Dear Doctor,

My newborn baby has refused to breastfeed. She’s four days old. I’ve tried everything, and the milk is in plenty but she refuses. Is she sick? The nurse said it will happen in time but I’m worried. For now, she uses the bottle. How can I get her to feed? Alexia

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Dear Alexia,

your newborn baby born at full term and of normal weight? Pre-term babies do not have the skill of feeding like the fully developed, hence, are unable to suckle adequately at the breast. With the growth of the baby, feeding skills also improve. An underweight baby is unable to suck at the breasts for adequate time because of getting fatigued too soon. Four days is still too young to assess the baby. The new mother also lacks experience. Due to it, the baby may not be latched properly to the breasts, hence, is unable to feed adequately. Bad position of the baby on the lap may cause her breathing trouble by pressing her nose against the breast, which again impairs feeding. Stress can alter the taste of breast milk, which may not be liked by the infant. Application of lotion, cream, and etcetera, on the breast before feeding can similarly alter the taste, as well as the quality of milk and the baby may refuse to take it. Heavy physical exercise can build up lactic acid in milk, which can put the baby off. 

A baby may be unable to feed due to a blocked nose or enlarged tonsils. Ear infections also affect feeding.  Birth abnormalities like cleft lip, cleft palate, chromosomal abnormalities like Down’s syndrome, also prevent a baby from feeding. A child born with underactive thyroid may have poor feeding. Any illness like liver or congenital, heart or kidney disorder or infection impairs the ability of a new born baby to feed properly.

Whatever the reason for refusal of a baby to take feeds, lack of proper feeding affects the overall health and nutrition. A newborn not fed adequately will fail to thrive.  Hence, it will become a serious issue needing correction.

Try to latch the baby properly on the breast, ensure that her nose is not pressed or blocked. Try giving more frequent feeds. Remain stress free, keep the breast clean and dry and do not apply anything before feeding.  Bottle feeding can be substituted for breastfeeding, to ensure good intake. A breast pump can also be tried. Treatment of any underlying sickness or correction of some physical defect in the child helps improve her feeding as well.

Dr. Rachna Pande is a specialist in internal medicine. rachna212002@yahoo.co.uk