I deal with this type of situation frequently since I run many "new moms
groups" each week - even today I had a woman who was sure she was "losing
her milk" since her breasts were now adjusting to BF by becoming softer,
less engorged and she stopped leaking between feedings.
Understanding normal infant behavior is key here - I explain numerous times,
for example, that at 3 months, it is entirely developmentally appropriate
for babies to grasp both hands together at midline, and draw them into the
mouth to chew. Drooling also begins around 10 weeks and peaks around 20
weeks. Between 3-6 months, one can expect babies will have one or both hands
in the mouth almost constantly, with drool. It necessarily doesn't mean a
tooth is breaking through - and more importantly for this mom, it's not a
sign of hunger or feeding cue - once a baby can get the hands to the mouth,
he will, and plenty.
If this mom is now pumping and bottle feeding, I would reinforce the
concepts that - she does have adequate supply (unless she is also
supplementing with formula throughout the day, which clouds the picture on
her supply - but if she is expressing and breast-milk feeding exclusively,
she is obviously making the all milk he needs). He's shown in the past that
he knows how to remove milk from the breast but may now be learning to fuss
quickly at the breast to get to the bottle faster. Just because babies may
seem to "prefer" the bottle doesn't necessarily mean the bottle is better
for them - some older kids prefer Twinkies and Coke but that doesn't mean
it's better for them. If he's "chunky" as you describe, also explain that as
babies get older, sometimes they become very quick and efficient and are
able to get a lot of milk in a shorter amount of time. Sometimes moms are
just settling down into what they think should be a long (30 minute) feed,
when baby is fussing after 5-7 minutes because he's DONE. She may think he
hasn't even barely eaten yet, but he may have already transferred 3-5 ounces
of milk in that period if she has a rapid let down.
Encouraging her to scale back the bottle feedings but continue to offer the
breast (especially when he is drowsy - just falling asleep or waking up, or,
in the side laying position), follow the URINE output - not stool output -
since at this age some babies stool twice a day, others stool twice a week,
but she should see 5+ heavy wet diapers and a 'juicy' mouth, especially
helpful as she scales back the bottle feedings so she can reassure herself
this is "all from her" rather than from the bottle feedings. If a baby is
making 6 heavy wet diapers/day with short breastfeeding sessions and no
bottles (or one nighttime expressed bottle by dad), it's pretty obvious that
mom is making milk and baby is getting it.
Most importantly, encourage her get an accurate infant weight, and then
another weight on the same accurate scale one week later, so she can
reassure herself that her baby continues to gain 4-8 ounces/week (at 3
months) on her milk.
I agree with the previous poster who suggested helping this mom to find a
New Moms Group for peer support and to see "a wide range of normal" and
learn to identify and normalize infant behaviors.
Nancy
Nancy Holtzman RN BSN IBCLC
Director of Early Parenting Programs
Isis Maternity - Brookline, Arlington, Needham
781.429.1500
www.isismaternity.com
-----Original Message-----
From: Veronica Tingzon [mailto:[log in to unmask]]
Sent: Tuesday, December 05, 2006 10:32 AM
Subject: 3 m/o baby refusing the breast
Dear Lactnetters,
I have permission to post from a mom that has a concern:
Her baby just turned 3 months old. He is a very chunky, normal baby. Mom is
a very stressed out person and is constantly calling me for breastfeeding
questions. First it was that her son wouldn't latch, then she was battling
low milk supply. Those were all valid, but because she had a rough start
(and has PCOS) she decided to start taking Domperidone. Breastfeeding became
much more pleasant since she started taking the "Dom". But, in the past
couple of weeks, the baby will have bouts of nursing strikes. He'll go on
breast, tug, and then refuse the breast. Mom is down to the point in the
last day where she's just pumping and bottle feeding.
I have been working with this mom since the baby was 1 week old.
The baby has always done well and transfered an ideal amount of milk when I
have seen them, but she says that he never displays his behaviors when I am
around. Quite honestly, I think she's more relaxed when I am around. She now
says that her baby constantly puts both hands in his mouth and furiously
gnaws on them. I asked if there was drool and she says there is a great
deal. It sounds like teething to me.
Can teething be leading to a nursing strike? Can it be that her milk supply
has fallen again? Can it be that the "Dom" is upsetting his stomach? Any
help would be appreciated. I have given her all possible reasons I could
think of and suggestions of how to get around the nursing strikes to no
avail.
Thanks,
Veronica Tingzon, IBCLC, RLC
Oceanside CA
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