Fussy at the Breast: Breastfeeding with lactation consultant Susie Prout

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Thank you, Susie, for joining me today. It’s great to have you on as our first ever returning guest.

SUSIE PROUT

Thank you for having me. I’m excited to be back. And I’m excited to chat with all of your listeners about what they’re concerned with.

KATH BAQUIE

Yeah, so the first time we chatted, which for anyone listening, it’s the second episode. So you have to scroll all the way back. It’s over a year ago now. And we talked about preparing to breastfeed. So the episode was focused on pregnant mums. So today, it’s so exciting to chat because we’re going to be talking about new mums and babies, and in particular, fussy breastfeeding. So it’s a big topic. And the reason we’re talking about fussy feeding is because I put out a question box on Instagram. And this is what pretty much all of the questions were about. So it perfect topic. So thank you, if you follow us on Instagram, thank you for your amazing questions. So to start off with, what do you classify as fussy feeding?

SUSIE PROUT

Fussy feeding can happen right at the beginning of your breastfeeding journey, or it can happen at any time. And there’s different reasons depending on how old your baby is why your baby would be fussing. So I would think of a fussy feeder more towards the three to four months and older. And I would think of a baby who’s being fussy in the newborn age, not because they’re fussing, but because there is a reason there’s a reason with their lapse. There’s a reason with the supply, there might be a reason with positioning very different to a baby who has fed well. And then as they start to be more aware of their surroundings, and they become more alert and know what they want. And they don’t want. They become fussy. So we’ve got two different types of I guess you could call fussy feeding.

KATH BAQUIE

Oh that’s interesting. So a lot of us perhaps are calling it fussy feeding because they’re fussing, but what would you call it if it’s that newborn phase, so its first few months.

SUSIE PROUT

I would call that like a breastfeeding problem or a supply issue or an attachment issue I would look at if your baby is fasting and not happy at the breast. It’s not because they’re being fussy. So we need to work out why it is. So I would look at the reason and then we will call it the what the reason that could be so if you’ve got a baby who is relatively you know, in the first six weeks, and is fasting in terms of pulling on and off the breast, so they go on, they may suck for 10 seconds and they pull off or they go on and they cry and they’re flailing their little arms and legs around, they never seem to just have one of those sleepy, happy, relaxed feeds. That can happen for a few reasons. The first it can happen if you’ve got an oversupply of milk. So when you have a new baby, they suck, suck, swallow is what they do. And they have a tiny little mouth, and they have a tiny little tummy, and they’re not used to all this milk coming out. And if you suddenly have a huge milk supply, they will go on to the breast, get all this milk in their mouth, get really stressed out and pull off. And then they’ll be like, Oh, but I’m actually really hungry, I want more. And so then they’ll go back on and same thing will happen. And they’ll keep doing that and look like they’re really unhappy. And you as a mum will look down and think I’ve got all this milk, it’s a falling out of their mouth, it’s spraying everywhere, what could be wrong. And it actually is because you’ve got all this milk, and it’s spraying everywhere, and there’s too much of it. And if you have an oversupply, you would usually see that happening in the first few minutes of your feed, because that’s when you have the letdown. So they may go on and be quite happy for the first 60 seconds before the milk actually comes out. Then the milk starts to spray out with force, those three minutes after that your baby is literally…

KATH BAQUIE

Gasping. I remember my baby gasping, trying to catch up with the flow.

SUSIE PROUT

And then it kind of comes down and your baby gets into the feed and likes the slower flow. And you can kind of kind of continue. And then the other side of it though, is and this is why you need to have an IBCLC to diagnose whatever this is because the other side could be an under supply. So your baby’s really hungry, gone on, the letdown happens. And it’s a bit piddly and it’s not really enough for your babies, your baby is on and off. Crying the same things hitting the breast pulling up their legs looks like they’re going to keep moving their head from side to side, then they go back on because they want more, but there’s not enough there for them. So they do the same type of thing, but it’s because they want more milk. And then the other reason that a baby will look like they’re fussing at the breast in the early days is with a tongue tie. So with the tongue tie, your baby can’t cloth, the nipple and the areola with their tongue up properly. And so they just can’t get on and stay on and they’re not comfortable on. So you’ll find them nipple feeding quite a lot. So they’ll be doing those shallow feeds. And when you have a baby whose nipple feeding, firstly, you’re in a lot of pain, because they’re damaging your nipple. But secondly, they’re not able to actually mess eyes, the breasts of their mouth, so they’re not actually able to initiate the letdown or get enough milk through. So those babies are really fussy at the breast, and they just don’t seem to ever get it. And a lot of mums will say they just don’t get it. They’re not understanding how to breastfeed, there’s something wrong with them. And it’s not wrong with them, it’s only wrong with their tongue, in that it’s pulled down to the bottom of their mouth, and they can’t lift it up enough and out enough to help with the breast. So those would be the three main reasons we then have reasons of positioning. So you might be holding your baby in a position that’s actually hurting your baby. So it depends how your baby’s been born, they might have had a forceps delivery, they might have had quite a heavy vacuum on their head, and they might have some pain down the one side. And if you’re holding them in a position that’s hurting them, again, they’ll be fuzzy because they’re like, I don’t I want the milk, but I don’t want to be held like this. And so those are probably the reasons I would say if you’re looking at fussing, those would be the reasons your baby’s not just fussing because they’re fasting for no reason. There’s a there’s a reason that those early days and we can fix that reason and then go on their merry way.

KATH BAQUIE

The tricky part is finding the right reason. Is that right?

SUSIE PROUT

Yeah, yeah. So a lot of the time girls will have a baby that is feeding. Okay, but fussing. So you know, they are breastfeeding. But they then will start to think, okay, something’s wrong. I’m going to get on to Google. I’m going to ask my friends, I’m going to go into some forums, and people will say, Oh, yes, my baby did that. And that was because of oversupply or this or that. And then people think that and then you think one thing and it’s another and until you go and see someone who can actually look at exactly what’s going on. It can be quite tricky.

KATH BAQUIE

And at what stage do you start to consider food intolerances? Because I know a lot of mums who start to restrict their diet, trying to find a reason for the fussiness.

SUSIE PROUT

Yeah, so a baby is passing at the breast. It’s that’s not related to a food intolerance. If a baby has reflux symptoms, fussy colicky off the breast, then we can be okay. So why have they got these behaviours and what’s going on but if they’re fussy at the breast, that’s not to do with the intolerance. However, they could be fussy all the time and they could be fussy on the breast and off the breast and with intolerances and allergies. If you think of cow’s milk protein intolerance, it’s over diagnosed hugely and it’s self-diagnosed. And I will have seen countless ladies who I’ll go to their house and they’ll say, I’ve gone off dairy and gluten and red foods. And, you know, they’re on about four different types of foods, just because they’ve taken it upon themselves to take away all these things. If you have a concern with an intolerance, and you were to see a padiatric dietitian, someone who specializes an allergist, someone who specializes in pediatrics, they would look at, okay, the usual suspects would be dairy, or the soy, and then they would put you on a plan because you need to be off these foods for at least 10 to 14 days before you would see any difference. There’s lots of chopping and changing that mums do because they’re feeling helpless. I mean, yeah, absolutely. But I think that jumping into intolerance really early, can really damage your breastfeeding relationship, because we don’t know that it’s that and often they’ll think, ah, baby’s got a bit of green poop. They must be allergic to something where it’s just probably nothing.

KATH BAQUIE

Okay, so let’s move into fussy feeders over three months old then. So what are the common reasons and signs of fussy feeders in the older baby age group?

SUSIE PROUT

Yeah, so you’d have a baby who’s feeding really well, in those early days, the first three to four months, and you’d be going along your merry way, and there’d be no issues. And then we talk a lot about the four-month sleep regression, or progression, as we call it, where babies start to realize a bit more cause and effect. So a newborn is not going to understand cause and effect, they’re not going to understand when they get to the breast and they suck and the milk is coming out, they’re just sucking because they’re at the breasts, they reflect that they do. But when they get older, and they go to the four months, or they’re more alert, they start to understand cause and effect, they do something and something’s going to happen to them, they start to understand that they can be fed in different ways. So they could be having a bottle and a breast. And they can start to prefer one over the other and start making a conscious choice that that’s what they want. And they start to have more play time. So baby will have their sleep, that have their feed that have their play time and have their sleep again, and it becomes a little bit more regimented. Not that you’re in a routine, but you are having a bit more alert time. And so all this happens, and they’re doing a lot of growing at that stage. And then they’ll start to become fussy at the breast.

And so one of the most common reasons to be fussy at the breast around that time is when you’re giving bottles and breast. And so most if used to give too many bottles in those early days, and I’m not against bottle feeding is at all I actually quite like breastfeeding mums to teach their babies to be able to have a bottle so that they know their baby knows how to take one. And so when you’re going back to work, or when you’re doing bits and pieces and baby gets older, you’re not then in there, I’m now having a baby who’s refusing the bottle. So it is good. But if you’re giving too many bottles, and you’re mixed feeding, I guess you could call it, it all could be going swimmingly well, but no baby I have come across is ever going to mix feed well, their whole breastfeeding, you know feeding relationship, there will be come a time when they start to prefer one or the other. And nine times out of 10 they prefer a bottle, a bottle is simple for them, because the milk is coming out the same way, the same amount, the same flow, where a breast is very different in that you have to work for your milk, you know, you’ve got a minute or so have no milk coming out. And you’ve got a lot and it’s a little bit different amounts of milk coming out. And breastfeeding is more than nutrition, it’s comfort, it’s warmth, it’s new for you wanting to bond there’s so much falling asleep, there’s so much more. So they’re very different. The way that you your baby sucks on a bottle and the way that your baby sucks and the breast are like chalk and cheese, you can’t even compare them. And so that would be the main reason the baby’s having a bottle preference. The other reason is that your baby needs to have a pre feed routine, not a routine in terms of feed every three hours, you still want to demand feed, but you want to have a time that your baby knows that it’s the time because if you think about it as an adult, if you were suddenly just I don’t know driving your car and someone just stuffed a piece of food in half and you weren’t aware that it will happening. You’d be like, Ah, what’s going on. And so if you’re if your baby is in play time playing with their toys on the ground, and you literally just walk over, pick your baby up and try and get them to feed in their playtime they’re going to be like, Well, I don’t want to feed now because that feed feeding on the breast is so much more. It’s sleepy, it’s I need to come down now and I need to do all this stuff. And so then they start to push away.

KATH BAQUIE

I’ve never thought about it like that. But that just makes so much sense and the number of times I just did whisk my baby and tried to chuck them on the boobs really good. I like that.

SUSIE PROUT

So what you need to do you need to have a pre feed routine. And so what that would mean is okay, so you think right, I’m going to feed my baby, when they wake up from their naps, I’m going to do more of a sleep and then you get a feed, then you’re going to play. Or you could do it the other way you could feed to sleep, that’s fine with it, or you could do both whenever you want it, but you can’t do a feed in the middle of the playtime. That’s not the feed time. So you think, okay, if I’m going to do my feed, when baby goes to sleep, I’m going to pick up my baby, when it’s time, I’m going to say the same words, I’m going to say it’s, you know, it’s feed milk time. Now, I’m going to walk to the room, I’m going to close the curtains the same way, we’re going to sing the same song, we’re going to put the sleep suit on, we’re going to dim the lights must sit in the same chair, I’m going to do exactly the same routine every single time I feed. And so your baby knows that as soon as you sing that song when you walk to the nursery, that they’re getting ready to have their feed. And same time if you were doing it when they woke up from their nap, you don’t get them out of their room, you stay in there, you know, it’s the same whatever you want to do, you make up your own routine. But it’s the same thing.

KATH BAQUIE

And if you’re out and about can you do like if you’re in your bedroom, the bedroom, for example, and you’ve got a particular routine that might be that you’re giving a certain comfort to for them to hold when it’s feed time. So that when you’re out and about, you can’t replicate everything, obviously. But you could do just, you know, say the same words and give them their little comfort, that sort of thing.

SUSIE PROUT

Yeah, you would do as much as you can. But it’s important that when you are out and about you’re feeding at the time that you would be feeding normally at home. So if your baby was going to be having a nap, and it was 10am, and it was time for their nap, you would do the feed before their nap when you were out. You wouldn’t just willy nilly give them a feed when they’re in their awake time unless they asked for it. I mean, this is just, you know, the bare minimum that then you would do if you whatever they were in their wake time and they came up to you and they wanted to feed you know, fine. It’s this is, this is only for babies. This is not for everyone. This is only for babies who are having breast refuse or when fussiness. So if your baby’s going really well, and you get to 4 months, you don’t need to put this into play. You only need to put this in play if your baby’s refusing a feed. And you also need to look at milk supply. You know, is there a reason that your baby’s getting more fussy? Is your milk supply dropping? If you are mixed feeding? Yes, it probably is dropping? Have you got your period back? you’re ovulating? You know, is it? Is it a hormonal reason that your baby is getting a bit fussy?

KATH BAQUIE

And is that due to change of taste?

SUSIE PROUT

Yeah, so if you are pregnant, there’s a little bit more colostrum that’s made into your breast milk becomes a salty taste. Some babies don’t care about that. But some babies get quite annoyed. And also, in the first trimester, you would usually have a lower milk supply. Some girls will have not enough milk in at first trimester, you also get quite sore nipples when you’re pregnant again. So often there’s that subconscious that you don’t really want to feed because Oh, you’re nauseas and you just feel gross. So it can be quite hard to feed through the first trimester. If you did feed through that. And you got to the second trimester, though, things usually settle down and your milk supply settles and everything goes okay. So some babies don’t care. But some babies really don’t like the taste, and they’ll just fuss. And then if you’re, if you’re not pregnant, be ovulating and you start to get your period again. And you’re going to have lower milk supply a couple of days around ovulation. And then a couple of days around when your period comes well, which is going to make babies fuss at the same time.

KATH BAQUIE

So what would be a possible explanation, to a kind of baby that is feeding well, but just want this one to two fussy feeds of the day?

SUSIE PROUT

Yeah. Okay. So that would depend, I guess, when the feed was if they were fussing towards the end of the day, it could be related to overtired or could be related to your milk supply. And then it gets a little bit lower at those times of the day. It could be related to when the frequency of feeding when you’re actually feeding baby does baby want to be fed then look at when it is how far it is from another feed. When did they have their sleep, just like plot out your 24-hour day and have a bit of a look. Because if there’s a one feed of the day that your baby is just fussing and doesn’t want and you keep pushing that feed and they don’t want it at the end of the day. Often it’s better to just not try then and try and half an hour’s time or something. Because if you are pushing a baby to the breast and they are pushing that and it becomes a fight every day to have that one extra feed. It’s better to just step away and give them that time and try again or go to the room and do a sideline feed on the bed or feeding the carrier when you’re out and about because if the baby starts hating feeds, they will then refuse other feeds and then there is always the risk of a breastfeeding aversion where a baby just stops wanting to feed altogether and they because they feel this as soon as they get to the because they’re going to be pushed there, they get this adrenaline. And if a baby gets an adrenaline rush every time they get to the breast because they don’t know if they want to feed, and they’re going to be pushed there, and that’s me pushing them out. As soon as anyone adults even get adrenaline, your appetite is diminished. And so they straightaway would not want to feed because I don’t like that. So keeping breastfeeding really happy and carefree and not pushing is better in the long run for your baby, because we won’t see that aversion.

KATH BAQUIE

I wish I had spoken to you nine years ago, because this bringing back my second and third experiences were much, much better. But my first baby, I found breastfeeding so hard, and I think I’m doing, I did all these things, everything that you’re talking about with the fussy feeding, it happened to me, I’m sure I was creating that aversion by desperately, like it’s a really tricky stage, right, because the mums, desperate they think, you know, my baby wasn’t putting on weight, or the maternal child health nurse might be saying that they’re not heavy enough, and then they’re pushing away from you.

SUSIE PROUT

It is really hard. And it’s very easy to talk this through in theory, but when you’re there with the emotions, and I’ve been there, I mean, I’ve breastfed my three children, and my first child. You know, I was going through all of this, even though I was trained in it, I was still going through all of this, and I was still trying to push my baby to the breast and he still refused. And you know, it’s very different when you were there. But to always keep in mind, I guess, when they are fussy that there is going to be a reason and we just need to work it out. And you can get back it’s just the more we stress and push, the harder it is.

KATH BAQUIE

So would you say fussy feeding is normal? Or would you say? Like it’s common, but it’s something we need to focus on? Like, what would you say?

SUSIE PROUT

So fussy feeding in the first three months is not normal. So there’s a reason if your baby is not feeding well and pushing on and off the breast in those really early months, that’s not normal. There’s a reason for that. But fussy feeding for months and over, I would consider normal. If your baby is refusing feeds, or no, that’s not normal, but just being fussy. At certain times of the day, your baby doesn’t want distractions, they want a quiet room, they don’t want to feed at certain times they want to feed only when they go to sleep, or when they just wake up. They don’t want to feed when they’re playing on the floor. They don’t want to feed in certain positions. That’s normal. It’s that’s just a baby growing up. And you think about it as toddlers when you’re, you know, over six months when you’re trying to learn how to give solids and they’re refusing solids. There if they’d suddenly refuse or their lunch for like three days in a row, it’s the same thing. It’s just as they get older, they just realizing cause and effect they don’t want to right now, we’ve just got to always look at the day. Don’t always look at one feed and stress. Just look at your day and be like Have they had enough breastfed today, how many breastfeeds? Are they really had? Oh, and then you probably will realize Oh, actually, they’ve actually done really well. And they were just fussy on the one feed. That’s fine. We often look at one feed, and we’ll think about that feed, but we will forget about the seven other good feeds that we’ve had in the day.

KATH BAQUIE

Yeah. Okay. I think this goes on nicely to my last question, which is a big question. What would be your top few tips for mums? For surviving this or thriving through this fussy period?

SUSIE PROUT

Yes. Okay. So firstly, in the first three months, if you’ve got a baby who’s not happy at the breast, the biggest thing is to get professional help. So seeing an IBCLC is essential for continued breastfeeding, as essential as going to the GP for something. As essential as seeing another health professional for a different ailment. If you are struggling through breastfeeding in those early days, you don’t know why. Then if you don’t see someone, chances are it’s not going to improve because it’s like doing the same thing every day hoping for a different outcome. It’s not going to improve. So that’s the biggest tip of seeing someone and seeing a lactation consultant, you can see them in many different ways you if you have birth, certainly, in Australia, a few first in the public sector, there’s usually a lactation consultant linked to you, depending on your hospital, but you could there’s usually a breastfeeding clinic in the public sector that you could if you were struggling, you know financially to see a private one. You could hopefully get on the list to see them that however the problem is with the public LC is that there’s long wait lists, and I always feel that you need to see someone within 24-48 hours.

That’s the problem. But otherwise, there’s a lot if you ask your child health nurse, often your maternal and child health nurse is a lactation consultant and they can help you or they can give you someone that can in your area. Otherwise seeing a private LC you’d be able to see someone that day or the next day and I think that that’s probably the biggest tip for the early days is to just work out what’s actually going on.

And then the tips for when you are having a fussy baby over four months, would be to look at the times that they fussy look at the times of day, they’re fussy and work out, if you can see a bit of a link. Try the pre feed routine. So try what I spoke about and get baby ready for a feed. Babies absolutely thrive on routine; they want to know what’s happening before it happens. They don’t want to be kept in the dark, they don’t like that. So you need to, to plan things and get them to know what’s going on. And also, if you’re looking at your milk supply, if you were to just pick up your baby off the floor and put them on the bread, the breast, you would have a bit of a delayed letdown because your body’s not ready for a feed. So then your babies then getting annoyed because they’re waiting for two minutes for a milk letdown to happen. Where if you do the pre feed routine, your body’s also like, oh, okay, I know that it’s going to be feed time soon, I’m going to let down quicker. And it’s all just going to be work a bit better. And the other thing is, if you’re wanting to use bottles and breasts at the same time, you certainly can and you can do whatever you want with feeding. But just to have it in the back of your mind that it’s not often a long term solution. I wish it was I wish we could do, we can always do one bottle in 24 hours, that’s not going to affect anything. But more than that, there will be a time that your baby will prefer the bottle, it will come, whether it’s at four months, whether it’s an eight months, there will be a time where they’re like whoa, I’m going to choose one over the other.

KATH BAQUIE

I’ve spoken to quite a few mums whose babies only have a bottle during the day. But then they’re happy to take the breast at night time.

SUSIE PROUT

Yeah, and that would work because they are doing a sleepy feed to sleep overnight and not alert feeds. And so that often will work for mums who go back to work, and they give their bottles in the day. And then this the feeds at night are very different because they are more the sleepy feeds. Feeding and then going straight back to sleep. And if it can work, it’s amazing. And for girls that have to give bottles because they are out, you’ve just got to do the best you can, you know, all you can do is give the bottles in the day and then do the rest if you can, and you can’t really worry too much about it because it is what it is. But if your baby is starting to fuss, and you are giving both, and you have an opportunity to not give both. And going back to more breastfeeds will often get baby back towards preferring the breast again. Because we often see lots of mums really stressed out about this. But if we look at it from a baby’s point of view, they’re making a preference. They’re making a choice because they know what it’s like to have both. And I guess because I see it so often. And in my practice, I would see breast refusal as for an older baby is one of the main reasons that I get contacted. I just see this so very often that we just look at, okay, why is it happening?

KATH BAQUIE

So really, when you think about going back to work, you often think about the practicalities, like childcare arrangements. And then you suddenly think oh, my gosh, is his whole feeding situation to potentially so.

SUSIE PROUT

Yeah, and it is really tough. I went back to work at eight months was my first and I went back three days a week. And yeah, he did refuse breastfeeding by nine months, because he just wanted the bottle. He just loved it. And it was really very hard for me. But at the end of the day, I had to go back to work where you know, we’re working mum. Often we don’t have the privilege of not doing it. And so all you can do is try your best with breastfeeding when you’re at home with them. And realize that you know you’re doing your best and your best is enough. And if you are wanting to continue with expressing your baby, if your baby did go to the point where they’re fussing turn to refusal, your baby is still getting your breast milk. Yes, it’s going through a bottle of your baby is still getting the exact same milk because they were getting if they were feeding from you.

KATH BAQUIE

Yeah, I love what you said in terms of everyone’s just doing the best they can and that’s good enough.

SUSIE PROUT

It is good enough. Absolutely.

KATH BAQUIE

Lovely. Well, thank you so much. Susie, how can the listeners find you because I know you have an amazing membership for breastfeeding mums. So tell us.

SUSIE PROUT

Yeah, so you can find me on Instagram @susieproutlactation or www.susieproutlactation.com and yes, so I also run the Australian breastfeeding podcast. I have about 60 episodes in there. I run the breastfeeding success membership. So it’s a program and a membership together. It’s a program to teach mums how to breastfeed and then the membership to continue with support as they continue with their breastfeeding, so that’s my main way of working with ladies now and I only see girls, one to one that joined the membership. So yeah, I’m really enjoying it. I think the girls are absolutely loving it and having not only the support but the education. It’s yeah, it’s a lovely way to help women.

KATH BAQUIE

Absolutely. So thank you and I’ll put all those links in the show notes. So thank you so much.

So before we sign off, please remember my team and I will be putting together the show notes for this episode with all the links at www.fitnestmama.com/podcast, so be sure to head there to find out how to connect with Susie and come and say hi to us. So send us an Instagram message. Send us a DM and let us know what you thought of the podcast. So have a fabulous day everyone and I look forward to you joining me next week for another episode of the FitNest Mama Podcast.

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