When does your baby have conditioned dialling up at the breast and what to do about it?

Dr Pamela Douglas5th of Oct 202328th of Dec 2024

baby breastfeeding

This page belongs to collection of short articles and videos in plain language, called When baby cries a lot in the first few months of life. Together, these articles and videos will give you a brief and simple summary of the Possums 5-domain approach to the crying baby. For comprehensive information on this topic, please consider reading The discontented little baby book.

What's meant by conditioned dialling up at the breast?

Conditioned dialling up at the breast is a common problem, which often causes a breastfeeding woman a great deal of distress. Of course, the baby is very upset, too. Sometimes, this problem is referred to as breast refusal or oral aversion.

Often, it’s missed altogether, and misdiagnosed as an allergy, lactose problem, reflux or tongue-tie.

By ‘conditioned’, I mean a habit which has developed over time. By dialling up, I’m referring to baby’s sympathetic nervous system.

A baby has a ‘conditioned dialling up at the breast’ when they repeatedly begin to fuss, or become agitated, either when starting the breastfeed or during the feed. The baby reacts or signals with an exaggerated distress response to small frustrations.

The baby reacts like this, not because they don’t like the breast, but because they have such an incredibly powerful and biological longing for the breast. Our aim is to help the baby remember that the breast is a lovely, satisfying place to be.

Why do babies develop a conditioned dialling up at the breast?

It’s not always possible to know why a baby develops a conditioned dialling up at the breast. Here are two common reasons.

Baby has had repeated experiences of not feeling stable at the breast. A baby is in an unstable position when they aren’t able to relax in a physically supported and aligned way into their mother’s body, or when they are accidentally experiencing some dragging on the breast tissue in their mouth as they suck.
We might, without meaning to, have been feeling under pressure to get milk into our baby. This typically happens when we are feeling under enormous pressure for the baby to gain weight. It can also happen when we’ve been advised to space out the feeds to every three hours or so. Then we might feel under pressure to make sure the baby has a big feed when the time comes, even if they don’t really seem to want to.

If your baby has a conditioned dialling up with breastfeeding, it's important to seek help from a breastfeeding support professional, perhaps your Maternal and Child Health Nurse, your local NDC Accredited Practitioner, or an International Board Certified Lactation Consultant.

How can we help a little one with a conditioned dialling up?

It is important to address positional stability when we have a baby with conditioned dialling up at the breast, using the latest understandings of how babies suck.

To help change the conditioned dialling up, we need to offer the breast frequently and flexibly, at least 12 times each breast in a 24-hour period – but really just whenever the baby is dialled down and it seems a good time for you both to try.

Frequent, flexible offers of the breast keep the baby dialled down and the days as easy as possible, and take the pressure off any one particular feed. Flexible means offering the breast at any time and place that it works for you and your baby. People often think you have to wait until a baby is grizzling or crying before offering a breastfeed, but that’s not true.

Breastfeeds might be brief, but the most important thing is that the baby has a settled and happy feed. Remember, it really doesn’t matter if the baby has just fed – adults often take a little break after eating, too, before deciding we’d like something else to eat, even if it’s just a little bit.

Our aim is to increase the number of enjoyable opportunities at the breast, and to avoid dialled up experiences at the breast. Over time, your baby learns that feeds aren’t about being dialled up and breastfeeding gets easier and more enjoyable.

Babies who have a conditioned dialling up with the breast needs lots of rich and changing sensory nourishment. Rich sensory nourishment keeps babies dialled down overall, which in turn helps make time at the breast dialled down too. If they are not wanting the breast, offer your baby a change of environment (most easily achieved by stepping outside the home, if you can).

Acknowledgements

I'm grateful to Professor Sophie Havighurst, Ros June, and Caroline Ma at Mindful, The University of Melbourne, for their feedback on the articles and videos in When baby cries a lot in the first few months of life. They helped me keep the language plain and the concepts as accessible as possible, for this brief and simple version of the Possums 5-domain approach to the crying baby.