Fussiness at the breast reason #5: baby has a conditioned dialling up

What is a conditioned dialling up at the breast?

Conditioned dialling up at the breast is a common but distressing problem, which can often be helped. However, the sooner we can identify what's going on, and change your baby's conditioning, the better.

• By 'conditioned', I mean a habit or an association which has developed over time.

• By 'dialling up', I'm referring in shorthand to the baby's sympathetic nervous system. You can find out about the dial on your baby's sympathetic nervous system here.

A baby has a conditioned dialling up at the breast when she repeatedly begins to fuss, or becomes agitated, either when approaching the breast or during breastfeeds.

The baby signals what can seem to be disproportionate distress in response to small or undiscernible frustrations. This is not your fault, although breastfeeding women usually find this situation very upsetting.

Our aim now is to re-teach the baby that the breast is a lovely, satisfying place to be.

Do some babies actually hate being at the breast?

Human babies want to breastfeed. Even when your baby has developed a conditioned dialling up (sometimes referred to as breast aversion or breast refusal), it's not that your baby actually hates breastfeeding, though it can seem that way. A love of breastfeeding, a primordial biological drive to breastfeed, is hardwired into your baby's nervous system for many months after the birth.

It's the other way around. The longing to breastfeed is so intense, so ancient, so powerful, that when things don't go well, your little one develops a habitual (or conditioned) sensitivity or distress or tension at the breast. In this situation, the sympathetic nervous system is conditioned to dial up so high that it disrupts or overrides the powerful drive to suckle from the breast.

It's not uncommon for a baby with conditioned dialling up with the breast to start crying the minute you even lie your little one back and begin undoing your bra.

What causes 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. You are, after all, having to work with your little one's wild and creaturely nature - she has only just arrived on this planet and her nervous system is very sensitive! But there are three main causes.

1. Very commonly, undetected positional instability and breast tissue drag problems result in repeated experiences of breastfeeds which don't work in a satisfying way, causing baby to develop a conditioned dialling up at the breast. Repeated experiences of frustration at the breast quickly develop into an ongoing association of the breast with distress.

2. Any pressure to feed at all can cause or worsen conditioned dialling up in your baby. If we feel it's our job to persuade baby to take more milk from the breast, or to stop being distractible at the breast and feed, we might accidentally place our little one under pressure to stay at the breast even when it's not working for her. It's a scary situation to be in for breastfeeding women because we so much want breastfeeding to succeed, for the baby's sake. Here are two examples.

   • It's normal to accidentally pressure our baby to take milk when we're worrying about her weight. When we are worried about our baby's weight gain, it's easy to feel under pressure to get milk in. It's as if, from an evolutionary perspective, something ancient and powerful in your brain starts to say: "If you don't feed your baby, she'll die". But unfortunately, feeling under pressure to get milk into baby can backfire, and cause a conditioned dialling up.

   • A conditioned dialling up can also happen when we've been told to space out the feeds to every three hours or so, and then feel under pressure to make sure the baby has a big feed when the time comes, even if she doesn't really seem to want to. We might be hoping that a big breastfeed will help our baby sleep, for instance. But again, feeling under pressure to get milk in can backfire, and cause a conditioned dialling up.

3. I have regularly seen women over the years who attribute their baby's conditioned dialling up at the breast to a single forceful attempt to push baby on to their breast by a well-meaning health professional. From then on, the baby dialled up whenever she came close to the breast. This was the 'shape and shove' or 'ram and jam' approach often used in the past by health professionals when baby was having trouble coming on. But any use of pressure like this can seriously backfire!

What can you do to repair your baby's conditioned dialling up at the breast?

Your baby really does want to be up close to your nurturing body, inside which he was nestled and protected until a short time ago, and he really does want to be up close to and feeding from your breast. If you follow the strategies I'm suggesting, he will usually quickly unlearn his dialled up behaviours at the breast, which have been overriding his elemental need to feed from you. The sooner we take steps to repair a conditioned dialling up at the breast, the easier it is to repair.

You can help your baby unlearn the conditioned dialling up by

• Learning how to make breastfeeds as stable as possible without any breast tissue drag. It is always important to bring the baby to the breast in a way that works with his breastfeeding reflexes. You can find out more starting here.

• Side-lying breastfeeds can side-step the negative associations with sitting-up breastfeeds and offer a way of growing enjoyable breastfeeding experiences together, so that baby remembers how much she loves the breast. You can find out how to keep you little one positionally stable in a side-lying position whilst feeding here. Of course, we do want you breastfeeding as you go about your life outside the house, so this has limitations! But side-lying side-steps any fit and hold challenges that your baby may have faced whilst you fed sitting up. In the meantime, you can work on strategies for eliminating breast tissue drag and creating positional stability for your baby in the sitting-up position.

• Sleeping close to the baby at night can be very helpful when your baby has a conditioned dialling up at the breast. In the very dialled down state of night-time sleepiness, in the context of the rich sensory motor experience of contact with, or being close to, your body, her fundamental biological drive is more likely to take over. Her sympathetic nervous system is more likely to remain dialled down. You can find out about safety and bedsharing here and when it's too risky here.

• Avoiding reinforcing the conditioned dialling up at the breast, which means letting go of the breastfeed if your baby is dialling up. This means that there is no pressure on any feeding experience.

• Offering the breast frequently and flexibly, really whenever the baby is dialled down and it seems a good time for you both to try, as well as when the baby is actively cueing. Frequent, flexible offers take the pressure off any one particular feed. Breastfeeds might seem to be brief, but the most important thing is that the feed is settled and happy. Remember, it really doesn't matter if the baby has just fed - us older humans often take a little break after eating, too, before deciding we'd like something else to eat, even if it's just a morsel. You can find out more here.

• Creating as many positive, dialled-down experiences at the breast as possible. You might grow lots of opportunities for your little one to be nestling, even mouthing the breast and nipple without expectation, if that's what she wants to do. (Newborns in particular like to do this, as their breastfeeding reflexes start to switch on.) Repairing a conditioned dialling up at the breast calls upon your patience, waiting and watching and trusting that your little one has the capacity to sort the breastfeeding out without you applying pressure, thanks to millennia of hard-wiring in the brain. This might mean creating opportunities to be together skin-to-skin without feeling under any pressure to have baby feed, just so that he remembers being around your breasts is a nice place to be, with lots of smiles and eye contact and delightful closeness. You can find out about sharing your bed with baby safely here.

• This is all helped by drenching the baby in as many rich outdoor or new environmental experiences as possible (anything that is not inside your own home). Rich sensory motor experience keeps babies dialled down overall, which helps shift the settings of her sympathetic nervous system so that she is less reactive in general, and more dialled down with breastfeeds.

• It's important not to feel you have to burp the baby or hold the baby upright during or after feeds. This disrupts the pleasurable neurohormones of feeds, and can cause a conditioned dialling up. You can find out more here.

What usually doesn't work when your baby has a conditioned dialling up at the breast

Sometimes you'll receive advice when your baby has a conditioned dialling up at the breast that is not likely work. I don't recommend

• Getting into the bath for skin-to-skin. You can find out more here.

• Giving bottle or some syringed breast milk first, before offering the breast. This might seem to help at the outset, but usually makes breastfeeding problems worse, because

  • The underlying problems aren't being dealt with.

  • It can also dial baby up unnecessarily, since she has to wait while her mother organises the bottle or syringe.

• Using dummy first to calm baby down then switching to breast. This might seem to help at the outset, but usually makes breastfeeding problems worse, because the underlying problems aren't being dealt with. You can find out about pacifier use here.

Managing thoughts and feelings when your baby has a conditioned dialling up

It's normal to feel very upset when you have a baby who frequently fusses at the breast, so this is a time to be deeply compassionate towards yourself. Our mind, which tries so hard to be helpful, might be going into overdrive proposing urgent solutions or forecasting dire futures when our baby is fussy at the breast. It's normal to find yourself dreading breastfeeds when your baby has a conditioned dialling up at the breast!

It's important to have some strategies in place for managing these normal, if unhelpful, thoughts and feelings. You can find out more starting here.

Even though you've always been trying your best, your brain is likely to tell you all sorts of unhelpful things about the situation, like: “It's my fault,” or “I'm a failure,” or “If only I hadn't done such and such everything would be fine now,” or “My baby doesn't like breastfeeding,” or “My baby doesn't like me.” It's important to remember that stressed, tired brains will say these kinds of things, but you can notice what your brain wants to say, and then remember that you don't need to believe such unhelpful thoughts. That's when you return your attention to the present moment - which is all we ever really have.

You can also make room for the inevitable feelings of grief and distress, and perhaps a fear that the conditioned dialling up will never change, by noticing that you have these feelings, and letting them be there in your body as your breathe around them and through them, and again bring your attention back into the present moment, living the day step by step according to your values, as best you can.

• You can find out about conditioned dialling up in the first 16 weeks of life here.

• You can find out about conditioned dialling up in babies and toddlers more generally and how to prevent it here.

Recommended resources

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

About conditioned dialling up and how to prevent it.