Today’s Podcast

Episode 156

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In today’s FAQ session we are going to talk about Nursing Strikes. I am first going to describe to you what a nursing strike is, why this sometimes happens and then we are going to talk about ways to bring a baby back to the breast.

Definition of a nursing strike:

A nursing strike happens when a baby who has been breastfeeding for weeks or months, suddenly refuses to breastfeed. You can only imagine how devastating this can be for the mother. It is confusing and mothers usually take it as a personal rejection. They keep offering the breast and their baby keeps turning it down.

I find that the most mothers tend to respond by verbalizing that their baby does not like them anymore. This makes them feel rejected and this can be quite hurtful to the mother. Or they think there is something wrong with their milk.

rounded-small-2This abrupt refusal usually has causes other then a direct rejection of the mother. There are some very common reasons why this happens and fairly quick and easy ways to bring a baby back to nursing. Other times, the strike goes beyond 2 days and moms benefit from seeking professional help with ending the nursing strike. Sometimes, we just cannot figure out why it happened in the first place, but we are just glad that the baby went back to nursing. Less common is the baby who never goes back to the breast. And this is a heartache for the mom who was far from ready to wean her baby.

I am going to go through a list of reasons babies go on a nursing strike. I will begin with the most common reasons and end with the least common reasons:

1. Babies bite their moms nipple and mom jumps out of her seat and screeches in pain. This kind of shocks the baby and they make the association and stop nursing.

2. Babies become ill. If they are congested and have a stuffy nose, they find it difficult to nurse properly. When they breastfeed, they need to have a good seal around the breast tissue. When they try and do this, it prevents them for breathing easily. So, they tend to pop on and off the breast numerous times. This sometimes causes them to go on strike, OR moms response to their baby coming on and off causes the strike

3. Some moms will do there best to keep their baby suckling, holding their body in close, not letting them come off so easily, pushing them to go right back on. All these behaviors on moms part would be a fairly normal response, which is why it know about because it happens so frequently. However, as far as your baby is concerned, they are not ready to stay at breast or come back so quickly. The more you keep bringing them back to the breast and they keep pushing away, the more likely they are to go on a nursing strike.

4. Besides a stuffy nose, the other most common illness is an ear infection. Interestingly enough, the more the baby suckles at the breast when they have an ear infection, the more their ear hurts them. So, you can see why they instinctively reject the breast by starting and stopping or just out and out refuse. It is a protective mechanism on their part and moms reactions usually are to keep bringing their baby back to the breast. After a while, the baby then does an out and out refusal and moms are left to try and figure out why this is happening.

5. When babies are breastfeeding, their bodies tend to be in a relaxed state. It is common for babies to pee and poop while breastfeeding. If they have a urinary tract infection and pee while breastfeeding and this causes them a burning sensation, they might avoid feeding if they are old enough make the association.

6. When babies have an oweeeee in their mouth, they also will avoid breastfeeding. Some common reasons are thrush, which can be an oral yeast infection which can be quite painful for them. It is like they are hungry, but when they go to breastfeed, it hurts them a lot.

7. Some moms have had thrush and have used a product called gentian violet to treat the thrush. I have seen cases where the gentian violet irritated or burned the skin, causing painful breastfeeding.

8. Babies that were never really breastfeeding well from the beginning, sometimes reach a point where they cannot cheat at the breast anymore or get what they need at the breast anymore, sometimes go through a nursing strike. Working closely with the mom, figuring out what the primary feeding issue is, fixing that & the baby usually comes back to breastfeeding.

9. There is also the coxsackie virus, which along with a fever and aches and no interest in eating, also causes mouth sores. I remember the first time I saw this in an infant. When the mom came in for an appointment because her baby was not breastfeeding for 2 whole days, I saw her on the third day.

I was actually quite shocked when I saw her because I could tell her baby looked flushed and when touching the baby I could tell her baby had a fever. I immediately told her that we could figure out why her baby was refusing to nurse later on, however her baby was very hot and she should call her pediatrician right away. She told me that her 7 month old baby had a fever twice before but never stopped eating, so she did not think one had anything to do with the other. She felt like if she could just get her baby to nurse, she could keep her babies energy up and hydrated just like she had with the other fevers and in a few days her baby was much better. But not this time, so she was worried and then had read about nursing strikes.

I decided to sit with her for a few minutes, ask some questions but if I could not get to the bottom of it, have her call her peds right away. After asking a few questions, checking for thrush and sores on moms nipple, I looked inside babies mouth and was quite surprised to see about 5 bumps that were like the size of a small erasure head. Her baby definitely did not want me poking around in his mouth and had that cry that told you it was painful when I touched the bumps. And yes, I did have gloves on which is standard practice for me.

The first step for this mom was to call and make an appointment with her pediatrician. Beyond looking flushed and feeling warm, Joshua did not have visible signs of deydration and Jackie said that his pee diapers were hardly anything at night, but changing several during the day. I wanted a physician to evaluate Joshua as this was outside the scope of my practice. We now had about 45 minutes until she needed to leave for her appointment.

The next thing I did was have her breastfeed so I could observe what was happening at the breast. Jackie was pretty tenacious as she put him to the breast and he took a few sips and then pushed away. This happened many, many times over and over again. He was transferring milk, just not a lot at one time. When I asked Jackie if this had been going on over the last few days, she said yes. Every time he pushed off, she was quite firm in pushing him back on again as she knew he needed to eat. I suspected that Joshua was not feeling well and the sores in his mouth prevented him from staying longer then a few minutes at a time. This prompted Jackie to keep bringing him back to the breast, many times as she knew he needed to eat. This combination of sores in his mouth along with being pushed and pushed back onto the breast probably caused his nursing strike.

Next, I put her on a plan to keep her supply up and ensure her baby was kept hydrated. She should always try at the breast first, but once she could see that he was long longer going to breastfeed, but pretty sure he did not have enough She could keep Joshua next to her skin and hand express and perhaps Joshua would be willing to lap up the milk as it dribbled down. Since Joshua was 7 months old, he might take fluid from a cup. If this did not work, she would try cup or spoon feed. I imagined that they would take small volumes frequently. Her job was to keep him hydrated and as he began to feel better, he will likely return to his normal breastfeeding behavior as long as he was not pushed to do so. A follow up phone call with Jackie revealed to me that he did have the virus and within a few days of ensuring hydration on his part

10. Less likely, however, when all was said and done, there have been some cases where I might not know for sure, but I think that the baby was not liking the taste of a product that mom was using on her nipples. In each case, the refusal happened after the mother started using something they had not used before.

In all the times this has happened with a mom that I worked with, it was with a baby that had been nursing the first few weeks, and yet it had been painful for her and she was cracked and bleeding of her nipples. She started using coconut oil, olive oil or lansinoh to soothe her nipples and shortly after her baby began to refuse to breastfeed. In these cases, the babies were well fed, happy to breastfeed, and just all of a sudden rejected the breast. I suggested she stopped using all products for the next 8 hours. She did and her baby did go back to the breast. At that point, I was able to work with her with breastfeeding. I will never know if that was the reason for sure.

11. There have been other times when the reasons have been either too little volume or too much volume. The babies also were seemingly happy to go to the breast in the very early days, but then suddenly rejected the breast.

12. Sometimes, babies reject the breast, go on a strike for a known or unknown reason. Because babies need to eat, moms offer milk from a bottle, the baby takes the bottle and then begins to show a preference towards the bottle. This is not nipple confusion. They clearly are not confused. They are showing a preference – one feeding method over the other.

13. These are all times when I jokingly say that I become like an investigative reporter, asking hundreds of questions, trying to get to the bottom of this puzzle. In the very early days of breastfeeding, babies may be okay to breastfeed, even if they are not getting enough food, but as the days go on, they get older and want more and more volume and are not getting it, they become fussier and fussier. I find that in talking to moms, I realize that the babies did not all of a sudden one feeding just stop, however, in hindsight it was a gradual distancing of the breast over a few days time.

The same thing goes for moms who have way more milk then their babies need, or can handle. EAch time they go to breastfeed, the milk is just shooting into their mouth, causing them to cough and come off breast choking. here again, it is usually over the course of a couple of days where the baby is getting fussier and then at one feeding just decides, nope. I am not going to take getting drowned here anymore.

When babies refuse the breasts, most moms are determined to get their babies to feed.
First of all they just know their babies need to eat.

Second of all, a few missed breastfeeds and their breasts may be sightly sore, somewhat overfilled or very painful and quite engorged and it becomes a situation where mom is like: hey, baby, you need to eat now. I need some relief here!

In my whole long career as an IBCLC, I have come to the conclusion that in 2 separate situations, when it appeared the baby went on a strike, but it really happened because of the extreme stress that their mom was under. In both cases, the moms had suffered a major life event that was stressful enough to just STOP their milk from flowing. It is not like they did not have the milk but they just could not let down. In both of these cases, the babies were older then 6 months old. They were very aware of their surroundings, very much in touch with their moms, and definitely knew what to do at the breast. However, try as they might they just could not get the milk to come. After a few feedings like this, and with their moms pushing them on/off the breast, they began refusing the breast.

I will never forget the one case. It was over 13 years ago and I remember the details. I saw moms by scheduled appointments but this particular mom just walked in, clearly distraught and my staff asked if I could see her now.
I had never met the mom before, but she came into the clinic I had been working at. She had apparently been trying to get her baby to breastfeed since the night before. It had been about 15 hours since her babies last feeding. She said he would latch on but immediately start to scream after a minute or so of sucking. She was very distraught, even more so then other moms I had seen and worked with when their babies had a nursing strike. She had a baby that appeared well fed and she said that she had always exclusively breastfed. But, I thought to myself, okay, Lori, this mom really wears her heart on her sleeve and she is just that much more emotional about this then other moms I have worked with. I was not being judgmental, I just could not figure this whole thing out.

She had come to the appt with just her baby and a few minutes into the consult, there was a knock on her door and it was her husband. He came in and said to her, come on, we have to leave now.

I did not know what to say in the moment, but as she started packing up her stuff, i said: Are you sure you don’t have just a few more minutes as I would like to help you figure this out. Then the bombshell came: Her husband raised his voice to me and said they had to leave now, otherwise they would be getting to LA so late. I looked at the mom and said: LA? She told me: Her twin brother had been killed in a shooting and she was rushing to get there to be with the rest of her family. I surmised that her body had suffered an enormous shock and its response was to go into lockdown mode to deal with the shock. She left with her husband. She never returned my two follow up calls and I just let it go. I did wind up hearing from her out of the blue, literally about 10 years and 3 kids later. She was shopping in the breastfeeding store that I worked at, recognized me, introduced herself. She did tell me that she got to LA that night, her parents took care of the baby while she slept for a few hours and when she woke up and went to breastfeed, he did so. She never had a problem since. I believe her body went into shock mode. I do not have anything to document this case, however, I am sure her baby stopped breastfeeding because of frustration with her milk not letting down.

In a few other cases, there were other traumas in the moms life that I believe led to her inability to let down. I have a few of these cases. For instance, there was the mom who needed my help initially and soon things were going beautifully with breastfeeding. At 5 weeks old, this mom found out devastating news. Her father was diagnosed with cancer and told he had weeks to live. Sadly, this mom was so grief stricken, her supply quickly dried up and she never got back to nursing her son. I did see her with baby #2, and as far as I know that baby nursed until self weaned. I am not sure of the exact age, but it was about a year or so ago.

When the supply is an issue, we work on ensuring that everytime the baby is hungry, he gets a full feeding, while mom works on building her supply. Grumpy, poorly fed babies, commonly refuse the breast. Bump up the supply, keep the baby well fed, and she is likely to get back to all breastfeeding. Too much milk, work on reducing the supply, positional changes so babies does not feel like he is getting water boarded every feeding, the baby is likely to get back to breastfeeding. When the reasons are because baby is ill, a care plan of keeping up the supply by removing the milk regularly, not force feeding the baby, but offer frequent small feedings keeps baby fed and hydrated. Once illness, fever, mouth sores, UTI, etc passes, the baby gets back to breastfeeding. If the reason is a change of flavor at the breast, once this is figured out and taken away – soap, perfume, nipple cream, detoxing, extreme dieting, etc. baby usually comes back to the breast.

Some of the most common ways that help end a nursing strike if the situation calls for it is to-

Spend several days with your baby, attached to you as much as you can. I call this Babymooning. I ask you to hunker down at home for a few days. Separate yourself from the business of your life and just spend all your time with your baby. Don’t let outside life interfere with your Babymoon time. Lay with your baby, sleep with your baby, bathe with your baby, wear your baby. Spend lots of time skin to skin with your baby.

Another tip – try to offer the breast at various times of the day and night and at various sleep and awake phases of your baby. Sometimes babies will begin feeding again after agood feeding while they were in a half sleep/awake cycle.

The biggest question you might have: Do all nursing strikes reverse itself?

Most of the time. Some of the times, sadly no. Sometimes we know why, but help came too late.
And sometimes, it is one big mystery and we never did figure out why and baby never went back to breastfeeding.

Okay, well you have definitely just had a good lesson in Nursing Strikes. While I hope this is not something you ever have to deal if, If you have ever experienced a nursing strike, please make sure that you take the
time to listen and work with your baby. Try not to be too anxious or too pushy as this will drive her further and further away from breastfeeding.

Lori J. Isenstadt, IBCLC

Lori j Isenstadt, IBCLCLori Jill Isenstadt, IBCLC is a huge breastfeeding supporter.  She has spent much  of her adult life working in the maternal health field. Once she became turned on to birth and became a childbirth educator, there was no stopping her love of working with families during their childbearing years.  Lori became a Birth doula and a Postpartum doula and soon became a lactation consultant.  She has been helping moms and babies with breastfeeding for over 25 years.  Lori founded her private practice, All About Breastfeeding where she meets with moms one on one to help solve their breastfeeding challenges.  She is an international speaker, book author and the host of the  popular itunes podcast, All About Breastfeeding, the place where the girls hang out.  You can reach Lori by email at: [email protected] or contact her via her website:  allaboutbreastfeeding.biz/contact

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