Question: My 4 1/2 month old daughter has started to pull away and yank on my nipples when nursing. As a result my nipples are getting sore. I used to enjoy nursing and would like to continue. What can I do to break her of this bad habit?
Answer: There are a number of reasons for babies to become fussy at the breast after they have passed the newborn period (the first six weeks or so).
One is that they become much more social during this time. A newborn infant will blissfully nurse for an hour or more, totally oblivious to her surroundings. There could be a major earthquake, and a newborn would nurse right through it, because newborns love to suckle.
Once a baby learns to actively interact and smile at you, she becomes much more easily distracted. She wants to nurse, but she also wants to play and smile at you at the same time. She is very interested in her surroundings, and wants to look around the room if the TV is on or a sibling is playing in the corner. It is very difficult to stay attached to the breast and look around the room at the same time. This can be very frustrating to babies, and can cause them to fuss and pull off the breast.
Another factor is patience. Your milk lets down vigorously at the beginning of a feeding, then slows down to a trickle. If your baby keeps nursing, she will be rewarded with another let-down. While a newborn is perfectly willing to keep nursing whiles she waits (remember, she doesn’t have much else to do that’s fun at that point), an older baby may get antsy after the initial flow of milk slows down, and may not be willing to continue nursing while she waits for another let-down.
Many older babies will get all the milk they need in less than 5 or 10 minutes. Your let-down reflex is well established by this time, and babies become very efficient at nursing. The baby who pulls off the breast after a few minutes and refuses to take the second side may simply have gotten her fill.
Many babies will fight sleep even while their eyelids are drooping and you know for a fact that they are exhausted. Most babies at this age do better with the early morning and middle of the night feedings, but fuss with every feeding in between. Does she do better with some feedings versus others, or fuss at all of them?
With a 4 month old, teething can definitely be a factor as well. I had 2 out of 6 babies cut their first teeth at 4 months, and teething can go on for weeks or months before the first tooth actually breaks through the gum. Some babies like to nurse more when they’re teething, and some don’t like they way it feels when their gums rub against the nipple. It may help to let her chomp on something (a teething toy, a knuckle, or a frozen washcloth) before you nurse her or when she pulls off.
Has she had a cold recently? Sometimes stuffy noses can make babies pull off the breast or bottle because it’s hard to suck and breathe at the same time.
Try to minimize distractions when you feed her, and see if this stage continues. Hopefully she’ll settle down somewhat, but she will probably never go back to nursing like a newborn again.
Anne Smith, IBCLC