jeanne hagreen <[log in to unmask]>
Subject: half time nursing strike (long)

Now, I
know everyone will say this baby is nipple confused or on a nursing
strike, but why will he take the breast when he is asleep but not when
he is awake and why will he breastfeed well at night?  His mother states
she would like him to breastfeed directly from her but if he will not,
she is quite prepared to feed him expressed breastmilk by bottle.  The
bottle is her chosen alternate method for feeding and she is unprepared
to think of any alternate methods.

Jeanne,
This IS a nursing strike.  Just count your blessings that it has not
progressed to complete refusal of the breast.  It is a "partial-strike", and
if the mother wants to continue to breastfeed she needs to do all the things
others have been suggesting to help the baby get back to more normal nursing.
This is "upset baby" behavior.  You and mom have to be detectives to figure
out what is going on inside the little guy's head.  One obvious change in his
little life is going to the sitter.  This is easy for some children, much
harder for others to adjust.  Another obvious event is the season.  Frequently
this happens when baby has a very slight cold or congestion that makes it a
bit uncomfortable to nurse.
This "partial-strike"  is a warning sign that something is bothering baby.  In
moms efforts to get him to take a bottle so she can return to work, has she
unconsciously become less available to baby.  Babies are smart.  They know
what and who they can depend on.
This is a situation where you are working with "baby psychology".
Do LOTS of skin to skin, sleep, bathe, cuddle.
Make breast available but never force.
Nurse whenever baby is willing--in his sleep when he will do it.
Keep milk supply up via pumping.
Substitute cup for bottle whenever possible.  Baby is falling in love with it.
Make it less dependable or available.  You said bottle was her chosen method,
but to be professional you must give her all the information she needs to make
that decision.  She needs to be informed that the baby is showing such a
preference for the bottle it is jeopardizing continuation of breastfeeding.
It is seductive, and satisfies baby's needs too well for sucking and food.
The cup will keep him fed but not provide that extra sucking satisfaction.
Don't give up or the nursing relationship will be over and this could progress
to a complete nursing strike.
Good luck,
Jane Bradshaw RN, BSN, IBCLC
Lynchburg, VA