The Baby Who Doesn’t Nurse

THE BABY WHO DOESN’T NURSE

Some babies don’t latch on as newborns.  Some may have started out nursing and then stopped.  Or maybe they never started. We’ll look at possible causes and solutions for each of these situations.
If your baby is past the newborn stage, please skip to the section on Getting an Older Baby Back to the Breast below.
You may also find our resources on nursing strikes helpful.

THE NEWBORN WHO DOESN’T NURSE

All mammals nurse after birth, without any special instructions, unless something interferes.  If a newborn “won’t” nurse, it’s because the baby can’t nurse for some reason.  Newborns may be unable to nurse because of:

•     Prematurity or immaturity.  Babies as early as 28 weeks may be able to nurse, but often it takes some weeks for them to latch or to nurse effectively.  Time, patience, gentleness, and togetherness are your friends.
•     Birth and surgical medications.  Some drugs take days or weeks to leave a newborn’s body.  Again, time, patience, gentleness, and togetherness.
•     Physical and medical issues.  While you and your health care team sort things out, remember time, patience, gentleness, and togetherness.
•     Knowing too little… or knowing too much.  Breastfeeding helpers have made many mistakes over the years, always with the best of intentions but not always with the best of results.  Sometimes it helps to take a step back, and remember that our bodies have adapted to feed our babies. 

Find local LLL support here.

Whatever the reason for your issues, you need to 1) keep your baby fed, 3) support and build your milk production, and 3) learn together.  You can do all these most easily if you keep your baby with you as much as you can, especially on your body and front to front. Have your bare skins together (skin-to-skin) as much as you can.

Keeping your baby fed

Ask your health care team to show you how to hand express your colostrum.  You may find that you can express the most colostrum in the first several hours after birth, when newborns typically have a long breastfeed. You will probably find hand-expressing directly onto a spoon the most effective and efficient way to go (cafeteria or takeaway spoons work well.) If you have a helper, they can tip the spoon into your baby’s mouth or wipe the droplets onto the tongue while you hand express into a second spoon.  You can also express directly into a syringe which you can get from a pharmacy or your healthcare provider.

Mothers and babies typically fall into a deep and peaceful sleep for more than an hour after their first nursing.  Even if your baby didn’t nurse, keep cuddling together, skin-to-skin, which allows your baby easy access to your breast. 

Supporting your increasing milk production

Expect your baby to want to feed at least every hour or two on the first day.  Keep clean spoons handy and express your milk every hour or so, to begin building your milk production and to avoid breast problems. 

In the first few days, hand expression is usually much more effective than pumping.  Colostrum is thick, sticky, and produced in very small amounts – often too small to cover the bottom of a container, so much of it simply sticks to the pump parts.  If you choose to pump, wipe off all the droplets you can with a clean finger, and give them to your baby. 

It’s important that you take out of your breast more colostrum and milk than your baby takes in.  Your baby may be eating a bit less because of this unaccustomed way of feeding, and you want to set up normal milk production.  Your milk production will increase automatically over the first few days, and frequent expression helps that happen faster, more smoothly, more fully, and with fewer problems. 

As your thick, small-quantity, sticky colostrum changes to thin, larger-quantity liquid milk, your baby will probably take more at each meal, and meals will probably be more widely spaced.  A good quality electric breast pump may become an effective option at that point. Most of the world uses only hand expression, so if you prefer it, it’s a great technique. Whatever method you use, at this stage express milk at least eight times each day – 10 or more if you can.  It’s much easier to cut back later than it is to boost your production if it’s set too low at the start. For more information on expressing milk after the early days, see our posts here:
Hand expressing
Pumping

Learning together

Here’s some of what we know babies are looking for when they want to nurse. 

•         They expect to have their whole front supported.  Some people call it belly to belly or chest to chest, or “baby doing a chest plant”.  Have both your baby’s nipples, both elbows, navel, and the insides of both knees touching you, head turned, and cheek against breast.
•         They expect their head higher than their hips.  Babies can eat in many positions, but just like adults, they tend to prefer a more upright position than a totally sideways one. 
•         They expect to have their feet supported.  No one feels secure with their feet dangling.  Even babies tend to feel more “grounded” when their feet touch something.  Maybe that’s why a mother, leaning back with her baby on her chest, tends to play with the baby’s feet.
•         They expect to feel their way to where they’re going.  Babies “lead with their face,” often turning their head side to side, feeling their way cheek by cheek.  They reach with their hands too, maybe holding Mama’s nipple when they find it, like little mountain climbers.
•         They expect to “come from below.”  Babies can push themselves forward, but they can’t back up.  If they “overshoot,” it can help to move them back a little so they can push forward again.
•         They expect their mouth to “come from below” too.  Babies tend to tip their head back to take the breast, so that they take in not just the nipple but the part of the breast that their tongue lies against.  They’re not so interested in the part of the breast near their nose, so “centering the nipple in the baby’s mouth” doesn’t make sense to them. 
•         They don’t expect to be told what to do.  Too often, we get caught up in holds, and positions, and trapping an arm or leg, and curling their lip out for them, as if they didn’t know what they were doing.  It makes more sense to give them time to sort things out for themselves. 

The easiest way to meet their expectations is to lean back in a propped-up hospital bed or in a similar position at home, so that your chest-planted baby is held on you by gravity.  Be a cheerleader, not an instructor. Help if you like, but follow instead of leading. A skilled breastfeeding helper can give you on-the-spot pointers. Some other things that may help:

•         Offer to nurse when your baby is asleep or very sleepy, such as during the night or while napping.  Babies can nurse without opening their eyes and even without waking up completely. Sometimes they do better half-asleep than fully awake.
•         Dim the lights and practice in a place that’s free from distractions.
•         Offer to nurse when your baby is already partly full, not frantic.  If your baby falls asleep at your breast without nursing, it still builds good memories for both of you.
•         Use lavish praise when you practice together, and be business-like with other ways of feeding:  “This spoon/eyedropper/bottle feeds your tummy, but being at my breast feeds your soul.”
•         Relax with your baby in different positions – both of you lying on your side, your nipple about level with your baby’s eye; sitting up, if you’re large-breasted, your baby in your lap; leaning back, your baby’s foot resting on your thigh; your baby more sideways or more vertical.  Look for positions that keep as much of your baby’s front against you as you can. Or try something that ignores everyone’s suggestions. There are no rules.
•         Consider sleeping together, once you’re home, with both of you topless.  Many babies have started nursing at night “accidentally”, when the pressure is off and the breast is right there waiting.   Before you bedshare, be sure to read our post on Safe Sleep so you know how to make your bed as safe as possible.
•         Provide plenty of skin contact.  Some babies latch on by themselves if you lean back and relax in a warm bath together, baby on your chest.
•         Use a baby sling or carrier to keep your baby close between feedings.
•         Keep the process happy.  Play at nursing rather than working at nursing.  You don’t have to try at every feeding, or even every day.  Everything will come together in time, especially if you have a skilled, gentle, hands-off helper.
•         Be patient.  Love your baby.

You’ll find much more information on expressing milk, supplementing, the early days in general, and finding a good helper in The Womanly Art of Breastfeeding, 8th edition (older editions are not as thorough or up-to-date).

Getting an older baby back to the breast

There are a number of reasons why an older baby may have stopped feeding at the breast, or may never have fed at the breast. They include being adopted, being unable to nurse for medical reasons such as having a cleft palate, mother and/ or baby having experienced a long period of illness, or maybe mother and baby have had a long period of separation.

Sometimes a mother may regret her decision to stop breastfeeding and decide to relactate. You can find information about relactating here.

If your baby is beyond the early months, has been breastfeeding happily and stops suddenly this may be a nursing strike, you can read more about nursing strikes here.

If your baby has not been breastfeeding, ever or for a sustained period, it may take time to coax him to feed at your breast regardless of whether you have a good milk supply or not. Forcing your baby to your breast is extremely unlikely to work, it is more likely to cause your baby stress, and may result in him forming an aversion to breastfeeding. As your baby gets better at nursing and is able to get more milk at your breast, he will grow to trust that breastfeeding works and will have more patience when latching on.

Lots of skin-to-skin contact (baby in only a diaper against your bare chest) can help your baby nurse better and even gain weight faster. Keep your baby with you as much as possible, and give him lots of opportunities to nurse, don’t worry if you’re not successful at first, keep offering.

If you allow your baby to fall asleep, skin-to-skin, at your chest, you can catch his earliest hunger cues when he wakes again. If  your baby moves toward your breast and then falls asleep before even mouthing your nipple, or after sucking a few times, then these are positive first steps, not failures.

Carry your baby close to you (a sling or other baby carrier can help with this). “Wear,” carry, hold and cuddle your baby as much as possible; carry your baby on your hip while doing other things, play with your baby, and give him lots of focused attention.

Sleep near your baby. If he sleeps with you, you’ll get more skin-to-skin contact, plus give him more access to your breast. See our post on sleep. If your  baby is not in the same bed, have his cot/bed beside your bed or in the same room so that you can catch his early feeding cues, breastfeed easier at night, and get more sleep.

Offer your breast when he is not hungry. Try giving him most of his feeding by bottle and then switching over to breastfeeding.

If he is used to a bottle, and completely refusing your breast, he may be willing to breastfeed with a nipple shield.

The following approach works for some families. You will need an at breast, or chest, supplementer link to do this.

• Only mom feeds the baby (both solids and bottles).
• Baby is always held by mom when being fed.
• Don’t allow baby to hold his own bottle. If baby is used to holding his own bottle you may need to gradually get him used to you holding it. Put a sock over it so that it looks more like a piece of clothing than a bottle.
• When baby is comfortable with mom holding the bottle, and being held by mom while feeding you are ready to try the at breast supplementer.
• The first step is to thread the tube of the supplementer through the nipple of the bottle he usually takes, and feed him that. It may contain your expressed milk or a supplement.
• Next, move the bottle nipple over your own nipple.
• Once he is comfortable sucking on the nipple with the at breast supplementer over your nipple you are ready to try and move him to your breast. Toward the end of the feeding try and switch him to your breast.
• You may try to feed at first with the supplementer (even if you have a good supply) as baby may like the faster flow he is used to getting from the bottle. You can eventually wean your baby off the supplementer.
• Even if you don’t manage to wean your baby off the supplementer it is a lovely way to share a nurturing at-breast relationship with your baby.
• Read more about at-breast supplementers here.

Revised January 2020