There are three main reasons why your newborn might have difficulty coming onto your breast

Here are the reasons why your newborn might dial up when you bring her to the breast, and not be able to come on.

1. Positional instability which results in nipple and breast tissue drag. Our health system has a serious blind spot concerning fit and hold in breastfeeding. Sometimes this is such a problem that your baby mightn't ever seem to be able to take the nipple. You can find out about fit and hold starting here.

2. Condiitioned dialling up with the breast. This can quickly develop if your newborn has experiences of positional instability. You can find out about conditioned dialling up with the breast and what to do here.

3. Your baby is not interested in breastfeeding right now. Is your baby dialling up because he wants a richer sensory motor experience? You can try the breast again in a while - even in a short while, if you like. It's just important that your baby doesn't feel under pressure at the breast.

Often, our health system has serious blind spots concerning these three reasons. You can find out about these health system blind spots here.

Does it help to dial down a baby with milk from a bottle before offering the breast?

You might hear it said that if you are having difficulty bringing baby on to the breast, with lots of dialing up, you should use a bottle of your expressed breast milk or formula to calm the baby down, then offer the breast again.

Sometimes in a breastfeeding consultation, if a baby is really crying (and the adults in the room may notice ourselves dialing up in response!) I'll ask a woman what she would normally do in this situation. She might say, with a kind of resignation, “I'll give her a bottle,” and so we do that. We try again at the breast when the baby has had something to drink and is dialed down.

Very commonly though, I am able to work with the woman to bring that dialled up baby onto her breast.

The problem with giving baby milk from a bottle prior to a breasstfeed to dial the baby down, as a strategy to use throughout their days and nights with a baby who dials up at the breast, is that it doesn't address the underlying problem. This is why, over time, the strategy of giving some milk prior to bringing baby to the breast is even likely to further undermine breastfeeding success. It's a coping strategy, not a repair strategy.

We need to decide, firstly, what is going on. The vital question to answer is: why is baby dialing up when you bring him to the breast? We work from the belief that the baby's crying, the baby's cues or communications, mean something. (Even if you can never really work it out, the crying means something to your baby!). You experiment with your responses.

Often women will say “I know she's hungry” and feel under pressure themselves to get milk in.

Hunger is best thought of as a wave which gathers force incrementally. Yes, some time may have passed since the last feed, yes, she may be starting to get hungry. But that doesn't necessarily mean the only solution to her dialing up is to breast feed, or that if the breast won't work you need to use a bottle. (Of course, sometimes the bottle use is appropriate, depending upon what's going on.)

But I invite you to remember that dialing up could also be a hunger for richer sensory nourishment.