do genuinely understand how difficult breast refusal/breast aversion is. I’ve been there myself. If you decide to book a consultation with me, we don’t just look at the cause of your baby’s aversion, we look at ways to resolve it. You’ll also get some emotional support, because it really is so hard! I’ve work with a lot of babies that have breast refusal/ breast aversion. I’m always delighted when we get a baby back to the breast and feeding calmly. If you’d like some help, you’ll find out more about my breastfeeding consultations here: www.rebeccascottpillai.co.uk/breastfeeding.