A baby who refuses to breastfeed and is not in the process of being weaned, is said to be on a “breastfeeding strike”. It is your baby’s way of telling you that something is wrong. It will take a little investigative work to identify the problem.

What is the most likely cause?

Some of the most common reasons for breast refusal include:

• Your baby is not latching on properly and cannot get a good enough mouthful of breast to feed effectively. Get help from a breastfeeding counsellor or infant feeding specialist to improve the situation.

• Mouth pain from teething, a cold sore or an infection (such as thrush).

• Your baby reacting to your shout of pain when she bites your breast.

• Your baby has an ear infection, which causes pressure or pain while breastfeeding.

• A cold or stuffy nose, which makes breathing difficult while breastfeeding.

• Supplementing with too many bottles of formula, resulting in reduced milk supply.

• Regular distractions, noise or interruptions while breastfeeding.

• Repeatedly letting your baby cry when she wants to feed.

• A major disruption in your baby’s routine, such as moving house or you returning to work.

• An unusually long separation from you.

Other less common causes include food or breast milk sensitivity or allergy, a cream or perfumed product applied on or near your breasts or a change in the taste of your milk. This could be caused by a drug, certain foods, the return of your periods, or if you become pregnant again while breastfeeding.

What can I do?

A nursing strike can challenge even the most dedicated breastfeeding mother. It can be a shocking experience for a baby to refuse the breast after some months of problem-free breastfeeding. By this time most mothers will have assumed that any difficulties were behind them. Whilst a mother is racking her brains to discover the reason for the strike, she may even (irrationally) feel that her baby doesn’t like her any more.

Although breast refusal can be a worrying and upsetting experience, it can be overcome, with patience and support.

While still encouraging your baby to breastfeed, you will need to express your milk by hand or pump every few hours (about as often as your baby had been breastfeeding). This will help prevent engorgement or mastitis and give your baby the milk that she needs.

Here are some ways to deal with it:

• Try offering the breast when your baby is asleep or very sleepy. Many babies who refuse to feed when they’re awake will do so when they are sleepy.

• Visit your doctor to rule out any medical causes (such as an ear infection or thrush).

• Try different feeding positions.

• Breastfeed on the move. Some babies are more likely to feed when you rock or walk them than when you’re sitting or standing still.

• Find a quiet room to feed in. It’s common for a six- to nine-month-old to go on a nursing strike as a result of his newfound discovery of the world. Babies of this age are easily distracted and often prefer to “snack” at the breast instead of settling down for a meal. Try using a dimly lit, quiet room, away from the sound of the radio or television.

• Give your baby lots of skin-to-skin contact (try breastfeeding without a shirt on or in a warm bath). A sling or carrier can help keep your baby close to you between feeding attempts.

It is easy to jump to the conclusion that a baby who doesn’t want to breastfeed is weaning himself. But it is unlikely that a baby under a year old who has been successfully breastfeeding is ready to give up.

Will it affect my baby?

Breast refusal can be upsetting for both mother and baby. Try to keep other elements of your baby’s routine as normal as possible during this time. Give her extra attention and physical contact. If you are worried that your baby isn’t getting enough food, keep track of her wet nappies. At least five to six wet disposable nappies per day – or six to eight non-disposables – indicate she is receiving enough fluid (disposable nappies are so absorbent that you may not notice every time she wees). Don’t hesitate to call the doctor if you are worried.

Can I still breastfeed?

Absolutely. It’s important to keep trying to breastfeed your baby. With patience and persistence you’ll get back on course.

• The letdown reflex

You may experience fleeting pain in your breasts when your milk “lets down”. The letdown reflex, also known as the milk ejection reflex, is caused by the action of the hormone, oxytocin. Oxytocin stimulates the muscles of the breast to squeeze out milk. In the first few days after the birth, the hormone is released in response to your baby suckling. Later, anything that makes you think about your baby, or feeding your baby, can trigger this hormone release. Some mothers find that their breasts leak when this happens.

The letdown reflex feels different to different mothers. Some feel a slight tingling, some feel immense amounts of pressure and slight pain or discomfort and others feel nothing at all.

Most mothers are unaware of the letdown reflex in the early days of breastfeeding, although they may be aware of “afterpains” – the pains experienced after birth as their womb contracts down to its pre-pregnancy size – which is caused by the same hormone. They may be more aware of the letdown when their baby is a few weeks old. As time goes by and breastfeeding becomes established, most mothers become less and less aware of it.

• Producing too much milk

Some women who produce an abundance of milk have painful twinges deep in the breast after feeds. Provided your baby latches on well each time he feeds, your milk supply should quickly step down to match your baby’s needs exactly.

• Thrush

If yeast enters the milk ducts, (as a result of thrush) it can make breastfeeding painful. Unlike letdown pain, which is short-lived, thrush pain persists throughout the feed and is usually even worse after feeds. However, thrush in the milk ducts is uncommon – read our article on thrush for more information.

• Engorgement

Engorgement can over-distend the milk-producing cells of the breast, making letdown difficult and sometimes painful.

• Mastitis or blocked ducts

Mastitis or blocked ducts can cause an area of the breast to become red, sore, hard and inflamed.

Other possible causes of breast pain are:

• poor breast pump usage. See our article on expressing for tips on how to do it.

• a badly-fitting bra. The side seams should be on your ribs, not your breast, and the cups should not compress your breasts. Go to a department store or old-fashioned lingerie shop and ask an assistant to measure you properly.

• premenstrual pain. If your periods have started again, you may experience premenstrual pain. This pain should go once your period begins and stays away for the next week or two. The pain then starts to build up again after ovulation. Most women will recognise this cyclical pattern if their breast pain is related to their menstrual cycle.

• fibrocystic breast pain. Some women have a condition called fibrocystic breast disease – lots of lumpy areas in their breasts which can fill with fluid and feel tender and painful. This is a benign (harmless) condition but if you suspect you have it, it’s important to see your doctor so that other causes can be ruled out.

What can I do?

If you learnt breathing or other relaxation techniques during your antenatal classes, try using them as you breastfeed. They may help you cope with discomfort during letdown. If your breasts are engorged, your baby may not be able to latch on well enough to remove the milk effectively. You may need to start off with gentle hand expressing or pumping until your baby is able to draw your breast in sufficiently.

If your pain is caused by excess milk, it may be difficult to latch your baby well to your over-full breast. When your baby starts to suckle, and triggers the strong letdown, he may come off coughing and spluttering. Try this technique: put your baby to your breast as usual. When you feel your milk first let down, gently break the suction and allow the initial spurt to spray into a towel. Let your baby latch on again, better, when the flow slows down a bit. The more often the baby latches on well, the more quickly your supply will settle down and you should be more comfortable.

So enjoy this period: once she’s mobile, travel becomes a far greater challenge.

Health and safety tips

• If travelling by air, feed your baby on take-off and landing to ease ear pain.

• Bring nappy rash cream, bags for dirty nappies, enough nappies for the trip and infant paracetamol for relieving pain and fever. You may also want to bring a colic treatment (ask your pharmacist to recommend one), saline nose drops for stuffy noses and teething gel if your baby is teething.

• Bring hats and sunscreen (with sun protection factor 15 or higher) for your baby. Babies under six months should be kept well out of the sun, and babies between six months and a year should have only very limited exposure, especially between 11am and 3pm on hot days.

• Get removable window shades for car windows to shield your baby’s skin and eyes from the sun.

• If travelling by car, babies should always travel in a rear-facing car seat, preferably in the back seat of the car. Never put your baby’s car seat in a front seat with a passenger air bag. Spend time before you leave to make sure the car seat is installed properly and that the belts on the car seat are threaded correctly. Make sure the harness fits your baby snugly and securely.

Food and comfort

• If you aren’t breastfeeding, remember to bring formula and add cooled boiled water as needed. You can buy convenient travel-sized packs of ready-made formula at most chemist shops. You may want to bring tins, jars and packets of baby food, but unless you’re travelling somewhere very exotic, baby food should be available at your holiday destination, too.

• Bring a plastic bib for your baby. They’re invaluable for containing pureed carrot and preventing several changes of clothing a day.

• Bring a baby blanket so you can stop in a park to let your baby have a kick or a nap.

• If your baby sleeps in a cot, reserve one when you make your room reservation or you may be out of luck when you arrive. Alternatively, bring along your own travel cot.

Entertaining your baby

Bring a bag containing a few of your baby’s favourite toys, plus a couple of new ones. Possibilities include anything shiny, babyproof mirrors, rattles, musical toys, soft animals, pop-up toys, plastic keys or teething rings.

Travel gear

A few well-chosen pieces of travel gear will help to smooth your journey and explore once you’ve arrived. For young babies, a complete travel system takes some of the hassle out of getting in and out of cars and airplanes. A lightweight buggy you can stash in your car boot or a plane’s overhead lockers makes sense for babies who can sit up (you can also drop off your buggy at the plane steps and have it waiting for you on arrival). For smaller babies a baby carrier may be useful. If you’re travelling somewhere hot, a baby sun pod is another great investment – the perfect way to keep your baby shielded from the sun’s harmful rays.