Aversion to feeding means screaming or crying when offered the breast or bottle, refusing to eat, or needing to be fed while moving or while drowsy/asleep. This is not a temporary nursing strike where baby refuses the breast/bottle for a few days because of periods returning, mom going back to work, teething, or illness, etc. The behaviors seen in baby are much more extreme for a true aversion. Most common causes:
👅Tongue tie: One of my biggest red flags for tongue tie is reflux and shutting down during breastfeeding (sleepy on the breast, popping on and off, refusing the breast and preferring the bottle but then shutting down on the bottle). Some babies with tongue or lip tie do fine for the first few months by compensating on a full milk supply. The aversion comes around 3-4 months when supply regulates. Address the ties and do oral motor exercises to strengthen the system and the refusal can go away.
🥛Intolerances/Allergy: This looks similar to reflux, but often with bowel issues as well (constipation, diarrhea, or mucousy/foamy poops). Babies who’s digestive tracts are uncomfortable don’t want to eat. They learn quickly to associate feeding with pain, so they shut down on feeding.
🤮Reflux: Easiest culprit to blame and mask with medication. The medication may mask the pain but won’t actually take the reflux away. Reflux is usually caused by food allergy/intolerance, gut issues, or tongue tie. Address the issue, resolve the reflux.
🥵Silent aspiration: Milk going into the lungs instead of to the stomach. If baby is having recurring chest infections, they should be seen by a speech pathologist right away for a swallow study to see if they actually are aspirating
🤯Behavioral: The number one concern of parents is feeding the baby. When feeding isn’t going well, it causes extreme stress, which can causes parents to do extreme things to try to fix the problem. It’s easy to spiral out when you’ve tried everything and it’s not working out of stress and desperation. Occasionally the reason for the refusal is no longer there, but it was so stressful in the moment, the panic that it could happen again sets in and perpetuates the problem. Some times the root issue is still there, but you’ve compensated and it’s causing a behavioral manifestation in both you and the baby.
While some things we hear about babies are common, that doesn’t mean they are normal. The idea that breastfed babies don’t need to poop daily has been normalized, but in reality, isn’t true!! The idea that there’s very little waste produced from breast milk is not based on scientific evidence and can actually prevent finding the true reason for baby’s lack of poop.
In the newborn stage, prior to 6 weeks, pooping tells us if baby is getting the appropriate volumes of milk from the breast. Many times when a newborn isn’t pooping, it’s a sign they’re not getting enough breast milk. As you increase milk volumes, baby starts to poop! Decreased milk intake can happen when baby has a tongue tie and can’t efficiently move milk from the breast, if feedings are scheduled (waiting for every 3 hours) or if baby is being sleep trained too early. Low milk supply can be caused by retained placenta, thyroid or hormone disorders or when there is a breast surgical history like a reduction.
Constipation can have other root causes.
🧬For some, it may be that their digestive biome is not ideal… things like antibiotics given to mom during pregnancy/birth or antibiotics given to baby shortly after birth shift the biome where it doesn’t ideally absorb and process milk. Introduction of formula also changes the gut microbiome. Some babies may have difficulty digesting certain formulas and may struggle with pooping until the right one is found.
💃🏻Not getting enough movement, tummy time or being in one position for too long (sitting in positioning devices like a dockatot for hours a day) decreases movement through the gut. Allergies and intolerances are another culprit. 🦷Babies who are teething may have a temporary change and miss a day or two and then return to daily stooling.
🤢Illness, change of environment (maybe a holiday/ move of house), change of daily rhythm etc can all play a role, and temporary changes are to be expected.
Every person is unique and so there isn’t any “one size fits all” reason why an infant may be struggling with constipation/infrequent stooling. If you baby isn’t pooping regularly, an IBCLC can help figure out what may be going on and refer you to the right specialist as needed.
Prolactin is hormone responsible for making breast milk. We know that when you’re breastfeeding, you need about 300-500 extra calories to supoort making nutrition for your baby. You’re still eating for two!! There are foods with phytoestrogens which help boost and support your natural prolactin levels.
There are several main classes of phytoestrogens. Lignans are part of plant cell walls and found in fiber-rich foods like berries, seeds (flaxseeds), grains, nuts, and fruits. Two other phytoestrogen classes are isoflavones and coumestans. Isoflavones are present in berries, grains, and nuts, but are most abundant in soybeans and other legumes. Coumestans are found in legumes like split peas, lima and pinto beans. Eating these will naturally increase prolactin which in turn helps support making milk 🌾We all know oats are the go-to for increasing supply. They are rich in plant estrogens and beta-glucan. But other grains like brown rice, barley, and quinoa work as well! 🧄Garlic! It will definitely flavor you milk, but research shows babies love the flavor and often suck more in response and it’s been shown to increase milk supply 🌱Fennel: Raw or cooked, fennel seeds can be added to a recipe, or drunk as a tea. There are also many lactation specific supplements that include fennel in pill form for a more concentrated dose 🥬Dark Leafy greens like spinach, kale, collard greens, and broccoli. And yes, you can eat broccoli while breastfeeding. 🥦 🌻Seeds: Sesame seeds, flax seeds, and chia seeds are all super boosters of making milk and can be added to baked goods and smoothies very easily 🍓Berries: Get a phytoestrogen boost with fruits like strawberries, cranberries, and raspberries. 🌰Nuts: Almonds are high in linoleic acid and known to be the most lactogenic nut. Packed with healthy fats and antioxidants, Vitamin E and omega-3, walnuts, cashews, and pistachios are all good choices. Snack on raw or roasted nuts, add them to cookies, smoothies, and salads. 🍏🍇🍍🥥🥑🥦🥒🫑🥕🧄🧅🍠🍞🧀🍳🥩🍔🥗🍪🥛
While maternal nipple pain and damage are classic signs of tongue tie in baby, I have seen many cases where the mother reports absolutely no pain with breast-feeding. These babies tend to have very high palates and some times a weak suck (not always). The actual nipple in most cases is large and long and goes up into the palate where the tongue tends not to be able to pinch it as much. There may be creasing of the nipple, but usually not the classic damage seen with other presentations of tongue tie. These mother‘s bodies often compensate with a fast let down and over supply of milk. These babies trigger let down easily and the mothers body responds with freely flowing milk. Baby drinks from the fountain without learning how to stimulate the breast and empty it on their or or learning how to trigger new let downs. These babies often gain weight well or even faster than expected until around 3-4 months when they unexpectedly drop off the growth curve and mom feels like her supply suddenly drops. Symptoms often include clicking at the breast (caused by that high palate and the fast flow of milk) which in turn increases the risk of reflux, colic and gassiness. Moms also complain that they need to constantly hold or shape the breast or baby loses the latch. These ties often go undiagnosed and many of these babies are switched to bottles and formula as the supply continues to decrease from the baby inefficiently moving milk from the breast which can also coincide with mother going back to work. If she is using a poor quality pump or the wrong size flanges and not moving milk well with the pump, she’ll often blame herself for the low supply.
Has your nipple looked white after feeding or pumping? The blood vessels have gone into spasm and are not letting blood through. When the nipple gets pinched, the arteries spasm and stop letting blood through. As the pinch is released, blood starts to flow, and it results in pain. Some say it feels like fire or ice. Others describe it as a burning, slicing, or pins and needles. It often gets misdiagnosed as thrush but will not respond to medications.
It can be caused by a bad latch, but also from undiagnosed tongue tie and using a pump flange that’s too big. For people prone to vasospasm, the repetitive act of feeding or pumping in combination with the abrupt drop in temperature when baby unlatches or the pump stops is enough to trigger a spasm.
🌻Watch for a deep latch every time 🌻Have baby assessed for tongue tie 🌻Check your flange size. If you’re maxing our the suction on the pump, your flange is too big. When too much areola is drawn into the tunnel, the areola swells shut around the nipple and causes the spasm.
Other tips: 🤲🏼Gently massaging, rubbing, or pinching the nipple helps. Immediately cover your nipples with your shirt/bra/nursing pad, then gently rub or massage them through the fabric. 🔥 Use dry heat like a lavender pillow, microwaveable rice/barley/flax pack, hand warmer/Hot Hands immediately after baby unlatches or you stop pumping. Leave heat on for a few minutes until the pain subsides. 🌸Limit or avoid caffeine 🌸Some research indicates hormonal birth control pills increase the risk of vasospasm. 🌸The main supplement that seems to help with vasospasm is vitamin B6. Dr Jack Newman suggests 100 mg of B6 twice day, as part of a B vitamin complex. 🌸Calcium plays an important role in blood vessel dilation. Magnesium helps in calcium regulation. Taking cal/mag often helps with vasospasm. 🌸For chronic, painful vasospasm that does not respond to other strategies, some doctors may prescribe a short course of the rx Nifedipine.
Breasts are made of a network of ducts, covered by a layer of fatty tissue. During pregnancy, estrogen and progesterone enlarge the milk ducts and multiply the glandular tissue that produces milk. After birth, estrogen and progesterone drop and prolactin and oxytocin rise. Prolactin makes milk production and oxytocin releases it into the ducts. Extra blood and fluid fill the breast just after birth to supoort your body adding hormone receptors in the breast to make milk. The blood and fluid surrounds the ducts and this extra pressure is what makes your breasts feel full between feeding. This blood and fluid reabsorb around 6-8 weeks once supply is established and you won’t feel that full/soft feeling except when you go a really long time between feeding or pumping. Breasts go back to prepregnancy size when supply regulates around 11-14 weeks but continue to make milk. When you wean from breastfeeding, it can take several months for prolactin levels to return to baseline (which is why you may still see milk for months after weaning). Once you stop breastfeeding, the milk making structures actually self-destruct – a process that involves massive cellular suicide, and the removal of the debris. Around 6 months after weaning, the milk-producing tissue is replaced with fatty tissue. If you return to your pre-pregnancy weight, your breasts most likely will return to the same size. They may not be as “perky” because the skin is a bit more stretched and the connective and fatty tissues in the breasts often shifts during pregnancy and breastfeeding. While they may look smaller after weaning most of us can expect that our breasts will return to a similar size as they were pre-pregnancy. They’re just a little more lived in and well loved.
15 minutes per side is a recipe for baking, not breastfeeding. Not every baby needs 15 minutes per side. Some babies take a full feeding in only a few minutes minutes, and from just one breast per feeding. Other babies may feed for a few minutes off each side. Older, more distractible babies are efficient eaters with more important things to do than state at your chest. They may graze at the boob a few minutes at a time or want to go back and forth from side to side.
Other babies may be boob barnacles and need much longer at the breast. Or they may want to be at the breast for more than just nutrition: teething, growth spurts, you going back to work, developmental leaps, sickness. Being on your body brings healing, comfort and stability while they’re going through all kinds of rapid changes and growth. Being on you for an hour or more is the best medicine to what ails them.
The only time we should be limiting time at the breast is in NICU with premature babies where fatigue is a factor or under the direction of a lactation consultant because of true low supply, tongue tie or other oral motor disfunction while on a triple feeding plan. This would be a temporary plan because of a true lactation issue.
In general, you know baby is getting enough breast milk when you have a pain free latch where the nipple goes in and out of baby’s mouth the same shape. You can hear baby swallow and don’t need to keep them awake at the breast for them to continue feeding. Baby should be making lots of heavy wet diapers and pooping daily or every other day. They also gain weight to their own curve and are a similar size of your unique family genetics.
If your baby typically latches for you, and feeds well, and refuses to latch, they most likely are done. Follow your baby’s lead and get to know their feeding habits. Trust your baby and trust your body. If you’re concerned about how your baby is feeding, schedule and appointment with a breastfeeding expert: an IBCLC lactation consultant.