(Originally posted on my former and now defunct Custom Made Milk blog February 27 2009. This post has been updated many times since then.)

There are many reasons why your baby might scream and cry while nursing. Here are some of the more common reasons, and the things that you can do to help keep your sanity.

FAST LETDOWN/FAST FLOW

If baby sputters and coughs before pulling off and crying, if baby spits milk all over the place, if you feel letdown immediately before your baby starts to scream, or if you frequently leak or spray milk, you might have hyperactive letdown or fast letdown.

Try nursing uphill. Lay on your back and position baby so that baby is nursing on top of you (make sure baby’s position allows him to breathe) If mom has hyperactive letdown AND baby has reflux you will want to sit baby up and make sure that baby’s belly isn’t in a squished position. Otherwise laying down/reclining in a cradle position is usually fine. Once you feel letdown, or once you’re well into the nursing session you can try sitting up. Try to avoid nursing uphill for the full session as it can cause clogged ducts or mastitis.

Fast letdown/fast flow is often accompanied by foremilk imbalance, which is covered further down.

In severe cases of fast letdown mom might find it helpful to pull baby off the breast when she feels letdown, and let the milk spray into a towel until the strongest part of the letdown is over, and then put baby back on the breast. If this doesn’t help mom might consider wearing chilled cabbage leaves in her bra for the half hour before a feeding. (Keep in mind that this can decrease supply so if you have fast letdown not accompanied by over-supply do not do this.)

If mom has oversupply or fast letdown she should examine her diet and medications to see if anything is known to increase lactation. Oatmeal in the morning, or certain medications, or other foods can cause hyperlactation and oversupply issues.

MILK FLOW IS SLOW/GROWTH SPURT/IMPATIENT NURSER/SLOW LETDOWN/IMPATIENT WAITING FOR SECOND LETDOWN/BOTTLE PREFERENCE

Babies often get frustrated with mom’s letdown when it’s slower than what they want and they’re hungry, or when they’ve finished one breast and still want more milk but don’t know how to say “ok mom, switch me to the other side!”. They might be going through a growth spurt and be frustrated with the fact that they have to nurse frequently to increase supply.. (Growth spurting babies also often cry for no reason) Or they might have gotten used to the fast flow of bottles at daycare or when dad gives baby a bottle occasionally at night.

Switch sides. Switching sides frequently does three things: It triggers faster letdown than sucking on one side would.. It lets baby get some milk from Side B while Side A is “refilling”.. AND it signals to the body that it needs to produce MORE MILK NOW. Frequent side switching is one way to increase supply. This is why in the early days of breastfeeding you frequently hear someone say ‘Nurse 10 minutes on one side, then 10 minutes on the other side”.

Then when baby pulls off Side B and screams? Switch back to Side A. During some growth spurts I was switching sides every 15 seconds. My son would suck three times, want to switch, suck two times, want to switch, etc. As long as baby is willing to latch onto the other side for even ONE SUCK, keep switching. You can massage the other breast while baby is nursing on one side to encourage faster letdown. Or you can do breast compressions on the side that baby is nursing on, to encourage faster flow of milk.

This pattern usually happens most often when baby has just woken up and is VERY hungry, or during the evening hours (also known as “witching hours” where baby is naturally cantankerous and mom’s milk supply is naturally at its lowest point of the day.

Do Not Supplement During These Periods. Supplementing when you are experiencing problems for these reasons will make them far, far worse. If you give a bottle to a baby that prefers a bottle, sometimes baby will eventually just reject the breast altogether. If you give a bottle to a baby going through a growth spurt you are telling your breasts to make LESS when they need to make MORE. If baby has never had a bottle and is frustrated with slow letdown already? He’ll be FURIOUS with it after he’s experienced the fast flow of the bottle.

REFLUX

All babies have some degree of reflux. Spitting up IS reflux. Reflux is only a problem when it is accompanied by pain or damage.

If your baby sleeps better on their belly or when elevated, frequently spits up and screams just after spitting up, is not gaining weight, has bad breath (normal baby breath smells like plain milk yogurt and never really “bad”, GERD breath is a stronger smell) etc. your baby might have GERD. Reflux can sometimes happen without spitting up and is known as “Silent reflux” where the spitup happens but is swallowed before it exits the baby’s mouth. Sometimes babies with GERD will over-eat or under-eat.

If you suspect GERD, have your pediatrician confirm the diagnosis. You might need to put your baby on anti-reflux medications or be more vigilant about keeping your baby upright. (Not just after feedings but throughout the day)

If your baby has GERD, frequent smaller feedings, burping frequently and making sure that your baby is feeding upright can be helpful. Practice with upright feeding positions such as sitting/standing with support. See if this changes your baby’s screaming at all.

Infant probiotics are sometimes helpful for babies that suffer from GERD or other problems. Make sure you get a hypoallergenic infant probiotic, some probiotics contain milk or shellfish in trace amounts which can cause problems for sensitive babies.

Another thing you should look into if your baby has GERD is the possibility that it’s food-triggered. Consider an elimination diet where you eliminate common allergens from your diet.  (see Food Allergy/Sensitivity below)

FOOD ALLERGY/SENSITIVITY/SOMETHING IN MOM’S MILK

Our milk is the purest, most hypoallergenic perfect substance known to mankind… However, things that we eat DO pass into our milk in teensie tinsey trace amounts. Most breastfeeding moms can eat whatever they want whenever they want and their baby will have no problem. Sometimes, though, something we eat will trigger a reaction in our baby. Sometimes that reaction is screaming while nursing or shortly after nursing.

A food sensitivity can be difficult to figure out. It takes 3-6 weeks for our milk to be “rid” of something. So if we eliminate milk, it might take us 3-6 weeks to see an improvement if it was milk that was triggering the problem. That’s fine if it WAS milk that was triggering the issue, but what if it was something else? Because of this, it’s best to eliminate the most likely culprits all at once, wait three to six weeks and slowly re-add them to your diet to see what it was that was causing your child’s problem. Sometimes it’s multiple things!

The most common problems are: milk/dairy, soy, nuts, caffeine (including chocolate), strawberries, and eggs (eggs, nuts and strawberries are foods that doctors recommend you wait a while before introducing as a solid food. These items can also cause reactions in a breastfed infant) Typically if you eliminate the items on that list, you’ll see an improvement in your child. Make sure you read the ingredients of foods. Sometimes milk is hiding behind “Casein” or “Whey”, or is listed as butter, cheese, etc.

If the first round of an elimination diet doesn’t solve the problems and you might have to eliminate more foods from your diet or try going on a “hypoallergenic” or “less likely to cause allergies” diet. Doctor Sears has an excellent article on elimination diets: http://www.askdrsears.com/html/4/T041200.asp (click through to get past the ad.) If your baby’s problems are severe or you are at the end of your rope, you can immediately jump into the full elimination diet for the fastest results.

Remember, if your baby is sensitive to foods that you eat, continuing to breastfeed is the BEST THING YOU CAN DO. Breast milk helps seal the baby’s gut and prevents many food problems from becoming life-long or more severe allergies. Introducing hypoallergenic formula might be tempting… Resist the temptation. It only postpones dealing with the problem. Continue to breastfeed while waiting for the dietary changes to work. Even more severe allergy symptoms such as traces of blood in the baby’s stool are not immediately dangerous to the infant so long as the baby is not becoming anemic, losing weight, or bleeding in large amounts. If your baby has severe allergy signs, go to your pediatrician immediately and request a referral to an allergy specialist and a lactation consultant that has experience dealing with allergies. The need to introduce formula is RARE, and even if this happens you can pump and dump and move back to breastmilk after you find out what was causing the problem and eliminate it.

Keep in mind that it’s not just what we eat, but what we drink, what supplements we take, and what drugs we use. Babies are frequently sensitive to caffeine, nicotine, herbal supplements, medications, teas, and other things that we take into our body. Remember to take those items into consideration when you suspect a food sensitivity or allergy.

Also keep in mind that the things we give our child can sometimes compound the problems. Your infant might be sensitive to the dye in his painkiller, for example. Or if you’re giving him gripe water or teething tablets, he might be sensitive to something in one of those things. Some infant probiotics contain milk or shellfish in trace amounts.

POSITIONING

Sometimes a baby might not like a particular position. Maybe they don’t feel supported enough, or maybe they feel cramped. If baby screams in one position, try a different one. Try the football hold, the reverse clutch, the clutch, the cradle, the dangle, the nursing-uphill, the sitting up, standing up.. Invent new positions, try those. As long as baby can comfortably latch onto the breast and is supported and able to breathe and swallow, it’s a position for breastfeeding.

GAS

If baby has upper or lower gas, baby might not want to nurse. Dangling baby belly-down over your knee (while you’re sititng up) or hipbone (while you’re laying on your side) and vigorously rubbing his back.. Laying baby on his back and pushing his legs toward his chest, bicycling his legs and alternating them, standing baby up with your hands under his armpits and his head supported, sitting baby up with your hand across his belly and leaning him forward against your hand, draping baby over your shoulder and patting/rubbing his back.. All of these methods can help deal with gas. If baby’s gas is severe and frequent, look into infant probiotics and/or infant gas drops such as Mylicon. Something you eat might also be making baby gassy. While the old story of “whatever you eat that makes you gassy will make your baby gassy” isn’t exactly true, I did find that certain foods that I ate made my baby gassy. For me it was brussel sprouts, broccoli and beans (for my first baby), dairy (for my second baby) and nothing at all for my third (She was gassy no matter what).

Fenugreek is notorious for two things: Increasing mom’s milk supply and making both mom and baby gassy. Most moms and babies are fine with fenugreek, but in some it will create explosive bowel movements and gassiness. If you’re taking fenugreek, look into an alternative supplement. The first that springs to mind is “More Milk”, a supplement made by Motherlove. Unlike Motherlove’s “More Milk Plus” which contains fenugreek, “More Milk” is fenugreek-free and may be the solution to your baby’s gassiness.

FOREMILK IMBALANCE/OVERSUPPLY

Another cause of gassiness and crying  is hypersupply or foremilk imbalance. Foremilk is quickly digested and causes gassiness and diarrhea. If baby gets too much foremilk and not enough hindmilk it requently results in gassiness and explosive green poops. The solution is to “block nurse”. Usually we use both breasts with each feeding, or alternate one breast per feeding. Block feedings are where you use one breast for a block of time.

A “three feed block” looks like this: If you feed at 10AM, 12PM and then 1:30PM you will use ONE breast for all of those feedings. Then for the next three feeds you’ll use the other breast.

A “three hour block” looks like this: From 8-11AM you will use one side. From 11AM-2PM you would use the other side. Some women need to do 4, 6, or even 8 hour blocks to see a reduction in supply.

This can cause engorgement in the unused breast. Use a breast pump or hand expression to express JUST ENOUGH milk to relieve discomfort and engorgement. Pumping off too much milk will keep your supply high. The goal of block feeding is to decrease your supply so that your baby can get the “hindmilk”. Once your baby’s gassiness/fussiness decreases go back to your usual feeding patterns or use one breast per feeding unless the baby pulls off and requests the second breast.

Some moms might need to pump the unused side a bit more at the end of the block and then wean off of the pump otherwise the baby has issues taking the unused side for the first few feeds. I had to pump 3oz off my unused side at the end of each block. I gradually weaned that down to 2oz and then not pumping at all. Then once the block feeding worked and baby wanted to feed off of both sides again, I eliminated block feeding completely.

If mom has oversupply or fast letdown she should examine her diet and medications to see if anything is known to increase lactation. Oatmeal in the morning, or certain medications, or other foods can cause hyperlactation and oversupply issues.

BOREDOM

If baby seems to be popping off to look at interesting things around them, baby might be hungry but just too  interested in what is going on around them. This is common in older infants that have discovered the world but that haven’t figured out how to nurse and take the world in at the same time. Try moving someplace more quiet/less distracting, putting a barrier between baby and the world, or removing a cover-up that is blocking baby’s view. Try distracting the baby with a nursing necklace or a toy or a little book, or by talking to the baby and playing games with the baby while nursing.

You can also try walking around with baby while baby nurses. If baby’s bored sometimes walking or dancing with them while they nurse is what they need to settle down and latch on.

TEMPERATURE

If baby is too hot or too cold, baby might scream instead of nursing. Check your baby’s hands, are they cold? Skin to skin contact is the best way to solve this. Strip baby down to his diaper and take off your shirt/bra and snuggle under a blanket with baby until he’s warm. Check your baby for signs that he’s too warm- nursing can work up a LOT of heat in a little guy! My son would become overheated very easily and even in the dead of winter he preferred to nurse in just a short-sleeved onesie and socks. During the summer it was hard to convince him to nurse when it was hot out and I’d use a damp washcloth to wipe his face and his pulse points (inside of elbows, inside of wrists, inside of ankles/knees, neck) and this would help him cool down enough to nurse. Make sure that you keep baby out of the sun! My middle child wanted to be warm when he nursed and loved to be inside of a 100% cotton sleeper covered by a 100% cotton blanket. My third child was happy as long as she wasn’t sweating or very cold.

BABY IS OVERTIRED

If your baby is overtired, often he will not want to nurse or will be too upset to nurse. Often an overtired baby will want to nurse for comfort, but will be too distraught to do so. Try dancing with your baby in a quiet dimly lit room and making shushing sounds. Sometimes nursing while dancing can help. Sometimes putting your baby in a baby carrier or the stroller and going for a walk will help the overtired baby fall asleep. My daughter when she was overtired needed to be skin to skin side-laying in our bed tucked under the sheets. My middle child would not nurse when overtired and would need to be bounced to sleep. He’d usually wake up fifteen minutes later and nurse ravenously and then fall back to sleep again.

BABY NEEDS DIAPER CHANGE

It’s common for a breastfed baby to either pee or poo while breastfeeding. Some babies find the sensation to be uncomfortable and want to be changed immediately. Check and see if your baby needs a diaper change.

BABY WANTS TO COMFORT SUCK BUT DOES NOT WANT MILK

Sometimes baby will want to comfort suck but doesn’t want milk. This is usually not a problem as most babies quickly discover how to suckle “shallowly” in a way that does not bring milk out. If mom has hyperactive letdown, or if baby can’t quite figure out how to suck without getting milk, the result can be one pissed off baby. For some babies pacifiers are helpful. Try not to introduce a pacifier before 6 weeks. If you do introduce a pacifier make sure that you use it only sparringly, offer it only after baby has eaten, and be on the lookout for signs of nipple confusion. My daughter would not take a pacifier and when I had oversupply I would sometimes have to pump out an ounce of milk or so and then let her nurse for comfort. (This increases your milk supply so avoid pumping like this if you can, and combine it with block feeding to decrease supply.)

BABY IS SENSITIVE TO BODY LOTION OR PERFUME MOM USES

Anyone can be sensitive to smells, and newborns are particularly prone to becoming overwhelmed by smells. If mom is using a new perfume or lotion, or if mom’s clothes smell different than usual it can either upset baby because mom doesn’t smell familiar and comforting, or it can irritate baby’s nose.

Try washing your clothes with the same hypoallergenic detergent that you use to wash your baby’s clothes, eliminate any perfumes and use your baby’s shampoo to wash your hair and skin for a few days. See if that improves the problem at all. Make sure you never use any soap on your breasts as it can deplete your breasts natural antibacterial oils and cause breast infections as well as be upsetting to your baby. Use warm water only.

MOM IS STRESSED

Babies are experts at picking up on stress. If mom is stressed, baby might be reacting to that. Try taking a deep breath, and letting go of whatever is stressing you. Listen to soothing music, relax, imbibe in something that soothes you. If all else fails, give yourself permission to eat that snack that you know you shouldn’t eat but that always makes you feel better. Or tell yourself that later that night you’re going to take a long warm bubble bath. Yoga breathing or deep breathing can help calm mom, and making low deep sounds such as “ohm” or humming can help soothe baby. If you’re really really having a hard time ask someone else to hold the baby, take a few minutes to breathe, and then try again.

URINARY TRACT INFECTION

If your baby has a UTI, sometimes this can cause distress while nursing. Babies often pee as they nurse. Try nursing your baby naked and diaper-free on top of a waterproof pad and see if the screaming coincides with urination at all. Sometimes the only symptom of a UTI is discomfort while nursing. Some babies will only scream while peeing if they’re nursing. Something about the feeding + pain is more agitating to them than the pain alone.

PLUGGED DUCT/ENGORGEMENT/MASTITIS

If mom has a breast problem, sometimes the baby can become upset while nursing. A plugged duct can work its way out and taste awful. Mastitis can cause the milk to have a slightly metallic taste, or engorgement can cause the baby to have a hard time latching on.

The solution for plugged ducts, engorgement and mastitis are: Nurse, and nurse more often. If baby is seriously freaking out about the problem and you know that you have mastitis, engorgement or a plugged duct, try pumping for either 5 minutes or 1 ounce, and then nursing again.

TEETHING

If baby’s gums are sore from teething, sometimes he’ll pop off and scream because he can’t get a comfortable latch. Try different positions to see if there’s another position that doesn’t put pressure on your baby’s gums. You can offer an iced teether or washcloth for 10 minutes before feeding, or rub a tiny amount of baby orajel or another gum-number on the problem spot before nursing (be careful that it’s a SMALL amount). If baby is very hungry and cannot nurse comfortably because he’s cutting a tooth it can be beneficial to give him a quarter or  half a dose of infant motrin or tylenol 15-20 minutes before nursing. This will dull the pain for him. A full dose is not usually necessary. Teething tablets or teething drops might also help, just make sure that you observe your baby’s behavior to make sure that he’s not sensitive to one of the ingredients. (Many teething tablets contain lactose as a base, and teething drops often contain herbs such as chamomile which some babies can be allergic to.)

EAR INFECTION

If your baby has an ear infection, nursing can be painful as suckling creates pressure. Baby should not be forced to nurse if his ears are bothering him. Instead, there are a few things you can try: Warm up some olive oil to slightly above body temperature (you should be able to stick your finger in it and hold it there comfortably without it hurting). Drip a drop or two of this into baby’s ear. Massage his ear and pull on the lobe to get it down near the eardrum. The warmth of the oil relaxes the drum.You can also massage just behind the ear lobe and under the jawbone- feel the spot yourself, you’ll feel a sensation in your ears when you hit the right spot.  I found massaging that area on my son helped with ear infections.   If it’s an external/outer-ear infection dropping some breast milk into the ear can be beneficial. An older child (over one year old) can drink a sweetened goldenseal-echinecea tea concoction which helps with ear infections. Ear ache homeopathic tablets might also help your child. A warm moist heat source such as a cornbag or rice sock placed over your child’s ear can also be beneficial in relieving pain. Just make sure it’s not too hot! Shake it around to make sure that the kernels are evenly heated and put it against some sensitive part of your body such as your breasts or belly and hold it there for 2-5 minutes just to make sure that the heat doesn’t build up on you.

If baby is hungry and refusing to nurse because of the pain of an ear infection you should bring him to see a doctor. A quarter to a full dose of infant tylenol or motrin might help ease the pain and let your child nurse.

The good news is that breastfeeding helps reduce the risk of ear infections, and nursing helps to drain the tubes. Keep on nursing!

MUSCULAR/NERVE/SKELETAL ALIGNMENT ISSUE OR BIRTH INJURY

Some babies are born with alignment issues or muscle stiffness, or they may have a fractured collarbone, pinched nerve or something similar from a difficult birth. Sometimes this is a minor injury that happens during birth, sometimes it’s a condition that the baby was born with such as Torticollosis.

If the problem with nursing is new and transient it may help the baby to nurse in a different position. (Ever wake up with a stiff neck? It is comfortable to turn your head in certain directions and not in others.) If the problem is consistent, such as the baby always rejecting one side, then physical therapy, an osteopath or a chiropractic skilled with working with infants may be beneficial. (Chiropractics that work with infants do not do “back cracking”, they generally work with positioning and firm massage. Never take a child to a chiropractor who is not skilled with working with infants.)

MISCELLANY

Sometimes babies will just freak out because of something that is bothering them. Who wants to eat if they have an itch they can’t scratch, or if every time they’re laying down the tag on the inside of their pj’s is bothering them? If a light is shining from above RIGHT IN THEIR EYES or if the TV is making a loud high-pitched noise that infants can hear but that adult ears have become deafened to?

If you can’t find another reason for your baby’s upset, look at the environment. Try nursing skin to skin with no nursing pillow, blanket, or clothes between you and your baby. Try wrapping a cloth diaper or towel around your baby to eliminate disposable diaper as the cause of your baby’s distress.

Shut off the lights, shut off the TV, move into a different room, turn the TV on, play music, dance while nursing, put the baby in a baby carrier and nurse that way. Strip your baby down and scratch every surface of his body lightly with your fingernails to see if that might be bothering him.

Remember also, that baby is not exempt from adult-like situations similar to restless leg or cramps. Your baby might be overwhelmed by a lack of motion, the need to move his limbs, or he might even have a cramp. See if any of baby’s muscles seem to be locked and if massaging that or applying pressure to that muscle helps the screaming. See if moving baby’s limbs around improves his mood (especially if baby is squirming or flailing), see if dancing and moving helps baby’s mood at all.

SOMETHING WE HAVEN’T COVERED?

Do you have a suggestion for something we haven’t covered? We’d love to hear it. Have you tried everything and your baby is still screaming while breastfeeding? Let us know, maybe we can find more answers for you.