Dr. Greene's Answer
Heather, having your baby scream at the breast must feel so disheartening. I’m sure there are many things that you imagined about how things would be between you and your baby – and probably these jarring screams were not part of the picture.
Babies tend to be at their fussiest (in all of childhood) between about 4 and 8 weeks of age. Many babies are especially fussy in the evening. There are many reasons for this. Partly, they are tired from a long day (I get crankier too, when I am sleep-deprived). Partly, the daily tides of hormones shift in the evenings – little discomforts become more noticeable (you may have noticed that most sicknesses seem worse at night).
Caffeine (think coffee, teas, sodas, Excedrin, Anacin, Midol), and caffeine-like substances (think chocolate and many cold medicines) can heighten this effect. Caffeine in the breast milk does affect babies.
When a baby is fussy at the breast, one of the first thoughts is often about foods in Mom’s diet. Apart from the caffeine issue above, most mothers can eat most foods without causing a nursing problem. Some babies are sensitive to certain foods – and you picked a good one to try stopping. Dairy (milk, eggs, ice cream, cheese), peanuts, and nuts are the most likely culprits.
Some physical problems, such as thrush or GE reflux, will cause discomfort that is most troublesome in the evening.
In general, babies who are fussy at one feeding will be less fussy if that feeding is moved half an hour earlier. This is especially effective if the baby has been asleep and you nurse before he wakes all the way up.
Sometimes swaddling the baby for the evening feeding will help – they like to feel more secure and protected in the evening. Some babies are sensitive to the cool of the evening, and wearing something warmer (especially on the feet and shoulders) might help.
Others, though, will take the evening feeding better with full skin-to-skin contact (perhaps under a blanket for added warmth). Some babies are most comfortable in the evening if the person holding them is standing up and/or swaying. Ironically, you both may feel more relaxed if you nurse standing up.
If he arches his back during feedings, though, a different nursing hold might work better. Try the football hold, to keep him in more of a ‘fetal position’, with his chin close to his chest. His bottom needs firm support, but his legs should be in the air with nothing to push against. You may need strategically positioned pillows or a nursing pillow to help.
In addition, the more that babies are gently jostled during the day, the less fussy they are in the evening. A carrier or sling may help. Singing during evening feeds helps for some babies.
I know, Heather, that you have already met with a lactation nurse, but when feedings continue to be problematic, I strongly recommend working with someone until they become easy and joyful for both you and the baby. This might be the same person, or a different lactation consultant or an experienced doula. There is no substitute for their practical wisdom, individualized to your situation.
You have my admiration, Heather, for all you have been though so far to nurse your son. You have already given him a magnificent gift that will benefit him for the rest of his life.