“Other” Reasons Why Babies are Reluctant to Breastfeed

I previously wrote about why babies may be reluctant to breastfeed in mostly normal newborn situations. With a little help, those issues usually resolve fairly quickly. Today I’ll look at more pathologic reasons, or reasons attributed to variations of normal that may persist after the newborn period.

1. Unidentified early cues; frustration

Sometimes, the parents simply aren’t aware of the infant’s early hunger cues. Hence, they ignore them.

As a result, the infant can become so frustrated that when the breast is offered, they’re already too exhausted from crying and then become reluctant to breastfeed.

We think of this as happening in the newborn period, but subtle signs of hunger can go unnoticed for months. I distinctly remember one 4-month old who still had unidentified early cues and, consequently, failure to thrive.

2. Anatomical variations: maternal

Anatomical variations in the breast can cause the infant to be reluctant to breastfeed. This can include:

• large breasts, large areolar, large nipples
• short, flat, or long nipples
• inverted nipples or dimpled nipples.

None of these are a deal-breaker for breastfeeding. But all of them can be explanations for breast refusal.

3. Anatomical variations: infant

Any type of anatomical variation can cause an infant to be reluctant to breastfeed. These include such conditions as:

• small mouth
• tight frenulum
• high-arched palate
• flat philtrum

4. Infant structural pathology

Whereas the previous list pertained to non-pathological variations in normal pathology, here, I’m talking about situations where the anatomy is not normal. These are almost always congenital conditions such as:

• torticollis
• fractured clavicle
• facial palsy
• more

We don’t have proof of this. But just think about it.

If your bony structure was traumatized, or if your neuromuscular abilities were affected during the process, you might not want to activate your feeding apparatus, right?

I’d wager that these are easily explainable reasons for why babies are reluctant to breastfeed.

5. Pain: infant

We might never know how or if a baby has pain. Yet, as I used to say when working as a nurse in labor/delivery: “That was a lot of thrashing and banging to get into this world.” Don’t you think that would be painful?”

Circumcision is another example of pain. (Don’t get me going!) 

We can’t ask a baby to rate pain perception on a scale of 1-10, right? But we can probably assume that substantial birth injuries — especially those for which the pain is significant or sustained (e.g., torticollis, fractured clavicle etc.) — are very painful for a long time.

And, we can only imagine that lesser injuries could be painful, right? For example, a hematoma can persist for months.

If they are in pain, do we need to think of any other reasons why babies are reluctant breastfeed? It just makes sense. 

6. Pain: maternal

With about one-third of the births in the U.S. occurring through a cesarean  surgery, it’s a fair bet that these mothers are in pain thereafter.

And, other than having taken care of hundreds of these women, why would I believe this? Well, because of a dirty little fact that is rarely discussed: It’s major abdominal surgery!

Worse still, mothers are sometimes afraid to accept adequate pharmaceutical pain relief because they hear that the medication “goes through the milk.”

It’s pretty darned hard to have a milk ejection reflex when you’re in pain.

The mother and the baby are one unit. If mothers are in pain, I believe that’s a very likely reason why babies are reluctant to breastfeed.

7. Maternal pathology

To my knowledge, we have only case studies to show that pathology is a possible source of breast refusal. Yet, these cases are compelling.

Two case studies show that a baby will refuse a breast because the mother has cancer. This was demonstrated in 1966 seminal study. It was published in the prestigious journal, Cancer. 

Since then, other cases have been reported in reputable, peer-reviewed journals. See the 1995 report from Hadary and colleagues, and the 1996 report from Saber and colleagues.  

More recently, 2019, Joanne Carr and her son Dougie were an example of breast refusal and a subsequent diagnosis of cancer. And, I’ve had a client who had a very similar situation. Meaning, I’m very sure this phenomenon is real.

Try not to freak out about this. If your baby is refusing your breast, it’s highly unlikely to be as ominous as cancer. So, as usual, anything in my blog or my podcast is only information, not medical or healthcare advice. Before you panic, seek professional advice.

8. Older infant nursing Strike

Older infants often refuse the breast as they are staging a nursing strike. I’ve described nursing strikes in an earlier post.

How have you handled a nursing strike or other reasons a baby may be reluctant to breastfeed? Share your thought in the comments below!