Fussy feeders: Why your baby might be unsettled while breastfeeding
Simone Casey explains what your bub is trying to say.
By Peter Malik
December 14 2018
There’s nothing more frustrating than when you think your baby’s hungry, yet she won’t feed. You put her to the breast, but she screws up her little face and beats you with her little fists as if to say, ‘No, mummy, I don’t want it!’
Be reassured, says Aimee Carroll-Kierce, a breastfeeding counsellor for the Australian Breastfeeding Association (ABA) from Ballarat, Victoria, most babies fuss at some stage, and some more than others.
“The list and reasons can be endless, common and completely normal but sometimes more complex than we first think,” she says.
When your baby fusses at the breast, “some mums immediately blame themselves or think they are doing something wrong. I hear them say that my baby doesn’t like my milk, or my breasts or breastfeeding.
My breasts are too big, too small, too full, too empty. I watch mums trying to feed their baby and they are doing everything right. Their baby is just learning and needs some time,” says Aimee. And there is support out there.
“There are a myriad of health professionals who can help. It can be very tricky to choose the best person to talk to. A good start is an ABA counsellor, who may suggest mums talk to their GP, a lactation consultant or maternal child health nurse and just take it from there. Trust your parenting instincts and find someone who really listens to your concerns,” adds Aimee.
In the meantime, if your baby is fussy, here are a few ideas to explore:
FRUSTRATED WITH LATCHING
Your tiny newborn already has inbuilt reflexes, but has never actually breastfed before, so give her time as you learn together.
“Some babies fuss at the start of the feed trying to latch on,” says Aimee.
“When this happens, I imagine they’re saying, ‘It’s too hard, I’m not sure how to open my mouth like I did last time, sorry mummy, can you take a deep breath and help me learn how to do the big wide mouth?’” Stripping off your top and your baby’s clothes can help enormously.
“Sometimes babies need mum to lie back and just cuddle skin to skin so the baby can creep over and self-attach to the breast,” says Aimee, “and sometimes babies need mums to shape and position their breasts to help them get a good seal and stimulation to suck.”
When positioning your baby prior to attachment, concentrate on ‘chest to chest, chin to breast’ to help bub’s reflexes to kick in – when your baby feels the breast on her chin, it triggers the ‘rooting reflex’ so she knows where the nipple is.
If bub has had top-ups early on, whether it’s in a bottle, finger feeding with a syringe, or in a cup, she may get used to her hunger being satisfied very quickly. Some babies are impatient even if they have never had a top-up.
“If your baby fusses after attaching well and comes off fussing, this may be because the let-down is too slow,” says Aimee.
You can usually tell this is happening if bub isn’t on long enough for you to hear a swallow. “Sometimes mums need to hand express before the feed to help the milk flow faster, or even hand express a little bit of milk into their mouth to remind them where the milk comes from,” she adds.
Placing a heated wheat bag on the breasts prior to breastfeeding may help your let-down – also known as the milk ejection reflex – trigger more quickly.
If you have a lot of milk with a strong let-down, you’ll know it. Your baby may gulp and gag during the feed or come on and off a lot with milk spraying everywhere. Spitting up is common, and if you don’t have a towel at the ready, you can both end up wearing it. “If fast flow is a problem, firstly check your attachment,” says Sharon Best, a midwife and lactation consultant from South Gippsland, Victoria.
“Try attaching your baby then lie back, often on a few pillows in bed or on the couch so the milk doesn’t pour down your baby’s throat.”
Another strategy is to wait until the spray of milk is about to happen (many women feel a tingling sensation), then take your littlie off the breast for a few moments and catch the milk in a towel.
“Some women prefer to express before attaching their baby; by hand is best so you can just express to finish the first let-down and put baby back on when the squirting has finished,” adds Sharon. Be careful when attempting this, as too much expressing may increase supply or worsen an oversupply.
BUILD-UP OF GAS OR WIND
Breastfed babies don’t seem to take in as much air during feeds as bottle-fed babies, but some are still bothered by wind. Again, Sharon suggests checking the attachment to make sure your bub has a good seal on the breast and isn’t sucking in excess air. “Try to watch your baby and let her finish one side before starting the next, with a short attempt at burping between sides and at the end of feeds,” she says. To burp bubs, you can place her over your shoulder or sit her up on your lap with gentle pressure on her belly.
“Many people find it is satisfying to hear a burp after a feed, but if you don’t hear a burp or your baby goes to sleep, don’t stress, just try holding your baby upright for a while after the feed.” Walking around and regularly patting her back or bottom usually calms a baby fussing from wind. If she still won’t calm down, you can always offer the same breast again as a little ‘top-up’ or comfort feed.
Fussiness on the breast can be related to bubs reaching certain milestones. “Just when you think you’ve got something sorted out and you don’t have to worry about it anymore, everything goes haywire! Some days or weeks things run smoothly, and then other weeks they don’t, and it’s these weeks that we’re referring to – ‘the wonder weeks’,” says Carla Browne, a midwife and lactation consultant from Queensland.
If baby is fussy, Carla suggests trying to feed in a quiet area of the house. “Sometimes it means cuddling baby whilst she fusses around and then putting baby back to the breast when almost asleep to finish off the feed. Sometimes it means feeding whilst standing up and rocking at the same time. Try whatever works: for one feed it’ll work, and the next it won’t.”
Sharon adds that wonder weeks, also known as growth spurts, may happen at any time, often around two to three weeks, six to eight weeks, three months and six months, but “it’s more important to watch your baby and respond to her cues than look at the clock or calendar,” she says.
“Research has suggested that babies don’t necessarily take more milk or grow more at these times, even though they may appear hungrier by wanting to feed or suck more,” she says.
Instead, they may need more emotional support responding to their growing awareness of the world around them.
If your baby vomits a lot of milk after and between breastfeeds and cries a lot, she may have reflux. There are lots of variations of this condition. “A baby spitting up milk but not bothered by it is often referred to as a ‘happy chucker’ and thisis not reflux,” says Joy Anderson, an accredited practising dietitian from Western Australia with a special interest in infant feeding. Then there are babies with ‘silent reflux’, who are unsettled but don’t spit up
much, but cry because of acidic stomach contents rising up in their gullet. “Further confusing things is the fact that all babies have weak muscles at the top of the stomach,” says Joy, “so it’s often hard to know when normal ends and significant ‘reflux’ starts.”
At the normal end of the scale, babies spit up and cry but are otherwise happy and healthy. At the other end is a baby who may not even keep enough milk down to grow normally and is miserable, wakeful and crying.
“Only very few babies fit the latter category and need medical attention,” adds Joy.
To relieve symptoms of reflux, small frequent breastfeeds can often help. Refluxy babies are often happier sleeping in a sling or carrier during the day or on an elevated mattress. “As long as the baby is gaining weight normally and has periods when she is happy and settled, there is no need to worry,” says Joy. “She will soon grow out of it. In the meantime, there may be some extra laundry to do!”
ALLERGY AND INTOLERANCE
If a bub is sensitive to foods in her mum’s diet, Joy says there may be a combination of excessive crying, reflux-like symptoms, abdominal pain, unusual bowel motions (sometimes with blood), wakefulness and other irritating symptoms like rashes.
“These can all make the baby very unsettled and she may ask for frequent feeds for comfort. Some may feed frequently and have lots of wet and soiled nappies, yet not gain weight well.
The baby’s irritated digestive system might not absorb the nutrients as well as normal,” says Joy. In these cases, seek professional help from a lactation consultant or dietitian with a special interest in food sensitivity in babies.
“As an initial trial, some mothers are advised to eliminate dairy and soy products from their diet for two to three weeks, as cows’ milk protein and soy are the most common culprits for food sensitivity in babies,” says Joy.
It is also important to seek help from a dietitian to ensure your diet remains balanced and you avoid mistakes.
It can be tempting to blame breastfeeding for fussy behaviour, but all babies, no matter how they are fed, get antsy from time to time. Aimee suggests going back to basics: cuddle your baby skin to skin; take a bath together; go for a walk or drive; grab your sling and dance; mimic the sounds of the womb – “Shhhhh, shhhhh!”; pop her back on the breast for a top-up.
“Your baby’s cry has been designed just for you, to send a message to your brain to respond to your baby’s cues and to make milk especially designed for your baby, to meet her every nutritional need for the first six months,” says Aimee. And know that even if today wasn’t great, tomorrow could be.