If baby truly has an oral aversion, an occupational therapist trained in
sensory integration techniques could be helpful.
Once you've ruled out all the usual reasons a baby CAN'T breastfeed, and
think that the baby just has decided it doesn't work, her are some tips:
Try distraction - show baby toys, especially things that rattle or
jingle, and get him laughing and relaxed. Then play with him with the
breast. Diane Wiessinger once suggested tickling baby in various placed
with mom's breast, and then tickling his lips. This has worked for me
with older nonlatching babies- tickle belly with nipple, make funny
noise, baby laughs, mommy laughs, tickle arm with nipple, same deal,
tickle cheek, tickle philtrum (ridge between nose and upper lip), baby
opens mouth, mom laughs and pops breast into mouth. Hopefully baby
sucks. If he just lets it sit there, fine, that's enough for the first
try. Mom can express some milk into his mouth after he is happy to
mouth the breast. Any time baby starts to resist or get tense, go back
to the toys, then try the breast again. Several very adamant older
non-nursers learned to take the breast this way.
Mom can also try the "tough love" technique (my name for it) - put baby
in just diaper on mom's bare chest, her reclining, him laying on his
belly on her chest. No one forces him to the breast but his reflexes
often take over. Mom strokes baby, talks softly to baby, tries to keep
baby's oxytocin level high. If he gets really upset, cup feed him a
tiny bit of milk and try again immediately. If he falls asleep on mom's
chest, let him stay there, and when he wakes up again, he is likely to
latch. This worked with 2 little girls who absolutely wanted nothing to
do with the breast. Each of them took it once or twice with a nipple
shield, and then refused, and nothing else worked, though the reasons
they initially had difficulty was resolved (first case mom was very ill
postpartum and could not bf, second case had severe tongue tie that was
divided weeks before, and her tongue motions were now so much better).
The first little girl took 3 days of this tough love before she latched
reliably without crying, and never looked back. SHe turned out to be
very gifted intellectually. With the little girl with the treated
tongue tie, we only had to do it once, for about an hour, and she's been
latching ever since. She seems to be a very smart baby as well.
Sometimes I think the smart ones make decisions early about what works
for them and what doesn't, and refuse to try what they've decided does
not work. We need to overcome their learned resistence by offering the
breast in a totally novel way (mom on hands and knees), or distracting
them so they don't realize what we are doing, or letting their reflexes
take over often works.
If baby learns to take in the breast and does not suck, then providing
flow from an eyedropper or periodontal syringe or mom expressing the
breast can work to make baby swallow. Once he swallows, the suck
swallow breathe cascade often starts.
Good luck, these older babies can be challenging to work with, but it's
not at all impossible.
Catherine Watson Genna, IBCLC NYC
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