Thursday, December 31, 2009

If My Baby Bites

By Barbara Taylor (1990)
Revised and adapted by Nancy Jo Bykowski (1999)
Revised and updated by Danelle Frisbie (2009)


Baby teeth may loom large in the minds of expectant mothers and those who know them. When a pregnant woman talks to others about her plans for breastfeeding, it's likely she'll encounter someone who will ask, perhaps with a smirk, "But what will you do when he gets teeth?"

Some people incorrectly assume that when a baby gets teeth it's time to wean. They may believe that baby teeth make breastfeeding painful for mothers. But as long as a baby is breastfeeding correctly, breastfeeding won't hurt, even after two, or four, or a whole mouthful of teeth have poked through baby's gums. After all, there is a reason they are referred to as milk teeth.

It's important to remember that a baby who is actively breastfeeding can't bite. When properly positioned, the mother's nipple is far back in the baby's mouth. The baby's lips and gums are positioned on the areola (the darker skin surrounding the nipple) about an inch behind the base of the nipple. The baby's tongue extends over his gums, between his lower teeth and the breast. The upper teeth may leave an imprint on the areola that is harmless, but while a baby is actively sucking and swallowing, he can't clamp down on the breast tissue. Pain occurs when baby's jaws close on the nipple instead of the areola, whether baby has teeth or not. Simply put, if the baby's nursing correctly, he can't bite, and if he is biting, he's not nursing correctly. If a baby does bite, it usually happens during latch-on, during a pause in the feeding, or at the end of the feeding when he is not actively suckling (and maybe even falling asleep).

If Baby Bites

A mother's natural response to pain may discourage further biting. Many babies startle at their mother's loud exclamation and immediately release the nipple. Some may even cry. This negative reinforcement seems to make many babies stop completely. In Mothering Your Nursing Toddler, Norma Jane Bumgarner observes,

Perhaps the reason that the vast majority of children learn not to bite so quickly is that we invariably react immediately and firmly to biting at the breast. There is probably no instance in which we apply behavior modification so immediately, decisively, and consistently. Besides, our children love us and respond to the urgency and sincerity with which we insist that they must not bite.

Such prompt and direct responses occasionally backfire with sensitive babies, who may react by refusing the breast altogether. This sudden disinterest in nursing or outright rejection of the breast is called a nursing strike. A nursing strike can be distinguished from actual weaning by its sudden onset and the fact that the baby seems miserable. It may take lots of coaxing to persuade a baby who has been "on strike" that it's okay to resume nursing. Therefore, it is wise not to exaggerate your response to biting beyond what is natural for you.

Do not try to pull your baby off the breast if he clamps down on your nipple. This causes more damage to the skin than the bite itself. Instead, slip a finger between his gums or teeth to break the suction. Leave your finger between his gums while you remove him from your breast. Another strategy is to pull him in as close as possible to the breast. This will cause him to release the nipple because babies are very sensitive to any blockage of nasal breathing. Some mothers may want to try gently pinching the baby's nose to get him to open his mouth and release the nipple.

Stop the feeding, so baby is not tempted to see if he can make you jump again. As soon as a bite or "near miss" occurs, offer your baby an object such as a teething ring or toy so he will know what is acceptable to use his teeth on (he may sincerely need to bite for teething relief). At the same time, tell him, "This is for biting. You need to be gentle when you nurse."

Some mothers may want to take firmer action after a bite and quickly sit baby down on the floor. After a few seconds of distress, baby can then be comforted and should get the message that biting brings negative consequences.

When you offer to nurse again, be extra careful about positioning and give your baby lots of positive reinforcement for good latch-on and careful release of the breast. Saying "thank you" and "good baby," and offering smiles, hugs, and kisses will go a long way toward gently teaching your baby the proper way to nurse. One mother made a game of this with her five-month-old son.

We were lying down to nurse. He released gently and I praised him. He smiled, latched on again, nursed for five seconds, and released gently and I praised him. He smiled and then latched on again. This went on for a while before I decided not to press my luck and got up and did something else with him.

Even very young babies can learn proper latch-on and positioning with gentle encouragement from their mothers.

Contributing Factors

Some babies are more persistent in their experiments with biting at the breast. Identifying the underlying causes of biting can help a mother decide on her best course of action. Some common factors that contribute to biting are teething, offering artificial nipples (such as pacifiers or bottles), low milk supply (causing frustration for a hungry baby), a baby who wants more attention, or a baby with a stuffy nose (again, frustration from not being able to nurse effectively and breathe). Whatever the underlying cause, biting is most likely to occur toward the end of a nursing, when baby's hunger is mostly satisfied and he starts to focus on other things or drift off to sleep.

When a baby is teething, his gums may be sore. They may look swollen or red. If you rub your finger over baby's gums, you can often feel a tooth that is about to erupt. Teeth occasionally come in very early and a few babies are even born with a tooth or two already erupted. For teething relief ideas, see this page.

Biting can occur if baby's nose is congested. Not having a clear airway interferes with correct suckling, and the baby tends to lose his grasp on the breast. This moves the nipple to the front of his mouth and if baby's jaws are still moving to compress the breast, he may unexpectedly bite down on the nipple. A breastfeeding baby whose nose is blocked by congestion may also turn his head from side to side while at the breast because he is frustrated at being unable to breathe. This may also cause the baby's jaws to slide toward the nipple.

If your baby has a cold or congestion that is interfering with breastfeeding, you may wish to check with your health care provider for treatment suggestions. Clearing out the mucus with a nasal syringe can provide relief for a young baby who can't blow his nose and spends much of his time on his back, although many babies don't like this and it should not be used to the point of causing baby undue distress or panic. Nursing in a more upright position may allow a baby with a stuffy nose to breathe more easily, since gravity helps the sinuses to drain.

Sometimes a baby who clamps down during nursing is asking for his mother's attention. Mothers may often find that they can read, talk on the phone, or watch television while their baby nurses and these activities are fine in moderation. However, older babies may sometimes react by doing whatever they can to recapture their mothers' attention, including clamping down at the breast. Some babies get a playful gleam in their eye just before clamping down. This kind of clamping down is most likely to occur toward the end of a nursing or when the baby wasn't that interested in nursing to begin with, he just needs his mother's attention. Babies are not being 'naughty' when they do this - they are simply using the tools they have at their disposal to tell mom that they need her to pay attention and interact with them.

Offering artificial nipples or pacifiers/dummies can contribute to biting. The mouth and tongue movements a baby uses while breastfeeding are very different from those used with artificial nipples. A baby may become confused about how to suck and start to chew at the breast rather than latching on correctly. Although sucking problems associated with artificial nipples are most common in the early weeks, they can also happen with older babies. Sometimes a baby will start to chew at the breast after learning to drink out of a cup with a spout, particularly if he tends to chew on the spout.

Another way artificial nipples can contribute to biting is that bottles of water or juice (or any supplement) given regularly often lowers milk supply. A baby may clamp down in frustration if his mother's milk supply is low. Increasing your milk supply through more frequent nursing (and always offering the breast first, before any other food/drink) should help. See the resources at the end of this article for additional information and tips on milk supply.

A subsequent pregnancy can also affect a mother's milk supply. Jamie Larson, of Cape Canaveral, Florida, USA, wrote about her experience in the March-April 1997 issue of New Beginnings. Her daughter had started biting at the age of eight months. Despite Jamie's careful attention to possible reasons and her consultation with her local Leaders, she was unable to identify a cause for Uriel's biting. Three months later, after Jamie had a miscarriage, Uriel's biting stopped suddenly and Jamie's milk supply increased dramatically. She hadn't been aware that she was pregnant and she hadn't noticed that her milk supply had dropped so much. A visit to the doctor showed that Uriel hadn't gained any weight during those months. Jamie said that after her miscarriage, Uriel gained four pounds in three weeks. Pregnancy always impacts mother's milk in one way or another - either in taste, in supply, or in quality. If you wish to nurse your child for a normal duration of time, you will need to use non-hormonal means of contraception to ensure that your milk is not impacted, and unexpected pregnancy does not follow too close to the baby you already have.

Once women's menstrual cycles return post-birth, many mothers find that their milk supply is slightly lower during their periods. The breasts may be more tender during menstruation, too, which can make nursing uncomfortable for the mother. Hormonal birth control methods may also affect a mother's milk supply, especially if they are started in the early months after birth. Other factors may be some medications and dietary supplements. Check with your local La Leche League Leader if you have any questions about whether a medication or supplement may be affecting your milk supply and do not take artificial hormones if you wish to nurse for a normal duration of time. [Note: The copper IUD is a non-hormonal birth control option that many mothers have opted for post-birth. See information on IUDs here. Other non-hormonal options include using a combination of charting (to know the weeks you are most likely to ovulate and avoid intercourse during those weeks or use additional protection during this time), condoms, spermicide like vaginal contraceptive film (VCF), and other barrier methods like Encare, diaphrams, the Today Sponge, and cervical caps.]

Another thing to consider is your baby's personality: Some babies are just more oral than others. When they start to crawl, they may put every piece of lint they find into their mouths. They like to experience the world through their sense of taste and explore textures with their tongues.

Positioning Matters

Around the age of three or four months, a baby becomes much more interested in his surroundings. Sounds such as a sibling playing nearby may intrigue him so much that he turns his head quickly to take a look. Unfortunately, he may forget to let go of the breast first and slide down onto the nipple. At any age, a baby who falls asleep while nursing may react to the nipple being withdrawn from his mouth by clamping down (be sure to always insert your finger first to break the latch and pull your nipple out before withdrawing your finger from a sleeping baby). These behaviors are somewhat reflexive and may require different coping strategies than other kinds of biting.

Older babies and toddlers may get into positions that make breastfeeding uncomfortable for their mothers. Sometimes, a baby will lean on his mother's breast in a way that puts pressure on the nipple even though his jaws are not on the nipple itself. Some active toddlers twist around while nursing and end up in contorted positions. When a toddler's mouth turns around too much, he can exert the same kind of uncomfortable, even painful, pressure. With firm guidance from their mothers, these babies can learn to curb their gymnastic impulses while nursing and breastfeed in a way that is comfortable for both mother and child.

Preventing Biting

Careful attention can prevent one biting episode from turning into a recurring problem. It can also head off biting before it even starts. Each situation is different, so you may need to try a couple of different strategies before you find one that works for you and your baby. Here are some ideas that other mothers have found helpful.

Be ready to protect your nipple when removing your baby from your breast, particularly if he's sleeping. Insert your finger into the corner of your baby's mouth far enough to come between his gums, wrap it around your nipple, and then pull out. If baby closes his jaws in a reflexive attempt to resume nursing, he'll clamp onto your finger instead of your nipple. Women who usually support their breast with one hand during nursing may find it easiest to use the index finger of that hand. Some women prefer to use their little finger. Whichever finger you use, keep the fingernail trimmed closely to prevent scraping your nipple or your baby's mouth or tender gums.

If it seems that your baby is clamping down because he wants your attention, start giving him your undivided attention from the beginning of the nursing. Touching, talking, and making eye contact let your baby know he has your full attention. Being alert helps you notice when your baby is losing interest in nursing. Play with him often. Read to him. Go on walks and point out the world. Wear him. Engage him.

You can learn to recognize when it's time to end a nursing by watching your baby's sucking pattern. Susan Meintz Maher, in the LLLI publication An Overview of Solutions to Breastfeeding and Sucking Problems, states,

By observing her baby while nursing, the mother may notice that tension develops in his jaw before he actually bites down. This can signal her to detach him before he gets a chance to bite.

Your baby may also pull his tongue back from its normal position over the lower jaw.

Pay extra attention to good positioning and latch-on techniques to help keep your baby focused on sucking and lessen the chance of biting. Be sure your baby's mouth is open wide before pulling him close and directing your nipple to the back of his mouth. Women with large breasts should be especially careful to support the breast with their free hand while baby latches on and may need to do this during the entire nursing. Keep the baby's whole body facing yours so he does not have to turn his head to nurse. A nipple latch trick for getting a good latch for proper sucking can be viewed here.

Don't force a nursing, particularly when your baby is older. Many mothers use nursing to encourage an afternoon nap, but some toddlers resist once they figure it out. If your baby is wriggling, rolling, or pushing against you with his arms, he may not be hungry or interested in nursing. If you feel your baby is just too distracted to settle down, lying down with him in a quiet room may help remind him that it's time to nurse. Walking or rocking may soothe a small, fretful baby enough to settle down to nurse, too.

If Your Nipple Is Sore

The nipple has many nerve endings and is very sensitive. Biting causes pain, while it's happening and sometimes for a while thereafter. However, much of the soreness comes from the baby pulling off the breast (or being removed from the breast) without breaking suction. If your nipple is sore, be assured that following good latch-on techniques (ones that assure that the nipple bypasses baby's lips and gums) will protect the nipple from further damage and it will heal very quickly. If just one nipple is sore, begin nursing on the opposite side first so your baby's most vigorous nursing will be at the less sore breast.

To speed healing and soothe the pain, you may express a little of your milk, apply it gently to the nipple and areola, and allow it to dry. Modified lanolin, sold under the name Lansinoh for Breastfeeding Mothers, is hypoallergenic and safe for baby (provided neither of you are sensitive to wool). There are also other organic, healing salves made by a variety of nursing-friendly companies, including work at home moms. Many mothers have found Lansinoh or related products helpful in easing nipple pain and healing nipples with a break in the skin. Gently pat the skin dry after breastfeeding, and then apply a small amount to the nipple area.

Gaining Perspective

The prospect of being bitten by your own baby can be a bit daunting, but motherhood can be hazardous at times. An enthusiastic toddler may step on your toes or knock his head against yours while giving you a hug, but that won't make you stop hugging him. You'll just take care to protect your toes and your head. The same can be true of your nipples.

Paying attention to your baby's cues is the first step in protecting yourself. Each mother will find a strategy that works for her and her baby. In Breastfeeding Pure and Simple Gwen Gotsch says:

What you do to teach your baby not to bite again depends on his age and his temperament. An older baby may be able to understand that if he bites, mother ends the feeding immediately, and there's no more nursing for a while - perhaps twenty minutes or more. This, along with mother's sudden yell of pain, may be too much for a more sensitive baby to bear, while a younger baby cannot understand the relationship between his actions and the consequences.

Patience, persistence, thoughtful observation, and sensitivity to a child's feelings are important mothering tools at any age. If your baby goes through a biting phase, be assured that it will be short-lived and you will be able to continue nursing until he outgrows the need.

~~~~

For additional information on biting and breastfeeding see:

Mothering Your Nursing Toddler [book]

Dr Sears: Tips for Biting While Breastfeeding

La Leche League: What Should I do if Baby Bites?

Australian Breastfeeding Association: Biting and Breastfeeding

Breastfeeding Basics: Teething and Biting

KellyMom: When Baby Bites


References

Bumgarner, N. J. Mothering Your Nursing Toddler. Schaumburg, Illinois: LLLI, 1982.

Brewster, P. You Can Breastfeed Your Baby... Even in Special Situations. Emmaus, Pennsylvania: Rodale Press, 1979.

Bykowski, Nancy Jo. "If your baby bites." New Beginnings, Vol. 16 No. 2, March-April 1999; 36-39.

Gotsch, G. Breastfeeding Pure and Simple. Schaumburg, IL: LLLI, 1994.

Lawrence, Ruth A. Breastfeeding: A Guide for the Medical Profession. Fifth Edition. St. Louis: C. V. Mosby Co, 1999.

Maher, Susan M. An Overview of Solutions to Breastfeeding and Sucking Problems. Schaumburg, IL: LLLI, 1988.

Mohrbacher, N. and Stock, J. The Breastfeeding Answer Book. Schaumburg, IL: LLLI, 1997.

Taylor, Barbara. "If your baby bites." New Beginnings, November-December 1990; 163-67.


~~~~

5 comments:

  1. The only time i ever really get bitten is when caden falls asleep feeding, if i try unlatching him to put him to bed he'll sometimes bite down and though it hurts like hell to me it is not a valid reason to stop breastfeeding him

    ReplyDelete
  2. ' Women with large breasts should be especially careful to support the breast with their free hand while baby latches on and may need to do this during the entire nursing. '

    Thankyou, thankyou so much! Ive always been well endowed in the chest area, and have felt very uncomfortable not supporting my breast. You are the very first person to mention this as though it is normal.

    ReplyDelete
  3. My daughter laughs at me if I yelp when she bites me, and sometimes tries to bite me again. Also, pulling her close to my breast so she couldn't breathe made her bite harder. Good article, though!

    ReplyDelete
  4. I agree with Nicole. My baby laughs when I yell. I don't think he's so much biting as just scraping his teeth on my sensitive areolas. Any tips for that?

    ReplyDelete
  5. She looks so cute. By the way I love that you posted some links about breastfeeding. I will refer some of these to my patients.

    ReplyDelete

LinkWithin

Related Posts with Thumbnails