Some babies will fuss, cry or pull off the breast during breastfeeding. There are a number of reasons why this might be happening. It’s pretty common to see this type of behavior at around 6-8 weeks, though it can occur at any time. If your baby is generally fussy (not just when nursing) see My baby is fussy! Is something wrong?
Determining the problem
Here are some of the problem-solving steps I go through when my baby is fussy at the breast or a mother asks me why her baby is fussing while breastfeeding:
How old is baby? Most babies go through growth spurts during the first few days at home and around 7-10 days, 2-3 weeks, 4-6 weeks, 3 months, 4 months, 6 months, 9 months, etc. Many babies are fussy during growth spurts.
Is baby working on anything new developmentally? Babies who are starting to notice the world around them can be notoriously distractible. Any kind of new developmental step that baby is working on can affect nursing temporarily, whether it be fussy nursing behavior or simply more frequent nursing.
When is baby fussing? To figure out the cause it’s helpful to pay attention to when the fussy behavior happens, both during the nursing session and during the day.
If baby is fussy right when your milk is letting down (or immediately after), there’s a good chance that the fussy nursing is related to a fast let-down. If baby is fussy before let-down, or a few minutes into nursing (and a while after let-down), then baby may be impatient for the fast flow of milk that comes with let-down. Fussing at the end of a nursing session (or what seems to be the end) may mean that baby needs to burp, or is ready to finish nursing, or just wants to suck (and doesn’t want to deal with a new let-down at this point), or wants to continue nursing on the other side or with a faster flow of milk.
If the fussy behavior is mainly in the mornings, it might be due to a faster than usual let-down if baby has just had a longer sleep period and mom’s breasts are fuller than usual. If baby is fussier during evening nursings, it may be due to the normal fussy time that most babies have during the evening. Although most babies don’t react to foods that mom eats, some do. If you eat a particular food at about the same time each day (or most days) and baby has a regular time where she fusses during nursing, try not eating that food for a week or two to see if things improve.
Does fussing occur on both sides equally or only on one side? Most moms have a faster let-down and/or a more abundant milk supply on one side than the other, so if your baby fusses more on one side, it may be due to these differences.
What else is going on with baby? Is she sick or teething? Is something new or different going on in her environment? Has she started solids or is she trying a new food? Is she exhibiting other symptoms besides the fussy nursing?
Does baby need to burp?
Many babies will cry, fuss, pull off the breast, etc. if they need to burp. Try to burp between breasts and after a feeding, but don’t worry if baby does not burp and is content. Breastfed babies overall don’t take in as much air during a feeding as bottle-fed babies do, so usually don’t need to burp as often. If baby has been crying before she nurses, or is so hungry that she nurses “frantically” or if mom has a fast let-down, baby could be taking in more air and may need to be burped more often.
Burping is usually only necessary during the first few months, though it may extend longer. Once your baby is moving more freely, she will be able to relieve the gastric gas herself. This usually will occur between the 4th and 6th month, but may be shorter in some children and longer in others.
If baby has a hard time burping, try burping more often during a feeding. The best burping position is one that applies firm pressure to the baby’s tummy. Placing baby over the shoulder way up so that there is pressure on baby’s abdomen often works well. Walking around while doing this might distract her long enough to get a good burp. You may even want to lie baby down on her stomach and burp her that way.
Babies often pull off and fuss during growth spurts. Most babies go through growth spurts, sometimes called frequency days, during the first few days at home and around 7-10 days, 2-3 weeks, 4-6 weeks, 3 months, 4 months, 6 months and 9 months (more or less). More growth spurt information in this link.
If baby seems to be pulling off the breast at any distraction (real or imaginary), then see The Distractible Baby.
Some babies will pull off the breast soon after let-down if mom has a forceful let-down. Baby may be frustrated by the too-fast flow of milk with let-down. A too-forceful let-down can also cause excessive gas or spitting up/vomiting. There is more information here on symptoms of and how to deal with a fast let-down reflex.
Some babies get very impatient if mom has a slow let-down. There is more information here on speeding up a slow let-down reflex.
Even very young babies can be quick to notice that pulling off, kneading the breast, etc. can cause an additional let-down, and can facilitate a faster, easier milk flow. Some babies become impatient with the slower milk flow following the initial fast flow at let-down. This may or may not be related to a slow let-down.
When a feeding begins at the breast there are drops of milk. Then when the initial let-down occurs (several seconds to a minute into the feeding), the milk flow speeds up quite a bit. At that time it may drip very quickly, squirt, or even spray. Some minutes later it slows again and the baby must continue to suck vigorously in order to elicit further let-downs. This pattern can continue through successive, multiple let-downs as long as the baby is continuing to nurse vigorously. Eventually, baby will learn that the flow will pick back up again if she’ll only continue to vigorously suck/swallow.
With bottle feeding, the flow is instant and continuous. The baby is required to work very little. Once a baby has had a bottle, especially a lot of bottles, she may begin to prefer the ease of bottle-feeding over the work of breastfeeding. She may become frustrated at the breast after the first let-down occurs and the flow of milk begins to slow.
If baby is getting bottles you might consider putting them away, at least for a while. When you must use a bottle, only use a newborn nipple for as long as baby will tolerate it so that she never gets a really fast flow of milk from the bottle, but has to work a little more to get the milk.
Sometimes babies of moms with oversupply or fast let-down will also get very used to the fast flow and object when it normally slows somewhere between 3 weeks to 3 months.
It can be helpful to do some breast compression when this fussiness starts or right before you expect it to. This will help speed up the milk flow again. Once compression stops helping, try switching baby to the other side when she begins to fuss and back and forth again (after using compression) as you need to.
Baby is done nursing for the moment
If baby is fussing after she’s been nursing for a while, and you’ve ruled out other causes, she may be in the process of changing her nursing pattern. Babies become very efficient at the breast with growth and maturity. They can milk the breast in a lot less time per feeding session than they required before. Baby’s frustration may just be a sign that she’s finished and wants to move on.
On a similar note, an occasional baby will just want to suck at the end of a nursing session and the flow of milk with let-down frustrates her. You might see if offering her a finger or pacifier (if baby is older than 4-6 weeks) to suck on during these times seems to help.
Baby prefers one side
Sometimes babies will refuse or fuss at a breast when the let-down is slower or too forceful, or the supply a bit lower. They in turn will prefer the side which lets down more/less quickly and in which the supply is more bountiful. See also: Lopsided! What can I do?
Fussy in the evening
Many young babies tend to pull off and fuss at the breast in the evening. See the article Cluster Feeding and Fussy Evenings.
Teething can cause fussy nursing behavior, as some babies experience gum discomfort with sucking. Baby might start to nurse, but then pull off and cry or fuss and not want to nurse anymore. See Teething for more information and tips.
Frequent pulling off the breast can be a symptom of thrush.
A stuffy nose can cause fussy nursing behavior. If your baby has a stuffy nose and is having a hard time breathing and nursing at the same time, see colds & congestion.
Allergy or food sensitivity
Some babies with allergies or food sensitivities exhibit fussy nursing behavior. Often when there is a sensitivity to something in mom’s diet, baby will come to the breast hungry but when she tastes/smells something in the milk that will cause her GI distress, she pulls off, bats her head back and forth, etc. Sensitivities to foods in mom’s diet are rare. If this is the problem, you will most likely notice other symptoms, such as excessive spitting up or vomiting, colic, diarrhea, rash, persistent congestion or runny nose, or excessive gas. More information on food sensitivities in babies and links to more allergy information can be found in my article Dairy and other Food Sensitivities in Breastfed Babies.
Low milk supply
Low milk supply can cause baby to be fussy at the breast. If you feel that your milk supply may be low, see this page for more info: Increasing low milk supply.
Reflux can result in baby being fussy at the breast. See Reflux and Breastfeeding for more information.
Tongue-Tie can result in baby being fussy at the breast. See Breastfeeding a Baby with Tongue-Tie (Resources) for more information.