Do you have an extremely fussy baby while breastfeeding? Here are some possible reasons why your baby is fussing at the breast, and how to deal with a fussy baby.

Not all fussiness and breast refusal is due to milk supply issues; it is essential that you investigate all the possible causes before considering supplementation.

When is supplementation necessary?

As time goes by, most babies will start to suck stronger and more efficiently. During the first few weeks after birth, a baby may drink up to 40 minutes per feeding but, as time goes by, he/she might only need 10 to 15 minutes at the breast. A mother may, for this reason, think that her baby is fussy when, in fact, her baby has had sufficient milk.

Check for signs that your baby is drinking enough milk.

Common Reasons for Fussiness during Breastfeeding

Ask Yourself the Following Questions:

How old is your baby?

Your fussing baby may be experiencing a growth spurt. A growth spurt usually occurs between 7 to 10 days, 2 to 3 weeks, 4 to 6 weeks, or at three months, four months, six months and nine months; this is just a general guideline; some babies do experience growth spurts at other times.

Growth spurts in the breastfed baby.

When does your baby get fussy?

Has he/she always been fussy? Is he/she fussy at only certain times while feeding? Does your baby seem to choke while feeding?

If your baby is fussing just as you begin to nurse, it may be due to slow or excessively fast milk let-down. This means that your baby is frustrated with the flow of your milk. A fast milk let-down is predominantly a problem in the mornings when mothers have a more rapid flow of milk, and babies might struggle to keep up. If your baby is fussy just after latching, you can also consider latching problems.

If you think you have a slow let down, you can pump milk for a few minutes before feeding to get the milk flowing before your baby latches on.

How to rectify a fast or slow let-down reflex.

If your baby only gets fussy after day 2-5, you can consider the problem to be either engorgement, overactive let down or delayed milk onset.
If your baby becomes fussy halfway through the feed or closer to the end of the feed, you can consider reflux; your baby needs to be burped more often, or it could indicate a food allergy, oversupply or foremilk/hindmilk imbalance.
Fussy evenings are often caused by extra air intake. Evening fussiness is a common occurrence; in fact, most babies are fussier at this time of the day. It could be because moms are busier in the evenings with meal preparation and attending to other members of the family, so they do not burp their babies as thoroughly as during the day. Try different burping positions.

Does he/she fuss on only one breast?

Fussing on one side of the breast is a sign of the difference in either the flow of milk, the quantity of milk, shape of the breast or the nipple.

Breast preference and breastfeeding on only one side.

Does your baby keep smacking or playing with his/her ears?

This could indicate an ear infection. Have your baby checked for an ear infection.

Ear infection in the breastfed baby.

Does your baby have white spots on his/her tongue?

White spots in a baby’s mouth could indicate Thrush.

If you suspect that your baby has thrush, get it seen to. A baby with thrush can be made more comfortable with medications.

Oral thrush.

Does your baby have a tongue-tie?

Tongue tie is fixed quickly, with just a little snip at the doctor’s office.

The signs of tongue-tie.

Does baby spit up often?

Spitting up is normal to a certain degree. Your baby may be suffering from acid reflux.

See Reflux in the breastfed baby.

What are your baby's signs of hunger?

Try feeding your baby earlier; sometimes babies may become fussy at the breast if they are over-hungry.

Is your baby latching on well?

Find a comfortable breastfeeding position for you and your baby.
Make sure that your baby has a good latch.
Know about all the problems that can cause a weak latch.
Tongue problems.

Do you have too much milk?

Does your baby have greenish, frothy, explosive stools with colic symptoms?

If you have an oversupply of milk, allow your baby to drain one breast before offering the other one; this ensures that your baby consumes the hindmilk, which is fattier and more substantial than the foremilk. Your baby will fuss less during breastfeeding and might even show decrease colic symptoms.

Alternate breasts only every 4 hours if you suspect oversupply or foremilk/hindmilk imbalance; this will ensure that your baby gets more of the fatty hindmilk.

Do you have flat or inverted nipples?

Or overly large nipples or breasts?

Or tubular breasts?

If you suspect that you have flat or inverted nipples, you can use techniques to draw them out, and there are ways of making breastfeeding more comfortable.

Is your baby producing the right amount of wet and dirty diapers for his/her age?

Normal urine and stool output for the breastfed baby.

Are you going through unusual stress at the moment?

A baby can pick this up and become overstimulated and fussy due to this.

Have you started your older baby on solids recently?

Tummy cramps may be a result of the introduction of solids.

Other Reasons Why a Baby might be Fussy at the Breast

• The baby may have physical or neurological problems, such as low/high muscle tone, sensory problems, or oral aversion (resistance to anything that touches the inside of the mouth). Does your baby push your finger out of his/her mouth? this could indicate an oral aversion. Touching your baby’s face may also confuse him/her, by making him/her root in that direction for the breast.

• Milk supply issues such as engorgement in the first few days, delayed onset of mature milk (milk coming in), food allergy or sensitivity to something in the mother’s milk.

• Changes in the taste of the breast milk: During menstruation, during pregnancy with another baby. During a mastitis infection, the milk may taste saltier.

• Baby might be overly hungry due to: Ineffective milk transfer (can be due to many reasons). Strict feeding schedules are also not recommended.

• If you were given any drugs during labor or if you and your baby were subject to invasive procedures during delivery, such as delivery via C-section or with vacuum/forceps. Medication given during a C-section can have an impact on a baby’s alertness and ability to suck, due to prematurity (even if he/she is just 2 or 3 weeks premature).

• The introduction of specific medications taken while breastfeeding may affect your baby. Medication and breastfeeding information.

Soothing fussy babies

Breastfeed when your baby is calm and in a dim, quiet room. An evening routine could be beneficial.
Carrying your baby in a sling in-between and during feeding can calm him/her; this provides warmth and comfort. Some fussy babies calm down when walked around or swayed while nursing. Skin to skin contact is helpful, as well as Kangaroo care.
Chiropractic treatment and craniosacral therapy are often implemented for fussy babies that have gone through birth trauma.
Try Dr. Harvey's Cuddle cure to calm a baby. Watch the video here.
Massage your baby after bath time. Try giving your baby a nice warm bath and massage before feeding him/her. You could take a bath together, and try nursing your baby in the tub. The warm water should calm your baby.

Sonia Rochel's Bathing Technique.

Swaddling will usually calm a fussy newborn baby.

An older baby may be distracted while feeding. Have you ever thought of using something like a nursing necklace?

How to Hold a Fussy Baby

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Baby Fusses at Breast Feeding Times

Breastfeeding and Fussiness