Breast Refusal: What is it and How Can You Prevent it?

Let’s explore a few frequently asked questions about this behaviour – how to prevent it, how to deal with it and how to keep breastfeeding your baby through any challenges.

Why Does Breast Refusal Happen?

Breast refusal can happen when the baby finds it difficult to latch on to the breast properly because he’s previously had a traditional bottle to feed from or a pacifier (dummy) to suck on.

The reason for this is that for your baby, feeding from a bottle and sucking on a dummy is a different technique than feeding from the breast. Babies use different facial muscles for these different types of sucking – bottle teats are somehow more rigid, with a constant flow of milk – so with bottle feeding, your baby doesn’t have to work as hard to get the milk. It’s easier for them, so this can become their preference.

For some babies, this can lead to breastfeeding problems when they are placed back on the breast, because they learn different feeding behaviour drinking from the traditional bottle than from the breast.

Will Feeding a Baby a Bottle of Expressed Milk Encourage Breast Refusal?

Feeding a baby a bottle of expressed breastmilk can possibly lead to refusal of the breast if the artificial feeding system does not mimic the same sucking behavior as breastfeeding.

In fact, feeding your baby expressed breastmilk is the next best thing to breastfeeding! But it’s important to make sure that your baby is not “un-learning” his/her breastfeeding behaviour while feeding from a bottle.

This is where the Medela Calma feeding solution can be very helpful. It is a one-of-a-kind bottle/feeding solution that mimics the natural breastfeeding sucking behaviour that infants use at the breast.

Do Babies “Forget” How to Suck?

Babies have strong instincts that show them how to suck from their mother’s breast. They are naturals! But sometimes, if they are not able to feed from the breast and get fed by a traditional bottle, they may have difficulties returning back to feeding effectively from the breast.

Can Breast Refusal Lead to Babies Not Getting Enough Milk?

In order to get milk from the breast, babies must coordinate the movements of their tongue and jaws in a sucking motion that’s unique to breastfeeding. The baby does not need to do this with a bottle – it’s easier to get the milk that they want – so babies get used to not having to “work” for the milk and it creates a new behaviour pattern that can lead to less effective breastfeeding sessions.

This can create a cycle where the baby gets less milk and the mother’s body creates less supply. If you think your baby might not be getting enough milk from breastfeeding, read this article. Or ask a lactation consultant or healthcare professional for advice.

How Can Refusal of the Breast Affect My Baby?

It can lead your baby to breastfeed less often or less effectively, which in turn may diminish your milk supply. Remember the cycle of demand and supply – the more your baby breastfeeds, the more breastmilk your body will produce. And if the baby is demanding less and less milk because of ineffective feedings, your body will start to produce less and less.

If this cycle continues too far, you may have to give up breastfeeding – your supply will dry up unless you pump.

If your baby refuses the breast for any reason you should see a lactation consultant.

Refusing the breast can also cause frustration with breastfeeding so there is an emotional element. If you feel like your baby is no longer breastfeeding effectively, you might be tempted to stop breastfeeding sessions too early and give the baby a bottle instead.

But cutting off breastfeeding sessions too soon can deprive your baby of “hind milk” which is the high-fat, high-calorie milk produced at the end of feedings. This is particularly crucial for the baby’s growth.

How Can I Avoid Breast Refusal?

The best way to avoid refusal of the breast is to try to keep your baby exclusively on the breast for at least the first 6 to 8 weeks. Hopefully, for this length of time, you are off work and able to be home to bond with your baby and focus on breastfeeding exclusively.

This will get your own milk supply established and also give your baby time to learn how to latch on and how to suck effectively from the breast.

Beyond the first six to eight weeks, here are a few tips for dealing with possible avoidance of breastfeeding:

• Contact a Lactation Consultant and talk things through if you have any questions.
• Use the Calma feeding solution, which mimics the natural sucking behavior of breastfeeding. Teach the baby to feed from Calma in a different position, e.g. sitting the baby in a baby bouncer
• Try pumping to get your milk supply going before you put the baby to the breast – this will help your baby not have to work so hard to get a good flow of breastmilk going
• During breastfeeding sessions, try skin-to-skin contact – this helps the baby feel calm and reminds the baby to prefer the gentle touch of her mother

New Research by Medela on Babies’ Sucking Behaviour

Recently, Medela spearheaded some new research into the sucking behaviours of babies and made some game-changing discoveries that have answered some of these scientific questions, which will help mums make informed decisions about feeding their babies expressed breastmilk.

To understand how nipple confusion can occur, let’s review how baby gets breastmilk out of the breast.

First, baby forms a good latch to create suction in his mouth. When your baby’s tongue is at rest, the suction level in baby’s mouth is low and no breastmilk flows. When your baby lowers his tongue, the suction increases and breastmilk starts to flow. Your baby is always in control of the flow of the breastmilk and how much of it he will drink.

How Does Sucking Work?

Successful breastfeeding is a complex interplay between mother and baby. In order to understand and manage infant sucking issues, it is first important to establish an understanding of the anatomy and physiology of breastfeeding.

This video at the bottom of this web page shows how the tongue works when the baby is feeding during the “suck cycle.”

Basically, the magic is in how vacuum plays a key role in milk removal. When the baby’s tongue is up, vacuum is the minimum level, and then the vacuum starts to increase as the jaw lowers and the baby’s tongue and soft palate move down. Milk flows from the expanded ducts when the baby’s tongue is at its lowest and the vacuum is at its maximum power.

This is where the Calma feeding device is so unique: it recreates that vacuum experience. This might help to explain why the Calma feeding solution is a good way to avoid nipple confusion.

Nipple confusion can be frustrating, but it does not have to mean the end of your breastfeeding experience. If you use some of these tips and techniques – and try the Calma feeding solution for your next bottle-feeding – you will hopefully be able to reduce the chance of nipple confusion and keep up a healthy, effective breastfeeding routine for as long as you and your baby want to.

What are your thoughts on this? Have you experienced “nipple confusion” with your babies? How did you overcome it? Leave a comment and let us know, or join the discussion at the Medela Australia Facebook page.