Dr. Greene

Fussy While Breastfeeding

Nursing is usually a powerfully bonding experience that calms and satisfies the baby. Sometimes, though, I hear from parents that their baby screams at the breast, which can feel so disheartening.

Babies tend to be at their fussiest (in all of childhood) between about 4 and 8 weeks of age. Many babies are especially fussy in the evening. There are several reasons for this. Partly, they are tired from a long day (I get crankier too, when I am sleep-deprived). Partly, the daily tides of hormones shift in the evenings – little discomforts become more noticeable (you may have noticed that most sicknesses seem worse at night).

Caffeine (think coffee, teas, sodas, Excedrin), and caffeine-like substances (think chocolate and many cold medicines) can heighten this effect. Caffeine in the breast milk does affect babies.

When a baby is fussy at the breast, one of the first thoughts is often about foods in Mom’s diet. Apart from the caffeine issue above, most mothers can eat most foods without causing a nursing problem. Some babies are sensitive to certain foods though. Dairy (milk, eggs, ice cream, cheese), peanuts, and nuts are the most likely culprits.

In one study, prolonged emptying of just one breast at each feeding (as opposed to equal feeding at both breasts) cut colic symptoms in half.

Often, babies who are fussy at one feeding will be less fussy if that feeding is moved half an hour earlier. This is especially effective if the baby has been asleep and you nurse before he wakes all the way up.

Sometimes swaddling the baby for the evening feeding will help – they like to feel more secure and protected in the evening. Some babies are sensitive to the cool of the evening, and wearing something warmer (especially on the feet and shoulders) might help.

Others, though, will take the evening feeding better with full skin-to-skin contact (perhaps under a blanket for added warmth). Some babies are most comfortable in the evening if the person holding them is standing up and/or swaying. Ironically, you both may feel more relaxed if you nurse standing up.

Some physical problems, such as thrush or GE reflux, will cause discomfort that is most troublesome in the evening. Treating the underlying problem can help.

Arching the back during feedings may be a sign of reflux – or a sign that a different nursing hold might work better. Try the football hold, to keep him in more of a ‘fetal position’, with his chin close to his chest. His bottom needs firm support, but his legs should be in the air with nothing to push against. You may need strategically positioned pillows or a nursing pillow to help.

Singing softly during evening feeds helps for some babies.

When feedings are problematic, I strongly recommend working with a lactation consultant until they become easy and joyful for both you and the baby. There is no substitute for their practical wisdom, individualized to your situation.

Breastfeeding is a magnificent gift that will benefit babies for the rest of their lives.

Your Comments

My daughter is a ltilte over 4 months now. About 5 weeks ago, I started supplementing with formula on occasion because I was having trouble pumping enough milk to sustain her (she began to refuse the breast after having the bottle during the days and breast at night). After a while of not breast feeding and only pumping, the milk starts to go down, so eventually she is mainly on formula.It is perfectly fine to give your baby formula and breast feed, I would suggest asking your pediatrician what brand he/she recommends for your baby. Keep in mind that if you do give some formula, it is likely that once you start, it will be a slow progression to solely formula. I was comfortable with that, as I was happy that she had formula solely for the first 3 months and she received the important immune building nutrients from me that were best. As for number of ounces, I always let her drink as much as she would like. During growth spurts she wnats more sometimes she wants less. Right now she drinks about 4 oz per feeding, and she is thriving well.
3/19/2012 10:24:11 PM

Thanks for taking the time to datebe this, I really feel strongly about it and love learning more on this topic. If potential, as you acquire expertise, would you thoughts updating your blog with extra info? It is extremely helpful for me.
3/14/2012 11:16:43 AM

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Dr. Greene

Dr. Greene is a practicing pediatrician, author, speaker, children’s health advocate, and father of four.

Dr. Levine

Dr. Alanna Levine is a New York based pediatrician and a mom of two children.