Baby not feeding from right breast

Lopsided! What can I do? • KellyMom.com

…When baby prefers one side, or when supply or breast size is greater on one side

By Kelly Bonyata, BS, IBCLC

Is this a problem?
Why does it happen?
Evening things up
Persuading baby to nurse better on the less preferred side
Will baby get enough milk?

Is this a problem?

Most women notice differences in milk supply, pumping output, milk flow and/or size between breasts. As with many other things (foot size, ring size, eyesight, etc.) asymmetry is normal in humans. In some women the difference between breasts is hardly noticeable; in others it is very noticeable. There is every variation in between. This is not usually a problem in terms of the breastfeeding relationship, so you certainly don’t need to do anything about it if the asymmetry does not bother you or baby; however some mothers prefer to even things out, particularly if there is a very noticable difference in breast size.

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.

Why does it happen?

Possible reasons for variations in supply/milk flow between breasts:

Normal anatomical differences. All women have one breast that has more working ducts and alveoli than the other (usually the left side, though either is normal). Some women also have differences between the two areola/nipples (inverted, flat, different shape/size) which make it easier for baby to latch on to one side than the other.
Baby’s preference for one side. Most babies have a side preference to some extent. From the start, your baby may feel more comfortable being held on one side and therefore nurse it more efficiently and/or more frequently.
Mother’s preference for one side. Mom (consciously or subconsciously) may offer one side more than the other because she feels more comfortable nursing on that side.
Breast surgery or injury. If one breast was ever operated on or injured in any way, supply and/or milk flow can be affected.

If your newborn is refusing one side, have her doctor do a good physical exam to check for birth injuries. Some babies will have an injury that goes unnoticed at birth, but causes baby discomfort when in certain nursing positions.

If baby suddenly begins to refuse one side, it could be caused by an ear infection or other illness in baby (making nursing painful or uncomfortable on that side), an injury to baby (or something else, such as a sore immunization site) that makes nursing painful in that position, or a breast infection in that breast (which can make the milk taste salty). Many babies who refuse one side do so because mom has a much faster or slower letdown on one side (baby might prefer either the faster or slower flow). If all other possible causes are ruled out and baby continues to refuse one side, then consider seeing your doctor just to rule out any breast problems.

Evening things up

It is fine to just do nothing, but if the lopsidedness is bothering you, you can try to increase milk supply on the smaller side to increase the supply/breast size/milk flow on that side. Be careful, though, not to neglect the larger producing breast too much and allow too much backup of milk in that breast, because that may make you vulnerable to plugged ducts and mastitis.

Here are some things that can help to even things up (you don’t need to do them all; start off with the one thing that looks most workable for you):

Start baby on the smaller side for each feeding for a few days (baby usually nurses more vigorously on the first breast offered).
Nurse on the smaller side twice as often. For instance if you nurse on one side per feeding, you might nurse on the small side for two feedings, the larger side for one, then back to the smaller side for the next two feedings, etc.
Pump the smaller side for 5-10 minutes after some feedings.
Add an extra pumping session (for 10-20 minutes – smaller side only) in between feedings.

If the larger side becomes overfull, express just enough milk to relieve the pressure. Most mothers notice an “evening out” of some proportion within 3-5 days of doing these things. Most moms use these measures for a short time only, until they get the desired results, but others continue long-term.

There may always be a small degree of difference in breast size – at least to your own eyes. If there is an obvious difference in appearance through your clothing, you may want want to use nursing pads to give a more even appearance. Usually a difference in size is much more noticeable to you than to anyone else.

Persuading baby to nurse better on the less preferred side

Try starting your baby on the preferred breast and then once let-down occurs, slide her over to the other side without changing the position of her body. For example, start her in the cradle position and then slide her over into the football position.
Continue to try different nursing positions.
Offer this breast to your baby when she is just waking up but not fully awake or already a little sleepy. She is more likely to instinctively nurse at this time.
Nurse in a darkened and quiet room.
Offer this side with motion; i.e. walk, sway, bounce, rock, etc. until your baby starts
nursing well.
If let-down on the less preferred side is too fast or slow, follow the suggestions in Let-down Reflex: Too slow? or Forceful Let-down Reflex
If supply on the less preferred side is low, follow the suggestions above and in Increasing low milk supply.
If baby seems to want a faster flow from the less preferred side, then try doing breast compressions to speed the flow.
See the suggestions in Help — My Baby Won’t Nurse!
Patience and persistence are key. Keep trying, and praise baby when she nurses well. Most of the time a baby will take the less-preferred breast with time. If baby is refusing or nursing rarely on one side, you may need to pump this side as often as the baby is nursing the other side in order to better maintain your milk supply.

Will baby get enough milk?

Yes – your baby can get all that she needs as long as she is allowed to nurse as often as she wishes – even if you nurse exclusively on only one side. If there is simply a difference in supply between breasts, baby will adjust her nursing to compensate. Overall milk production is generally not a concern unless other factors are involved.

If baby is completely refusing one side, you’ll want to pump that side as often as she nurses to maintain supply until you get her back nursing on that side.

If all else fails, one-sided nursing is very possible as long as your baby is allowed to
nurse without restriction. The side that you are not nursing on, once allowed to “dry up,” will be smaller than the other side. This will result in some degree of lopsidedness (though it may not be obvious), but this will remedy itself once weaning occurs.

What to do if your baby is refusing one breast

It's not unusual for a baby to prefer one breast over the other, but it can be frustrating. If your baby is refusing one breast, encourage them to nurse from the less-preferred breast by always offering that breast first, when they're hungriest. You can also try offering it when your baby is just waking up and still sleepy. If they still refuse, you can successfully nurse from only one breast and pump on the other side.

Why is my baby refusing one breast?

Infants, especially newborns, may have periods of preferring one breast to the other. You may notice your baby fussing, pulling away, or simply refusing to nurse from one of your breasts.

A newborn may reject one breast because it's harder to latch on to for some reason. The rejected breast may be more engorged or have a difference in the nipple, for example.

An older baby may reject one breast because it has a low milk supply or a slower flow or letdown than the other breast. Your baby's breast preference can make the milk supply situation worse: You can end up with a low milk supply in one breast if your baby nurses more often from the other one.

Sometimes a baby will be more comfortable being held on one side than the other. If your baby seems to suddenly prefer one side, it may be because something hurts them. Maybe they have an ear infection in one ear, or maybe the side that they were just immunized on is tender, for example.

If your newborn is refusing to nurse on one side, ask their doctor to check for birth injuries. Some babies will have an injury that goes unnoticed at birth, but causes them discomfort in certain nursing positions.

If you've had surgery (or have another physical difference) in one breast, you may have a lower flow of milk in that breast. It's not common, but having cancer in a breast can also result in low milk flow. If you think that one of your breasts isn't producing as much milk as the other, talk with your healthcare provider.

What can I do if my baby only nurses on one side?

Try to gently and persistently encourage your baby to nurse at the less-preferred breast by always offering that breast first, when they're hungriest. Or, it may work better to offer that breast when your baby is partly full and sleepy.

You can also try offering the less-preferred breast when your baby is just waking up and perhaps still sleepy enough to take it. Experiment with different positions, and perhaps rock or sway your baby while nursing.

Another strategy is to start your baby on the preferred breast and then slide them over to the other breast without changing the position of their body.

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If your baby seems to want a faster flow from the less-preferred side, try doing breast compressions to speed the flow of breast milk.

If the less-preferred breast is engorged and your baby is having trouble latching on, try hand expressing or pumping just enough milk to soften the breast and make your areola compressible.

How can I avoid engorgement on one side?

If you're consistently nursing from one breast, you'll want to pump or hand express milk from the other side to avoid engorgement and keep up production. You may need to use the expressed milk to supplement your baby's feedings – though you may find one breast produces all the milk your baby needs.

Engorgement happens when a breast becomes overfilled with milk. You'll know you're getting engorged if your breast feels uncomfortably full, swollen, warm, throbbing, or painful. Your nipples may become flattened. If the swelling is severe, your breast may be so full that the skin looks shiny.

Do I need to switch breasts while breastfeeding?

If your baby is getting enough milk and their breast preference poses no real adversity for you, there's no harm in letting your baby nurse from one side only. (For example, you may want to keep nursing on one side while you pump on the other.) There are plenty of women who have nursed successfully from one breast only.

If you end up nursing on one side only, that breast may be larger than the other. But once your baby is weaned, your breasts will go back to more or less the same pre-nursing size.

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What to do if the baby takes only one breast - "Healthy baby's online cabinet"

Ksenofontova Olga Leonidovna

Deputy chief physician of MBU "EKPC"

First of all, you need to understand the question - did the baby always prefer the same breast, or had there been no problems with alternating breasts before? If a child initially has a tendency to breastfeed with one breast, it is possible that he has problems with the cervical spine and neck muscles. On the other side and at the other breast, it is simply uncomfortable or painful for him to lie. This problem will be solved by a neurologist or pediatrician during examination, and this is usually detected almost once - in the first weeks of feeding. Then, for the duration of treatment, you should choose comfortable positions for feeding at both breasts - it can be from under the arm, hanging over the baby, in a cross cradle, and so on, the main thing is that the position of the child’s body is convenient for his muscles.

If the child does not have physical health problems, the reason for the refusal of one breast may be in the formation of the refusal as such. The baby may be sucking on a pacifier and developing nipple tangles, or selectively rejecting one breast in any position because it contains too much milk. And then, at the beginning of feeding, it pours too much from it, which makes the baby refuse it in favor of another breast - softer and with less pressure. Perhaps the reason for the refusal is the psychological discomfort of the baby - it is inconvenient for the mother to reproach the child with one of the breasts. She is not so comfortable putting the baby to her chest, and he catches this on a subconscious level, refusing the “unloved” breast. Sometimes the refusal of one breast is a kind of “demonstration of strength” by the baby and a way to control the mother, a kind of whim of the baby. Sometimes the breasts can be somewhat different from one another - it is easier and easier for the baby to get milk from one breast than from the other. And then the child can refuse a more “complex” breast in favor of a simpler one.

First of all, do not panic and be nervous. With a strong nervousness of the mother, the baby may refuse the breast completely, feeling her physical and emotional stress. At the same time, the mother’s milk in a state of stress is “clamped” by oxytocin in the chest and it becomes more difficult for the baby to get it. Pull yourself together and calm down. But you need to correct breast rejection at its earliest stages, until the baby has switched to breast rejection altogether or you yourself have come to terms with the fact that you will feed from one breast for the rest of the time. First of all, you need to understand for yourself that you are the mother of this baby and you are the leader in your couple, you are the main one and you will need to decide which breast and which of the feedings you will give to the baby. Feeding on demand implies not only the requirements of the baby itself, but also the requirement of the mother - if she has chest discomfort or a feeling of breast fullness, if she needs to feed in this situation with her left or right breast. It is extremely important to understand this for yourself and follow this rule. You need to be completely confident in yourself and in the correctness of all your actions. However, in such a delicate situation as the beginning or already completed refusal of the breast, you should not go too far either, insist on your opinion and breastfeeding with a certain breast should be extremely delicate, since violence in terms of breastfeeding can turn the situation in the opposite direction to you.

How to start the process of dealing with the rejection of one breast? First of all - change the program - that is, feed the baby with the unloved breast in an unusual position for him or use non-standard places for feeding him, sometimes you can feed the child with the unloved breast on a walk, in the kitchen with the noise of working appliances, in the car while traveling on business . Do the same when feeding for falling asleep: always start feeding by offering the baby his favorite breast, and when the baby starts to fall asleep, quickly change the breast to the one that he does not take well. Offer the same breast at night. When the baby wakes up for feeding, half-asleep children are usually more willing to agree to an unloved breast, if only to cling to their favorite milk faster again. Can be used to persuade you to take an unloved breast sources of white noise hair dryer, noise or splashing of water, sounds of nature or light music. Usually, breast rejection does not last long, and if you quickly eliminate the cause of discomfort and cope with your tension within yourself, then the child will quickly again be evenly applied to one and the other breast.

If you let the situation take its course, you can get a categorical rejection of the breast because there will actually be less milk in it due to its low stimulation. Then the baby will be capricious and offended by the lack of milk when trying to suck, and over time will refuse one breast altogether. Then you will have to feed with one breast, which entails a chain of new problems, for example, the formation of different breast sizes.

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Why does the child not take one breast?

In the process of breastfeeding, a mother may encounter a situation where the child does not take the right or left breast, preferring one of them over the other. Of course, mothers become very nervous when they see that the child has stopped taking one breast. The baby can take it, make a few sucking movements, then drop the breast and start crying - and so on in a circle. Feeding a child from an "unloved" mammary gland becomes a real problem and even a reason for a woman to refuse breastfeeding.

Why doesn't the baby take the second breast?

The first step is to check the baby's health. For example, if a child from the first days or weeks of life can suckle well on the right breast, but does not take the left one, there may be problems with the cervical spine, neck muscles and the baby is uncomfortable in a certain position. After examination, a pediatrician, neurologist or orthopedist can correct such violations by prescribing massage courses, osteopathic sessions and other therapies. It is better to do this in the first months of the baby's life, so that the physical development in the future is harmonious.

Also, the child may not take the second breast if it is less comfortable for him due to the structural features of the mammary gland (the nipple is flat, too large or inverted, the flow of milk is greater or, conversely, not as strong as the baby would like).

In addition, it may be uncomfortable for the mother herself to feed on the right or left breast (for example, there is scoliosis, back pain), then the attachment may become ineffective, the mother applies to this breast less often, the flow of milk in a breast that is less “comfortable” for the mother decreases over time and the baby may begin to refuse it.

What should I do if my baby won't latch on to one breast?

Of course, you should start by looking for possible reasons for breastfeeding. Further tactics will already depend on this.

It is necessary to exclude problems with the health of the baby together with a pediatrician, neurologist or other specialists. It is very important for a mother to try to pull herself together and calm down, although this can be difficult, and to establish emotional contact with the child. It is advisable to temporarily stop using a pacifier, a bottle, in order to eliminate the occurrence of a problem due to “tangled nipples” and normalize the sucking need of the child.

If the matter is in the structural features of the mammary glands, then it is important to optimally choose suitable postures, and possibly devices for feeding.

It is very important not to waste precious time and stop the rejection at the very beginning. Unfortunately, often with the refusal of one of the breasts, sometimes the complete refusal of the child from the breast begins.

The situation when a child does not take the left or right breast, acts up at the breast, is always very unpleasant and emotionally exhausting for the family, therefore, it is often easier to cope with it together with an experienced and supportive specialist.