Breast rejection: a little-appreciated cause of lactation failure

Breast rejection is a common cause of breast-feeding failure. We describe 51 mother-infant pairs who visited the Hospital for Sick Children breast-feeding clinic because the baby refused to take the breast. Management was successful in 21 (40%), partially successful in 11 cases (22%), and unsuccessful in 16 (31%). (Three mothers were lost to follow up.) We believe that the early introduction of bottles results in the baby's developing an ineffective suckle, which then causes frustration when the baby tries to breast-feed. Good management of breast-feeding in the newborn period involves avoiding bottles and teaching the mother proper positioning and latching, as well as signs that indicate whether her baby is getting adequate milk. A method of giving supplemental fluids without direct bottle-feeding is described.