Breast refusal: Due to thrush or nipple preference?

My baby was born and I returned to work when she was six weeks old. Within two weeks, she started refusing the breast occasionally. Then I noticed just a small amount of thrush in the corners of her lips, but no patches in her mouth. Around the same time she developed yeasty diaper rash and the doctor prescribed Mycolog-II. Now she does has white spots in her mouth so we started using gentian violet for her and my nipples. We are on the second day. Doesn't that provide some immediate relief? I know I have to get rid of the thrush, but my hunch is that it's more nipple preference than mouth soreness. She loves her pacifier and I often can trick her into nursing by doing a quick replacement. But she's wise to me now and it's no longer working. Do you think it's only the thrush or do I have a bigger problem? She nurses pretty well at night and I try to take advantage of it so my supply stays up. I am only able to pump once at lunch time with my Pump in Style. She gets two bottles of expressed milk while I'm away. Two days a week I telecommute. So she only gets six bottles per week. Now she is getting more as I am giving in to her screaming. How do I get her on track again?

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Debbi Donovan

Debbi Donovan is a Board Certified Lactation Consultant, as well as a retired La Leche League Leader. For more than a decade, Debbi... Read more

It's impossible to say if your little one's breast refusal is due to the thrush or because she has been receiving bottles. The first thing to do is treat the thrush. Thrush can be very painful to babies (and moms), and it does bother many babies during a feed. By the time you receive this letter, hopefully you will have seen marked improvement in this area. Gentian violet is a very effective antifungal, but it may not provide immediate relief. In fact, during the first two days of treatment, some babies and moms find their symptoms worsening. This of course should begin to turn around, or you and the baby need to be promptly reevaluated.

Your baby may be very attached to her pacifier because of difficulties with breastfeeding. Maybe you have a very abundant milk supply. Or your supply could be diminishing slightly with the use of bottles in place of certain feeds. Your daughter's pattern of weight gain would give you a good idea which of these is more likely. Normal weight gain for a baby under three to four months of age is four to eight ounces each week. If your baby has been gaining consistently over the average, and is not getting much in the way of supplemental feeds, you can be pretty confident that your milk supply is abundant. Good output, of between five to six wet diapers and regular substantial bowel movements, is another good indicator. When your baby nurses, do you hear regular swallowing with each suck, with some pauses in between? This is very normal. If you have a very abundant supply you may hear your little one gulping or sputtering, having some difficulty handling the milk flow. If you don't hear or see your baby swallowing, she may not be properly accessing your milk supply.

Since you are offering bottles in your absence, remember not to feed your baby any milk (refrigerated or frozen) that was expressed during the time that you were being treated for thrush, once your treatment is completed. For at least several weeks, boil bottle nipples, pacifiers, and pump parts that come in contact with milk (except the gasket) for at least 5 minutes each day. Bottle nipples and pacifiers should be tossed out and replaced with new ones each week during this time.

Continue to take advantage of the times your daughter enjoys nursing, and build on these positive nursing sessions. Allow lots of skin-to-skin contact between you and your baby at other times during the day. Carry her against your body, dressed only in a diaper (using a baby sling), nap with her, take her into the bath...Offer your breast if she seems interested. Be patient with her. Gentle mothering will best help her return to your breast.

Try to cut down on the use of bottles. During the day, if she refuses to nurse, comfort her, wait a few minutes and try another setting. Maybe she would prefer to nurse lying down on the bed, while walking around, or in the bath. If she adamantly refuses to nurse, you can bottle feed her against your bare skin, in the breastfeeding position. After she has had just enough to begin to relax, you can see if she will accept your breast in place of the bottle nipple.

To get your breastfeeding relationship back on track, it would be best to work with an IBCLC in your area. If the suggestions I have given you don't seem to be improving your situation within a couple of days, it is really important that you and your baby be evaluated by a Lactation Consultant. Very best wishes at getting your breastfeeding relationship back on track!

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