Gail -
Often refusal of one breast is due to position - it helps to try the
slide over position or some of the prone positions as well as cradle &
football.  Sometimes this refusal is due to a visual or neurological
problem as well.  The baby can have a very strong preference for one
side.  In these cases thorough medical evaluation, chiropractic
adjustment, cranio-sacral therapy might all be used to be sure that there
isn't a neurological or biomechanical reason for the preference.  With my
daughter I was actually able to diagnose a dislocated elbow because of
refusal to use on arm.  She wasn't a newborn, but rather a nursing
toddler, at the time.  The principle is the same.
In addition to these factors there can also be a difference in the milk
flow from the less preferred breast.  Using a pump either before or after
nursing (or hand expressing which I have always preferred) and taking
note if the let down seems more or less forceful on the neglected side,
can also be useful when trying to work these things through.  it is
important that the supply be kept up in both breasts while the diagnosis
is being made.  Remember that the bably can do well on many shapes of
nipple.  I would always remind mother of the preference issues regarding
pacifiers and bottles, etc.  whenever there is a latch-on difficulty.  It
is also helpful to remember that most women can nourish a baby on one
breast only - so it is not a matter of life and death to have the baby
using both breasts at all times.

Sarah Friend Barnett, LLLL, IBCLC
Bronx (New York City), New York
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