Common Breastfeeding Problems

The road to a successful, satisfying, mutually beneficial breastfeeding routine is often complicated by bumps and swerves along the way. The early days, when you may be at your most tender, can be particularly rough: Your body is still recovering from labor and delivery. You and your baby are struggling to learn the finer points of latching on, which are so essential to breastfeeding success. You’re also adjusting to each other’s nursing supply and demand. You’re sleep deprived. Friends and relatives, in-laws and neighbors, everyone seems to have an opinion about what you should be doing and how you should be doing it. And you’re just trying to learn as much as you can about who this tiny new person, all snuggled in next to you, is.

Add to that the breast soreness, nipple pain, the need to respond to middle of the night cries, and a body that feels like it belongs to someone else completely – perhaps even more than it did when you were pregnant – and you have a lot of factors challenging your preciously regarded pre-childbirth image of yourself, with baby at breast, in the happy still of the night, breastfeeding contentedly by the light of the moon, gently humming a lullaby to your satisfied infant.

True, there are probably some new mothers who do waltz right into that idyllic scene. But many new moms limp there, feeling engorged, massaging their way through blocked milk ducts, gritting their teeth through cracked, sore nipples, wondering if that broccoli they ate the dinner before is what’s making their infant howl through the night. But either way, if you muddle through – past whatever common breastfeeding problems may await you – you may get to the promised land.

Remember a few things: Get help when you need to. Talk to your healthcare provider. Find a lactation consultant. Get advice from a trusted friend or experienced mom. Keep that happy picture in your head, and think about what a great thing you’re doing for your baby, passing on all those antibodies and bonding skin-to-skin. Forgive yourself for the things you aren’t doing, and feel proud for the things that you are. Because breastfeeding can be hard, it can be challenging, and sometimes, it can be painful, but it can also be pure, total, unadulterated bliss. Honest.

Leaking

Problem: Your letdown response is completely out of control. When you nurse your infant on one breast, the other breast leaks so extremely that you turn into a sopping mess. Or whenever you even think of your baby’s soft little head, milk just seems to pour from your breasts, soaking your clothing and causing you embarrassment when you’re out in the world or away from your baby and unable to nurse right away. What can you do?

Solution: First of all, know that leaking or spraying breasts is a totally natural – and not uncommon – occurrence for mothers who are breastfeeding. In fact, some mothers’ breasts even leak during pregnancy. And while not every mother leaks, whether during a feeding or at other times, many, many women do. Mornings, when milk supplies are at their height, seem to be a particularly prime time for leakage. It can happen when your breasts are so full that the milk simply overflows or when something unexpectedly triggers your letdown reflex.

The good news is that, for many women, leaking is most extreme in the early weeks of breastfeeding and then abates as their bodies adjust to their baby’s feeding schedule, often after about six to 10 weeks. For some women, though, the issue does not go away altogether or sneaks up on them when they’re not expecting it.

Although you may not be able to stop your breasts from leaking, you can do a few things to minimize the effect:

1. Nurse or express milk (by hand or by pumping) before your breasts get too full.
2. Wear breast pads – cloth or cotton disposable (without the plastic liners as these can cause problems and promote infection) – in your nursing bra. Be sure to change damp pads often to prevent the growth of bacteria. Keep extra pads with you in your purse or your diaper bag.
3. Keep an absorbent cloth – like a soft, cloth diaper – with you when you nurse your infant or pump if you tend to leak from one side while you nurse from the other.
4. Dress accordingly: Wear washable clothes that won’t easily stain. Some women try to wear print tops in order to camouflage leakage. Bring an extra shirt with you – or perhaps a cardigan sweater, scarf or jacket for a quick cover-up when needed.
5. When you sense letdown occurring at an inopportune time, cross your arms to apply pressure to your breasts. (Or, if you can do it discreetly, press on them with the palms of your hands.) This may help stop the flow of milk.

Nipple confusion

Problem: You’ve recently begun giving your breastfeeding infant a bottle. Your baby adjusted pretty well to the bottle, but now seems to have trouble when you try to breastfeed. All that progress you made mastering the fine art of the latch appears to have been forgotten. What’s going on? And what can you do about it?

Solution: For your infant, as well as perhaps for you, breastfeeding can be a bit more challenging – or should we say differently challenging – than sucking milk from a bottle. In general, your baby needs to suck more vigorously, use more muscles and master different tongue motions to get milk from your breast than from a bottle. Babies have to open their mouths wider and work a little harder to breastfeed, and so, if they have grown used to sucking on a bottle or pacifier, they may become frustrated, cry or outright refuse to nurse. And if your baby goes on a hunger strike or encounters serious nursing difficulties, his weight gain may slow, your breasts may become engorged, and, if it goes on for a while, your milk supply may decrease, further exacerbating your baby’s frustration.

To prevent this from occurring, experts recommend that mothers avoid introducing artificial nipples or pacifiers until well after breastfeeding is established with their infants, especially if you’ve encountered trouble mastering the latch and are still trying to settle into your supply-and-demand routine. It’s worth noting that some babies seem to have no problem at all switching from breast to bottle and back again, and lots of babies are happy to suck a pacifier periodically with no deleterious effects on their interest in nursing or the mastering of its logistics. And generally speaking, once nursing has been fully established, the danger of nipple confusion is greatly decreased, and you can give your breastfeeding baby a bottle without fear of potentially setting off a chain of difficult events.

If you do need to give your baby a bottle early on, some experts recommend “finger feeding” with a supplemental nursing system as an alternative that may help head off the prospects of nipple confusion. Created with the idea sucking on a finger is more similar to sucking on a breast for your infant than sucking on the nipple of a bottle would be, these systems enable you or another caregiver to tape a tiny tube to your little finger through which your infant can suck expressed breast milk.

And if your baby already has nipple confusion? Don’t worry. Though it may be tough-going in the short term, you’ll probably be able to reestablish your breastfeeding routine if you give it your all. Just return to the breast exclusively, if possible, offering your baby a chance to nurse at every feeding, and steer clear of bottles or pacifiers until you get back in the swing of breastfeeding. Try to feed your baby before hunger kicks in too hard, as this can make babies more fussy, making it harder for them to latch on. Try to relax about the whole thing, and if the problems don’t seem to be letting up – and you’re concerned that your infant may not be getting enough milk – call your pediatrician. He or she may be able to offer guidance and advice or to recommend a lactation consultant who can help see you through the rough patch and get back on track with breastfeeding.

Also note: It may be better to call in help sooner than later. The longer the feeding problems continue, the more likely it is to keep your baby from getting the nutrients he needs and that your milk supply will begin to diminish. Don’t panic, but do try to nip nipple confusion in the bud as quickly as possible.

Cracked and sore nipples

Problem: Not to put too fine a point on it, but your nipples are killing you. They’re sore not only after every feeding, but – ugh – pretty much a constant irritation. They look red and pointy, not round and smooth. And when your baby latches on, the pain is unimaginable. You don’t know how much longer you can keep this up! Is this normal? What should you do?

Solution: First of all, go out and get yourself one of the lanolin-based creams marketed especially for nipples that become inflamed while nursing: Lansinoh, Belli Cosmetics Pure Comfort Nursing Cream or PureLan 100 Nipple Cream by Medela are all good options. Also, avoid using soap on your breasts when you bathe or shower, since that can further dry and irritate your nipples. Just wash with plain water. Some experts note that breast milk itself can also help reduce inflammation and soreness and recommend letting some breast milk air dry on your breasts after you nurse your infant.

But those all treat the symptoms of what may be a bigger problem: a bad latch.

Sore, inflamed nipples are often an indication that your baby may not be latching on – connecting to your breast – correctly. Ideally, your baby will open his or her mouth very wide and clamp on around a large amount of breast tissue, so that your nipple ends up in the very back of his or her mouth, where the hard palate meets the soft palate.

When your baby latches on with a wide mouth and takes in as much of the breast as possible, you’ll feel less of a pinch. If your infant doesn’t open wide and takes in only the nipple, you’re going to feel a pinch every time his or her tongue comes up. Plus, since your baby isn’t getting as much milk, the pull may feel more extreme.

Make sure you get a good latch by inserting your finger into the corner of your baby’s mouth – between the baby’s mouth and your breast – to break the latch. Then try again, putting the breast in the baby’s mouth when the mouth is at its very widest. Try to get the baby to take at least one inch of your areola into his or her mouth.

Low Milk Supply

Problem: Your baby keeps nursing and nursing and you’re worried he’s not getting enough milk. As soon as he pops off the breast, he seems to be hungry again. Are you not producing enough breast milk to keep him satisfied? Is your milk supply low? What should you do?

Solution: Relax. Most mothers go through a period in which they wonder whether their milk supply is up to the task of feeding their hungry, hungry infants, especially in the early days. And while it’s true that some mothers are unable to produce enough to meet the demands of their growing babies, inadequate milk supplies are rare, experts say. Your body may be going through a period of adjustment to meet your baby’s changing needs – he may be going through a growth spurt – but in all likelihood, it will rally and produce just the right amount of milk to do so. If your baby is continuing to develop and gain weight on schedule, everything’s probably just fine. Just keep nursing him on demand, even if that demand seems constant.

However, while it’s true that in most cases, regular breastfeeding will correct any disconnect between a baby’s demands and a mother’s supply, in rare cases – about 2 to 5 percent of breastfeeding moms – a baby really does need more milk than his mother is able to provide. If you think this is the case, you should consult you child’s healthcare provider.

In many cases, low milk supply may result from early breastfeeding difficulties – mastering latch on, a baby who just doesn’t seem all that interested in eating, nipple pain that’s gotten in the way. These problems may be temporary and correctible with regular, diligent breastfeeding.

How can you tell if your baby is getting enough to eat?

• Weight gain: Make sure your baby’s gaining weight at a rate of about an ounce per day for the first three months (after the initial newborn weight loss in the first few days of life, which is common), and then about half an ounce per day for the next three months. If your breastfeeding baby is gaining weight at this rate, he’s probably getting enough milk.
• Elimination: Is your baby pooping regularly? During the first month, he should be moving his bowels at least three times per day. After that, he may poop less frequently, but if he’s pooping every day or two, you’re probably OK. He should also have about five or six wet diapers a day, if you’re using disposable diapers, and seven to eight, if you’re using cloth.
• Nursing frequently and well: If your baby is nursing every two to three hours and is getting in at least eight to 12 sessions a day, and if he appears to be swallowing and you see signs of milk in and around his mouth, those are good signs.
• Appearance and behavior: You can take comfort if your baby appears to be active and healthy.

If you don’t see these signs of adequate milk production with your child and you think your body may not be meeting his needs, call your child’s pediatrician or a certified lactation consultant – or both. For the sake of your baby (and you), you should address the problem straight away. It may simply be a matter of getting some help with your breastfeeding technique, or something physical may be at play. But either way, you shouldn’t delay getting help.

Inverted Nipples

Problem: You want to breastfeed your baby, but you have flat or inverted nipples (they don’t protrude at all from the areola when stimulated, or they retract inward), and you’ve heard that can make things difficult for an infant to latch on and nurse. Can you still breastfeed your infant? Or do you just have to let that dream go?

Solution: The good news is that, yes, in most cases, even women with flat or inverted nipples can breastfeed their babies. With correct latch-on technique – and if you don’t let your breasts become engorged – flat nipples rarely pose a problem with nursing. In certain cases, nipples that are deeply inverted can obstruct milk flow, but those cases are extremely rare. In any event, engorgement can exacerbate any problem you may have, so try to avoid letting your breasts get overly full.

There are a few things you can do to help yourself on the way to breastfeeding success:

While you’re still pregnant

• Breast shells (AKA breast shields or milk cups or breast cups): Taking advantage of your skin’s natural elasticity during pregnancy, these plastic devices apply a gentle, constant pressure to the areola to gradually bring out the nipple. Worn inside the bra, ideally starting in the third trimester of pregnancy, you can gradually increase the amount of time you wear the shells each day as you become comfortable with them. They can also be worn after the baby is born about a half-hour before nursing in order to continue to draw out the nipple.
• Hoffman’s technique: Some experts recommend massaging your breasts several times a day in a particular way to loosen adhesions at the nipple’s base and allow them to protrude. To do this, put your thumbs on each side of the nipple at its base, then push in firmly against your breast tissue while pulling your thumbs away from each other in order to stretch the nipple and loosen any tightness at its base. Repeat the exercise five times a day, working around the breast clockwise. This can be done both during pregnancy – generally beginning in your final month – and after breastfeeding has begun. (Take note: You might not want to use this technique if your pregnancy is high-risk. Nipple stimulation can cause your uterus to contract.)

After you give birth

• Use a breast pump: A breast pump can help draw out a flat or inverted nipple. Some women find that if that they use it immediately before nursing their infant, it can make it easier for the baby to latch on.
• Breast shields: As noted above, wearing them for 30 minutes prior to nursing can help draw out flat or inverted nipples for an easier latch.
• Ice: Some women find that they can draw out their nipples by applying ice to them prior to nursing.
• Get help, if you need it: Remember, your priority is feeding your baby in the healthiest way possible. Don’t be afraid to talk to your healthcare provider or a certified lactation consultant in order to get the help you need.

Breast Engorgement

Problem: It’s only been a few days since you gave birth, and suddenly you’re experiencing a miserable pain in your breasts. They feel hard and lumpy and swollen and tender at the same time. They throb. They fill up till they’re ridiculously full. Even your armpit hurts. Not only that, you seem to be running a low fever. What’s going on? And what can you do about it?

Solution: What you have, friend, is breast engorgement. Your milk has come in, blood is flowing into your breasts and the tissues are a bit swollen. Some new moms experience engorgement when their milk first comes in, usually within 72 hours of giving birth though engorgement can happen later as well but other moms’ milk comes in without the pain and suffering. Either way, don’t worry: It’s miserable, but it won’t last.

Here’s how to handle breast engorgement:

1. Try to remember, through your discomfort, that your milk coming in is a good thing: It means you can feed your infant. Soon you and your baby will adjust to each other’s needs, and your milk production will recalibrate itself accordingly.
2. Nurse frequently – at least every two to three hours, even if it means waking your baby for a feeding. It’s important to get into a good rhythm as soon as possible. And as your baby nurses, gently massage your engorged breasts to encourage milk flow.
3. Make sure your nursing bra is giving you adequate support – and you might even want to wear a light nursing bra to sleep at night for a little extra support.
4. Because it can be difficult for an infant to latch on to a breast that is engorged, try to hand express a little milk, if you can, to soften it a bit before trying to nurse. If you need to use a pump to express milk, don’t pump too much: This could stimulate your milk production even further, exacerbating the problem.
5. Some women find ice packs – applied after nursing – help soothe the swelling. Others swear by green cabbage leaves, applied directly to the breasts (yes, seriously). An over-the-counter pain reliever, like ibuprofen or acetaminophen, may also help relieve the pain. (Don’t apply heat to your breasts; it may make things worse.)
6. Keep a healthy perspective: If you nurse your baby consistently, engorgement usually relents in a day or two and your breasts, while still full of nourishing milk for your infant, will soften a bit.

Blocked Milk Ducts

Problem: You’ve been nursing for a while, and everything seems to be going along OK, but suddenly you notice a small, hard, tender lump on your breast. It hurts to touch it, and it looks a little red and inflamed, too. In fact, you feel kind of tired and achy all over. You may even have a low fever. What’s going on? And what can you do about it?

Solution: Sounds like you have a blocked (or clogged or plugged) milk duct. These can develop when your milk fails to drain from the breast completely during a nursing or pumping session. Contributing factors can include an overly constrictive nursing bra, feedings that have been skipped or interrupted before they are complete, a pump that’s not doing its job properly, stress or illness. Or it could be happening for no clear reason at all. No matter the cause, you should deal with a blocked milk duct right away to prevent it from developing into an infection.

Here are some tips on dealing with a blocked milk duct:

1. Nurse frequently and be sure to empty the breast completely during a breastfeeding session. It also helps to massage your breast, working from the sore spot down towards the nipple to encourage milk flow. You may also want to encourage flow by applying a warm compress to your breast before nursing.
2. Change your nursing position. If you’ve been favoring the cradle hold, switch to the football hold. If you’ve been wedded to the cross-cradle, try the side-lying position. This can help redirect the area of the breast to which your child is applying suction. Some women find that shifting position so the baby’s chin is directed at the blocked duct helps provide relief.
3. In the interest of preventing another blocked duct, check your bra for a proper fit and nurse your baby regularly. Try not to miss feedings.
4. Don’t worry about your baby catching an infection from you: Breast milk, amazing stuff that it is, is antibacterial, so your baby is well-protected.
5. If the problem continues – if fever remains for longer than 24 hours or the pain just isn’t going away – consult your healthcare provider. He or she may be able to provide you with help.

Breast Infection (Mastitis)

Problem: Your breasts are red, hard, sore and … hot. It feels like you may have a blocked milk duct, only way, way worse. Not only that, you feel more than anything like you have a miserable flu: chills, fever, exhaustion that’s not just a result of the usual sleep-deprivation. What’s going on? And what can you do about it?

Solution: You may be among the one in 20 breastfeeding mothers who develop a breast infection called mastitis. (Lucky you.) It’s often caused by germs being transferred from your infant’s mouth to a milk duct in your breast via a crack in your nipple – or it can happen as a result of engorgement. Exhaustion and stress can also make you more vulnerable to infection. Though mastitis can strike a breastfeeding mom at any time, it generally arrives anywhere from 10 days to four weeks after you begin nursing your baby.

Tips on treating mastitis:

1. Apply moist heat to your breasts.
2. Nurse your baby more frequently – making sure your baby completely empties the breast during a session – even if nursing is painful. (Don’t worry, your infant won’t catch your infection: Breast milk has antibacterial qualities to protect nursing babies.)
3. Treat the pain with an over-the-counter pain medication like ibuprofen.

Important:If symptoms don’t improve within 12 to 24 hours, call your healthcare provider. He or she may opt to treat you with antibiotics – as well as lots of rest – which should begin to alleviate your symptoms in a couple of days. Make sure you take the full dose of antibiotics as prescribed to prevent a reoccurrence of infection. If the antibiotics don’t help within a couple of days – if your fever remains and your breast is still sore and tender – let your healthcare provider know immediately. If left untreated, mastitis can develop into a breast abscess, which may require surgery, so it’s best to address the problem right away, before further complications occur.

Prevention:Eat healthily, sleep well, and try not to get too stressed out. Oh, and make sure your baby – or your pump – thoroughly drains each breast during a feeding.

Fussy Baby

Problem: My baby and I seem to have mastered breastfeeding, but lately, he’s seemed extra fussy. A friend told me that his temperament could have something to do with my diet. Is that true? And if so, what can I do about it?

Solution: Many women find that they can eat pretty much whatever they want while breastfeeding – without any effect on their babies – though it’s generally a good idea to avoid nursing after, say, drinking alcohol. Others find their baby becoming uncomfortably gassy after his mother eats certain foods. Of course, a little gassiness on your baby’s part is nothing to worry about – all babies, like all people, pass gas sometimes; what we’re talking about here are consistent signs of discomfort after you eat a specific food.

Figuring out which food is the culprit may not be easy: Is dairy causing your baby problems? Is your baby responding to wheat, corn, fish, eggs or peanuts? To determine what your baby’s food sensitivity might be, keep track of what you eat and begin to systematically eliminate one sort of food at a time, for a week or two each (it takes a while for a food to completely clear your system), noting your baby’s response. If your baby’s disposition improves, you may have tracked down the right suspect. Reintroduce the food to see if the behavior returns; if so, you know which food to eliminate for a longer period of time.

Here’s a list of foods that most often produce colicky behavior in breastfeeding babies:

• Dairy products: milk, cheese, ice cream
• Caffeine: coffee, tea, soda
• Certain vegetables: broccoli, cauliflower, cabbage, onions, green peppers
• Tomatoes
• Soy products: soybeans, soy milk, tofu
• Nuts (including peanuts)
• Shellfish
• Chocolate
• Citrus fruits: oranges, grapefruits, lemons
• Wheat
• Chicken
• Beef
• Eggs
• Corn
• Prenatal vitamins

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