Dealing with breast refusal
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Some babies simply refuse to breastfeed and arch their backs, scream and fight with their hands as soon as they get near the nipple.

This would obviously make the mother anxious and concerned. Causes for this include:
•    A slow let-down (milk ejection) reflex, which frustrates the baby
•    A forceful let-down, which may choke the baby
•    An incorrect feeding position – it could be that the head is flexed forward and the nose is pressed into the breast tissue.

The let-down reflex
•    Apply warmth in the form of a wheat bag or face cloth to stimulate the reflex.
•    Express a little milk before attempting to feed, to get the milk flowing.
•    If the let-down reflex is very strong, attempt breastfeeding while lying back a little to slow the flow of milk down, or press the nipple inward toward the chest with palm of the hand to slow the flow down.
•    If the situation is desperate and the baby has not fed for 4-6 hours, express some milk that can be given in a feeding cup.

Managing breast refusal
Positioning the baby
If it appears that the position is incorrect, do the following:
•    Tilt the baby's head slightly backward, to free the nose from the breast.
•    Check that the nose is clear as it may be clogged with mucus. If it is clogged, put a drop of saline nasal drops in each nostril and clear with a nose cleaner.
•    If it appears that the baby does not 'like' a particular breast, allow it to feed on the easy side first – it might be that the mother feels clumsy with a particular hand.

Reduce the mother's anxiety
•    The mother should take deep breaths to help her to stay calm. Sometimes this will be hard to do and she may feel frightened or angry at the baby.
•    If this happens, ask another caring adult to help her regain her composure.
•    Calm the baby down and do not attempt breastfeeding while the baby is screaming.

Suggestions to calm the baby
•    Burp the baby by holding it in an upright position; then the wind or gas should come up easily.
•    Hold and comfort it.
•    Check to see if the nappy needs changing.
•    Cuddle it quietly by trying different positions such as upright or on its tummy.
•    Hold the baby close.
•    Swaddle it in a wrap or blanket so it is warm and secure.
•    Play calming music or hum gently in a low note.
•    Walk the baby up and down rhythmically.
•    Massage or stroke it while in a warm bath.
•    Try KMC when both mother and baby are calm again so that the baby can see, feel and smell its mother.

Re-latching the baby
•    Obtain help from a breastfeeding consultant.
•    Try and feed the baby while it is still half-asleep.
•    Allow the baby to suck on the little finger and then try and shift it onto the breast.
•    Experiment with different feeding positions.
•    Express a few drops of milk onto the nipple to tempt the baby.
•    Express milk and feed the baby from a cup.

  This article is an extract from The pocket guide to breastfeeding by Diana du Plessis.

Did you have any problems breastfeeding your baby? How did you solve them?

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