Donna wrote:
<One mother came to our monthly new mothers networking meeting last week,
very upset that her 3 month old was refusing to nurse, screaming very soon
after latch on.  This baby was being given one bottle of expressed milk a
day from almost birth (their idea) so it really wasn't a nipple confusion.
I did get the baby to nurse after the meeting and the mom cried - - she
thought it would never happen again.  The strange thing that came out of
this through a discussion on the flu vaccine, was that this mom had the flu
shot on sat and this all started to happen on sunday. . . Has anyone heard
of a baby refusing to nurse after mom got the flu shot?>

1) I haven't met a mom/baby dyad where baby seemed to refuse the breast in
response to mom's flu shot, but anything is possible.

2) Re: your statement that baby was being given one bottle of expressed
milk a day from birth so it really wasn't a nipple confusion.  What about
nipple preference?  The baby wasn't confused, I agree.  It was a clear
refusal by the baby.  You describe the baby as latching on and then
screaming.  Breast refusal seems more likely to occur without any latching,
so could it have been something to do with the flu vaccine??

In cases of nipple confusion and nipple preference, here is how I explain
to parents and staff about the difference between the two.

Nipple confusion looks like this:  after having had exposure to an
artificial nipple, either bottle nipple or pacifier, a baby is still
willing to root for the breast but just doesn't seem to remember what to do
at the breast (in cases where the baby has previously displayed sustained
latch and nutritive sucking).  This can also occur when baby has never
successfully latched on to the breast, has had exposure to artificial
nipples, and is still interested in rooting toward the breast.  These
situations are extremely common when babies who have been observed to have
a good feed at the breast, are later sent to the nursery for overnight
bottle-feeding by the nurses, followed by difficulty at the breast the next
morning.

Nipple preference, on the other hand, is a clear preference expressed by
the baby.  Among breastfed babies, this will either appear as a clear
preference for the breast with refusal of artificial nipples, or the
preference may appear in favor of the artificial nipple with a refusal of
the breast.  The baby's refusal may be adamant (crying and/or screaming
and/or pushing away from the breast, which may be felt by the mother as a
rejection of her mothering).  The baby may also refuse the breast
with "good manners" by simply turning away from the breast in a quiet
manner, appearing to be consistently not interested in the breast.  Of
course this can occur among all babies, breastfed and bottle-fed alike.
Many bottle-fed babies develop a very clear preference for a certain brand
of artificial nipple.

"What is nipple confusion?" and "Why does it happen?" are common questions
that come up in prenatal bfing classes.  It's important to let parents know
that whether some nipple confusion occurs or whether the more advanced
situation of nipple preference occurs, lactation consultants are skilled
and available to assist families with such situations. I have met countless
mothers in the immediate postpartum who very sadly refer to a previous
child who had been bf for x period of time and then began refusing the
breast after highly variable lengths of time with artificial nips - - one
week, two months, four months, even one baby who at eight months rec'd his
first bottle of EBM and then refused the breast after that one bottle.
Mom's next babe was in NICU for two months - - with that babe she pumped
for two months and then went to AIM, babe didn't ever go to breast.  I met
her after the birth of her third child.  All was going well but she was
adamant that this baby would NEVER have a bottle.  I still remember her
emotional delivery of that statement.

While empathizing and having great compassion for mothers and babes in such
situations, I reassure mothers, in an upbeat manner, that this is almost
always a fixable problem and to give us a call, should such a problem occur
with this new baby.  Such a problem can be felt as absolute, however,
putting a fast end to breastfeeding.  It's important to emphasize that
we're here to help mothers and babies with those situations and any other
breastfeeding situation that needs addressed.

There are many analogies to use in explaining why nipple confusion and
nipple preference can happen at any time, even in an older baby.  These
analogies are also helpful when a mother is becoming chagrined and even
worn out by a baby who continues to need a great deal of help in learning
to latch on.  I like to use the analogies of learning to ride a bike or to
play a musical instrument.  When we first begin to ride a bike without
training wheels, we jump on and fall off many times.  Then after several
more tries, we start to have a little success but are still a bit wobbly.
As we become more and more skilled in riding the bike, we don't wobble any
more.  And when we really have all those motor skills figured out, we just
glide along and it's smooth sailin'.  This is easiest if our parents buy us
only one kind of bike for us to first learn how to ride.  Providing us with
a 3-speed, a 5-speed, a mountain bike, and a Big Wheel would stress anyone
out!  You can apply similar analogies with learning a musical instrument.
Parents typically provide their child with one new instrument to learn in
the beginning vs. starting their child on two or more new instruments.  How
stressful for the child or any new learner, including adults, to begin
taking violin lessons on the same day you are beginning guitar lessons!
These analogies are helpful when a family keeps pulling out a bottle in
between your visits, as they continue to call you for assistance in helping
their baby learn to breastfeed. Learning to eat, learning to ride a bike,
learning to play soccer or a musical instrument - - these are all motor
skills that improve with practice!

I received a flyer some months ago for a workshop where Diane Weissinger
was to speak on the use of analogies.  Diane, if you're listening - - do
you have any other analogies to share?

Debra Swank, RN BSN IBCLC RLC
Member of the Valerie McClain Fan Club
Winchester, Virginia USA

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