We see many mothers in our clinic who come because their baby is on a “nursing strike” (refuses to take the breast) or pulls at the breast and cries at the breast, often pulling at the breast and pulling off the breast but returns frequently to the breast. This is something new usually, and the babies used to be very good, happy breastfeeders previously. These mothers at first had an abundant milk supply but for a number of possible reasons, the milk supply has decreased. Because they had, at first, an abundant milk supply, they often do not believe that the milk supply has decreased and look for other reasons. True, many of these babies still seem to gain weight quite well, but it is obvious that something is wrong. But because the flow of milk has slowed, the baby is not happy, being used to much more rapid flow before.

What is wrong? If one watches the baby at the breast, one will see that the baby is quite content to stay at the breast when the flow of milk is rapid (as demonstrated by the pause in the chin as the baby opens up his mouth to the maximum before closing his mouth—see our website or youtube videos for babies drinking well at the breast, or not).

What are the symptoms these babies have and/or which diagnoses that are frequently made?

1. Of course, the baby may not gain weight well or even lose weight. But be careful, different scales can weigh differently or the weights are not recorded accurately. Happens all the time. And some babies continue to gain reasonably well.

2. Here’s the big one: reflux. There is an epidemic of reflux out there. It seems as if every other baby in our area is on drugs for reflux. And most of the babies who are diagnosed with it don’t actually have it. I’m not saying all babies, I’m saying most. But the babies who are reacting to a decrease in flow, act just as the books say babies act when they have reflux.

3. Colic. Because they cry a lot, especially in the evenings, when mothers have less milk even usually. But beware of colic that “starts” at 3 or 4 months of age. Of course, a baby may have colic, whatever that is, for the first 3 months or so and then change his/her crying because the flow of milk has decreased.

4. Overactive letdown reflex. Many of these mothers did have babies who choked and sputtered at the breast early on. The treatment for this is to get the best latch possible (but see my post on spitting up and choking at the breast). Frequently mothers are told to feed only one breast at a feeding or block feed. See my previous post on block feeding. But these babies I’m talking about do not drink at the breast, they pull at the breast because the flow of milk is slow. See our youtube or website videos for just such a baby.

5. As mentioned above, fussing at the breast, crying at the breast, pulling the nipple.

6. Biting, teething. Babies don’t bite just to try out their teeth. They bite because the flow of milk is slow. Teething does not explain this either.

7. Both 5. and 6. can lead to late onset sore nipples.

8. Very long feeds or very short feeds. In the latter case, the baby often will suck his hands or fingers.

9. Baby starts to wake up again in the night even though s/he was sleeping through the night previously. There are other reasons for this, but this is one of them.

10. Thrush in the baby. Babies are only very rarely bothered by thrush and I don’t believe they refuse the breast or cry at the breast because they have thrush.

11. Infrequent bowel movements. After the first 3 or 4 weeks, many babies have bowel movements only every 3 or 4 days, even less frequently and if the baby is generally content, gaining well and drinking well, this is normal and nothing should be done about it as long as the bowel movements are soft when the baby finally has one. The record I am aware of is 32 days without a bowel movement. But infrequent bowel movements may also be due to a decrease in milk intake by the baby.

12. Allergy to something in the mother’s milk. This can happen, but like reflux, far too frequently diagnosed and many mothers are on a white rice and water only diet.

13. The baby is “self-weaning”. Babies under about 2 years of age do not “self-wean”. If they refuse the breast, it’s because the flow of milk from the breast is slow. This is also often called a “nursing strike”. Though I believe there is such a thing as a nursing strike, as with allergy to something in the mother’s milk and reflux, the diagnosis is made far too frequently.

Why would the mother’s milk supply decrease? See next post, coming soon.

From Jack Newman, MD, Author,  Newman Breastfeeding Clinic & Institute in Toronto

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