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Thread: Baby won't nurse while awake?

  1. #1
    Join Date
    May 2017
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    BC, Canada
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    Default Baby won't nurse while awake?

    Has anyone experienced this? I've been feeling completely alone.
    My baby is 7 months old now. For most of their life they have refused to nurse while awake. They will only take a bottle. They even had some weight loss in the first couple of months due to my misinterpreting their refusal of the breast as not being hungry, when in fact they just wanted a bottle. However, unless they are full, once asleep I can usually latch them no problem and they will nurse until full.

    My partner and I are both on the spectrum... Could this be a sensory issue?

    I believe our troubles started on day one. I had a successful home water birth but was ambulance transferred to hospital a couple of hours later due to hemorrhage. Later that night they began to suspect babe had an infection. We ended up in the NICU where they were on IV antibiotics for 5 days. The first night a nurse came to me from the NICU to my bed in the birthing unit, where I had an IV and catheter and couldn't get up, and asked to give formula. I had just given birth and had been awake for probably 48 hours. I was alone as my partner had gone home to get some sleep. I said yes. There's no way I would have said yes under better circumstances.

    I'm really just looking for anyone who might have a similar experience, but any thoughts or suggestions are welcome. I've always imagined myself nursing into the toddler years but it is so hard to maintain my supply when babe is nursing less and less at night and I just feel like I've spent so much of their life hooked up to a pump so they can still have my milk.

  2. #2
    Join Date
    Jun 2009
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    Default Re: Baby won't nurse while awake?

    Hi and welcome. There are a few threads on here about babies not nursing when awake. Most of the time, the issues begin after a few months, not right after birth. But you may find information that helps you if you can find those threads. You may find those threads by searching terms like baby only nurses when asleep or baby will not nurse when awake etc. on the internet. I am not sure if there is a search function within the forum and cannot look now, but if I get a chance I will look later.

    So sensory issues particularly (obviously) oral aversions are one suspected cause of a baby not nursing when awake. This could include some innate sensory issue I assume, but if baby had any facial or oral trauma with feeding early on, this cause would be more clear. Also since for a baby, nursing involves so much more of the body, sometimes trauma or discomfort or tightness etc. in other parts of the body (neck, head, back, extremities) might cause baby to feel uncomfortable when nursing, causing an aversion. But as far as I know, no one really knows why this particular concern (nursing refusal while awake) happens. There are most likely many possible causes and several could be occurring at once.

    A fairly common cause or acerbation of this issue in bottle fed babies or partially bottle fed babies is parents being pressured to feed baby more than baby actually needs, either because baby temporarily really did need more to eat but the extra feedings continued past that point, or because the baby was being held to an unrealistic or too rigid growth expectation. Both scenarios are very common. So parents feed baby more anyway they can either feeding baby more overall and/or feeding baby more at a time or more often than baby prefers. When this happens, sometimes in desperation parents resort to feeding baby while asleep, which in turn leads to baby simply not being very hungry when awake, so it becomes a vicious cycle. In extreme cases baby is essentially force fed while asleep (or even when awake) and that could cause further aversion...such situations are not typically the parents fault, it is the fault of doctors that do not understand growth differences can be normal and also have little or any understanding of breastfeeding and how to approach feeding issues in a breastfeeding supportive way.

    General breast refusal is frequently caused or exacerbated by overfeeding with bottles or solids, again because baby is just not hungry enough when awake to make the effort to nurse. Especially if baby is or at one time was having nursing issues (trouble transferring enough milk, or the opposite, not able to control the flow so baby is getting too much milk at once) then the relative 'ease' of bottle flow compared to the breast or (with the latter issue) possibly slower (than a fast flowing breast) flow of bottles will also cause baby to learn to 'prefer' bottles and refuse to nurse.

    Bottle preference of one kind or another might not have been the root cause of the issue, but now that baby is 7 months old and (I assume) gaining normally(?) you might want to consider if those possible exacerbating factors might be part of the issue. At this age, it is entirely possible that early nursing problems that caused the issue in the first place have resolved, and baby is continuing to nurse only when asleep because baby is habituated to that pattern due to being bottle fed when awake.

    I am curious if you ever went to see a lactation consultant and what they found, if anything? Can you see someone now? If you can, I suggest call around, ideally you want someone well versed in nursing issues including breast refusal in older babies.

    When a nursing issue has dragged on this long, many parents understandably lose hope of solving the issue. It may interest you to know that in many cases, even serious breastfeeding issues can be and have been resolved in later baby hood or even toddlerhood. All kinds of issues, including total breast refusal or baby never nursing at all, have been resolved later on.
    Last edited by @llli*maddieb; October 15th, 2017 at 11:15 AM.

  3. #3
    Join Date
    May 2017
    Location
    BC, Canada
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    Default Re: Baby won't nurse while awake?

    This has been really helpful, thank you. So much of what you said makes sense with my experience.

    Firstly the NICU was very focused on weight gain and they kept insisting on formula top ups after nursing, especially in the first couple of days before my milk came in. The pediatrician even wanted to tube feed my (TERM!!) baby because their respiration rate was high. Thankfully the nurses didn't take that recommendation. Continuing after leaving the NICU I was still getting external pressure about weight gain from the midwifery collective. I really agree with you that there are problematic expectations out there in this regard.

    Then I ended up with oversupply (most likely due to pumping so much for fear of losing my supply because of the formula!), which I had suspected was part of the original problem too. It took a while to figure out what was wrong because I never had blocked ducts or mastitis. It was eventually diagnosed by my midwife. But babe had many instances of choking and spluttering at the breast in those first two months or so.

    As well, they've pretty much always had an aversion to being held in a lying down position. I am nearly certain this is not due to reflux. They have always slept fine on their back and were happy to lie on the floor on their back (and tummy) to play. I have always gotten the impression that it's just about wanting to look around and have the best view, and to stay awake.

    Baby has been gaining steadily since 8-10 weeks old and I believe was around the 16th percentile for weight at 6 months. (As an aside, my family doctor saw them for a well visit for the first time at 6 months and told me "less milk, more solids." I got the same feeling of pressure for more weight gain.)

    I have not seen a lactation consultant since we left the hospital 6 days PP. I am on social assistance so paying for one isn't an option, but I THINK I have access through my local public health. I will have to find out if I am still covered this long after birth.


    I SO appreciate all the info. It has been very encouraging. If you have any tips on where to go from here (in the mean time before I can hopefully see someone), it would be greatly appreciated. Currently babe makes a face and turns away from the breast when offered, and sometimes cries, whether hungry or not.

  4. #4
    Join Date
    Jun 2009
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    Default Re: Baby won't nurse while awake?

    Hi again.

    Interesting you are reporting early fast letdown/overproduction. If I recall the other threads on this correctly, this seems to be a reoccurring theme when there is this type of breast refusal (which I have just decided I am going to unofficially name "awake refusal.") I also know that some LCs have mused that there is way more OP than there used to be, probably due to the pressure on mothers to pump whether it is needed or not, or to pump more than is needed when it IS needed. So could the possible increase in OP that some LCs suspect also be leading to an increase in "awake refusal"? just something to think about.

    If OP/fast letdown was a contributor to the problem, I assume that is no longer occurring as it would be unusual past the first few months for mom to continue to overproduce. If it is still happening, there are a few different methods for slowing flow or helping baby handle fast flow. Let me know if you need info on that.

    If baby dislikes feeding laying down- and this would be common, actually- there are many nursing positions to try where baby is sitting up, maybe leaning on mom while mom leans back slightly so baby is tilted up, etc. I had OP and I practically had to have one baby in a completely upright position to nurse when the flow was fast. He was really big and I sat on the couch and let his legs hang down between my legs and held him upright to nurse. Later he straddled one of my legs. There are so many positions to try and the older baby is, usually the easier experimenting with multiple positions for both mom and baby gets.

    For understanding and navigating the weight gain pressure, I strongly suggest the excellent book My Child Won't Eat by Carlos Gonzalez. It is NOT about making perfectly healthy children or babies eat more, it is about how doing that is almost never needed. Many parents have found wonderful reassurance and support from this book!

    Yes it is possible the "less milk, more solids" doctor was pressing you on perceived slow gain, but just fyi, I got the SAME advice with my very rapidly gaining son (same one I talked about above) but that was because at 9 months he still refused all solids. It was still terrible advice no matter. Ironically, if a baby actually took in more solids and less milk, this would more likely lead to slower gain, as most foods people feed 6 month olds (and indeed most healthy foods overall) are lower in calories than human milk or formula. On the other hand, you might want to look at how much milk in bottles overall baby is getting and also how much at a time, as again if this is too high, it might be contributing to breast refusal.

    Kellymom has what I think is the best overall article for gently encouraging the refusing baby to nurse. Try to not get too frustrated. Sometimes many, many things have to be tried many, many times. https://kellymom.com/ages/newborn/nb...ack-to-breast/

    If you can see an IBCLC do it, I also strongly suggest free in person peer support such as LLL groups or other breastfeeding support groups. One thing I saw happen over and over again at LLL meetings was reluctant nursers want to nurse when they saw other babies nursing. Even just hanging out with other breastfeeding moms who are comfortable nursing in front of others might help.
    Last edited by @llli*maddieb; October 15th, 2017 at 09:18 PM.

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