You may have some problems or discomforts when breastfeeding, but don’t let them get you down! They're common for breastfeeding moms and there are things you can do to resolve them. Here we give you the A-Z of common problems and solutions. If you have more questions or need help with breastfeeding, you can contact your local Beba-ks Center (also known as Women's Health Resource Center).
Blocked ducts and mastitis
A blocked duct is a painful, swollen, firm mass in the breast, often with warm red skin over the mass. Mastitis is an infection with similar symptoms but it includes a fever, is more painful and the redness/warmth over the mass is usually more intense. Blocked ducts will almost always resolve with the following basic treatment within 1-2 days after starting, but mastitis will likely require antibiotics. Make sure you resolve your blocked ducts as they can turn into mastitis. How to resolve blocked ducts:
1. Drain the affected breast fully – it is only by nursing that you will be able to clear the blockage and get the milk to flow freely again. Do this by:
- Nursing more frequently on the affected side e.g. offer the affected breast to your baby first.
- Helping your baby better drain the breast during each feed by doing breast compressions (click here for instructions) and positioning the baby so that his chin “points” to the blocked duct.
- Massaging the blocked duct (lump); press down firmly with your fingers or a fist just above the lump, then slide your fingers/fist along through the lump towards the nipple, stopping just before you reach the nipple. Continue doing this 5-10 times while nursing or when heating the affected area.
- Expressing (by hand or using a pump) the affected side if the baby does not thoroughly drain that side.
2. Apply heat to the affected area, especially before nursing. Do this by taking a warm shower or with a warm washcloth, hot water bottle or heating pad, but careful not to make it too hot and only apply heat for 5-10 minutes.
3. Try to rest and drink lots of clean water.
4. Remove your bra.
5. If using breast pads to absorb leakage, change them regularly (at least twice daily).
“Treat mastitis as you would a plugged duct (see above). Remember that it is perfectly safe to nurse your baby. Antibodies in your milk will protect your baby from any infection. Suggestions that you wean from the infected side may make matters worse. Frequent nursing will help the infection clear up more quickly.”
Source: La Leche League International, http://www.llli.org/nb/nbmarapr07p76.html
If your symptoms do not improve or worsen within 24 hours, contact your doctor.
Colic is the term used to describe uncontrollable crying in an otherwise healthy baby. Its true cause is unknown and it is no more common in breastfed versus formula-fed babies. Gas doesn't cause colic, but a colicky baby might be extra gassy because he often swallows air when he cries.
Engorgement is when your breasts swell dramatically and seem filled to bursting, most often when your milk becomes more plentiful during the first and/or second week after birth. This might make nursing on the affected breast more painful when the baby first latches on due to swelling. Usually the fullness/swelling subsides within 12-48 hours as your body adjusts and your baby drinks from your breast. “You can prevent or minimize the effects of engorgement by:
- Nursing early and often. Nurse as soon after the birth as possible, and at least ten times a day after that.
- Ensuring that your baby is positioned well and is latched on properly (click here for instructions).
- Nursing "on cue". If your baby sleeps more than two to three hours during the day or four hours at night, wake him to nurse.
- Allowing baby to finish the first breast before switching sides. This means to wait until baby falls asleep or comes off the breast on his own.
- If your baby is not nursing at all, or is not nursing well, hand expressing or pumping your milk as frequently as baby would nurse.”
If this doesn’t relieve your symptoms, you can try:
- Warm compresses: “apply a warm, moist compress and expressing some milk just before feedings. Using heat for too long will increase swelling and inflammation, so it is best to keep it brief. Cold compresses can be used between to reduce swelling and relieve pain.” Source: La Leche League International, http://www.llli.org/faq/engorgement.html
- Breast massage: “with the palm of your hand and starting from the top of your chest (just below your collar bone), gently stroke the breast downward in a circular motion, toward the nipple. This may be more effective when done while you are in the shower or while leaning over a basin of warm water and splashing water over your breasts.” Source: La Leche League International, http://www.llli.org/faq/engorgement.html
- Areola massage: with your fingers positions as shown below, press inward toward the chest wall and count slowly to 50. Pressure should be steady and firm, and gentle enough to avoid pain.
Source: K. Jean Cotterman, http://www.nbci.ca/index.php?option=com_content&view=article&id=83:engorgement&catid=5:information&Itemid=17
Cabbage compress: “rinse the inner leaves of a head of cabbage, remove the hard vein, and crush with a rolling pin (or similar). They can be used refrigerated or at room temperature. Drape leaves directly over breasts, inside the bra. Change when the leaves become wilted, or every two hours. Discontinue use if rash or other signs of allergy occur. Some reports suggest that overuse of cabbage compresses can reduce milk production, therefore discontinue the compresses when the swelling goes down.” Source: La Leche League International, http://www.llli.org/faq/engorgement.html
Contact your doctor if your symptoms do not improve after trying the above relief methods, if you have symptoms of mastitis (fever of more than 38.1°C), if your baby is unable to latch or if he does not have enough dirty diapers.
Food allergies and sensitivities
In most cases you can eat anything (spicy foods, beans, dairy, etc) because the food you eat is rarely problematic. A baby will often be gassy or fussy in the early weeks especially since milk is a new food for him (he is used to being fed through the placenta) so don’t be quick to blame your breastmilk. But, if your baby is especially fussy every time you eat a certain food then try cutting it out. Dairy (milk, cheese, yogurt, butter) is often the most common cause of problems so try cutting dairy out for a few weeks to see if there is any improvement. Symptoms of problem might include diarrhea, rash, fussiness, gas, constant spitting up or vomiting, hard stools, bloody or mucousy stools, runny nose, cough, or congestion. In the rare instance that food is causing gassiness and fussiness, it is most likely a problem with dairy protein. Also, if you have a family history of allergy, avoid these known allergens during breastfeeding.
Hiccups are common in babies under one year old and are a normal, harmless nuisance caused by spasms in the diaphragm. Breastfeeding does not cause hiccups and it is safe to continue to breastfeed a baby who is hiccuping if they are happy to continue to nurse. In fact, breastfeeding can help stop hiccups in the same way as when an adult drinks water to stop their own hiccups. Hiccups will decrease in frequency and severity as both she and her digestive system mature. Some common causes of hiccups include:
- Overfeeding, so try slowing down feedings, giving small/more frequent feeds and burp your baby as you switch from one breast to the other.
- Swallowing air during feeding, so ensure your baby has a good latch and try positioning your baby upright during nursing. Also keep her upright for 20 minutes after feeding.
If your baby has persistent and excessive hiccups, she might have reflux.
Jaundice and breastfeeding
Jaundice is common in newborn babies and your doctor will advise if special treatment is required. Breastfeeding does not cause or increase jaundice, so long as baby is getting enough milk, and should be continued as it is medically best for your baby. If baby is breastfeeding well, then more frequent feedings will help reduce jaundice. If baby is not feeding well, the first approach should not be to take the baby off the breast and give formula. You should first try to improve the baby’s latch and do breast compressions so he can get more milk (click here for instructions). Rarely, if ever, should breastfeeding need to be stopped even for a short time.
Low milk supply
This is a common concern, but oftentimes is a false alarm. Often women are concerned they don’t have enough milk if their:
- Breasts no longer feel full. False alarm! When your baby is between 6 weeks to 2 months old, your body has adjusted to how much milk he needs.
- Baby has fewer stools. False alarm! From six weeks old your baby will have fewer stools than before and can go days without one.
- Baby wants to nurse longer and more frequently. False alarm! Babies will experience several "growth spurts" in the first few months of life (often around 2-3 weeks, 6 weeks and 3 months), but if you let him breastfeed as often and as long as he wants this will help bring up milk supply quickly.
Milk supply is very often a simple case of demand and supply, so the more you breastfeed, the more milk you will produce. The most important indicators baby is getting enough milk are number of diapers and weight gain. If you are still concerned about your milk supply after considering this and ruling out the false alarms noted above, you should:
- Call us or visit your local Beba-ks Center (Women's Health Resource Center) for free information and support.
- “Encourage your baby to breastfeed frequently and for as long as he will.
- Offer both breasts at each feeding. Allow baby to stay at the first breast as long as he is actively sucking and swallowing. Offer the second breast when baby slows down or stops. "Finish the first breast first," is a good general rule. This technique gives baby lots of the fatty "hindmilk."
- Baby should end the feeding. He may do this by falling asleep and detaching from the breast after about 10 to 30 minutes of active sucking and swallowing.
- Be sure baby is latched on and positioned correctly at the breast, that is, lips should be on the areola (the darker skin area), well behind the nipple. We can help fine-tune positioning as well as suggest ideas to ease soreness.
- A sleepy baby may benefit from "switch nursing" that is, switching breasts two or three times during each feeding. Switch breasts when baby's sucking slows down and he swallows less often.
- All of baby's sucking should be at the breast. Limit or stop pacifier use while encouraging baby to nurse more effectively. If you are supplementing, even temporarily, you can give the supplement by spoon or cup.”
- Practice breast compressions; see how here.
“This may be a stressful time. Take care of yourself. Pay attention to your own need for rest, relaxation, proper diet and enough fluids.”
Source: La Leche League International, http://www.llli.org/faq/increase.html
Sometimes a mother produces more milk than her baby needs and this can result in a foreceful ejection of milk from her overfull breast. This can be upsetting for babies during and between feedings. Typical symptoms of oversupply include:
- “Baby cries a lot, and is often very irritable and/or restless
- Baby may sometimes gulp, choke, sputter, or cough during feedings at breast
- Baby may seem to bite or clamp down on the nipple while feeding
- Milk sprays when baby comes off, especially at the beginning of a feeding
- Mother may have sore nipples
- Baby may arch and hold himself very stiffly, sometimes screaming
- Feedings often seem like battles, with baby nursing fitfully on and off
- Feedings may be short, lasting only 5 or 10 minutes total
- Baby may seem to have a "love-hate" relationship with the breast
- Baby may burp or pass gas frequently between feedings, tending to spit up a lot
- Baby may have green, watery or foamy, explosive stools
- Mother's breasts feel very full most of the time
- Mother may have frequent plugged ducts, which can sometimes lead to mastitis”
Source: La Leche League International, http://www.llli.org/faq/oversupply.html
To address this problem, try:
- Nursing your baby on only one breast per feeding. If needed, you can express the other breast to relieve pressure and freeze the excess milk for later. If your baby wants to nurse again within two hours, offer the same breast again.
- Expressing some milk before you start nursing to reduce the rate of milk ejection. Do not express too much as that will tell your breasts to produce more milk.
- Positioning your baby more upright during nursing and/or reclining yourself so that gravity helps slow the rate of milk ejection. The side-lying position is also good.
- Feeding your baby before he is too hungry, which means he will not suck as hard which will not stimulate your breasts as much.
- Stopping pumping, if you have been doing so to store milk, until your milk supply better matches your baby's current needs.
If you are producing a lot of milk you can use breastpads to catch leaks, but remember to change them at least daily. Also, your baby will likely swallow more air, so frequently burp your baby to minimize the problem.
There are many reasons why a baby will refuse the breast or cry when nursing, but almost none mean you should stop breastfeeding. Some common triggers and solutions are:
- You have an oversupply of milk which is coming out too fast or in too much volume causing your baby to be upset. See above on how to manage this.
- You have an undersupply of milk or it is taking too long to ‘let-down’ causing your baby to be upset. Try breast compressions to improve your supply.
- Your baby or toddler has an illness or injury that makes nursing uncomfortable (an ear infection, a stuffy nose, thrush, a cut in the mouth). See your baby’s doctor in this case. For a simple stuffy nose, try clearing your baby’s nose before feeding and position her upright during nursing.
- Your baby has sore gums from teething. Try rubbing her gums before nursing.
- You have changed your deodorant, soap, perfume, lotion, etc. and you smell ‘different’ to your baby. Try going back to your old products, but if that is not an option then extra cuddling, stroking, and skin-to-skin contact will help re-establish closeness.
- You've been under stress (such as having extra company, traveling, moving, dealing with a family crisis). Try to get extra help to take some of the stress and/or duties from you and reassure your baby with extra cuddling and skin-to-skin contact.
- You've recently changed your nursing patterns (started a new job, left the baby with a sitter more than usual, put off nursing because of being busy, etc.). Try reassuring your baby with extra cuddling, stroking, and skin-to-skin contact.
- You reacted strongly when your baby bit you, and the baby was frightened. Try reassuring your baby with extra cuddling, stroking, and skin-to-skin contact.
- Your baby is distracted and unsettled, which is common as your baby becomes more aware of its surroundings (by 4 months old). Try nursing in a quiet room and in a position that is most settling for your baby, and don’t worry as this will pass soon.
Source: La Leche League International, http://www.llli.org/faq/strike.html
Sometimes, newborns sleep for longer than three hours at a time, or fall asleep often on the breast. If your baby is feeding well and his daily diaper count and weight gain are on track, then there is no need to worry. If not then aim to nurse at least ten times each day until he is having at least four good stools in his diapers each day for at least a week. Sleepy babies are often difficult to wake for a feed so try these tips:
- Undress him partially or completely.
- Stroke or tickle him and talk to him.
- Wipe his face with a damp cloth.
- Put a little milk on his lips and/or in his mouth.
- If he is falling asleep on the breast try talking loudly, stroking him, switching breasts or burping him when you notice the suckling slowing.
Tender nipples are common at the start of a feed for the first week or so of breastfeeding. However, if nipples are very sore, or are cracked, bruised or bleeding there is something wrong. Almost always, sore nipples are caused by improper positioning of the baby at the breast. Click here to learn on how to get the best position and latch for breastfeeding. Other causes of sore nipples include: 1) engorgement; 2) incorrect use of a pump; 3) pacifiers or bottles causing your baby to have nipple confusion and therefore breastfeeding incorrectly; 4) yeast infection, see #13 below; 5) removing baby from breast without first breaking the seal by inserting your finger in the corner of her mouth.
Taking the baby off the breast is a last resort. There are lots of ways to treat sore nipples:
- Nurse on the least sore side first or only nurse from the least sore breast for part or all of the day if you are able (check diapers to be sure baby is getting enough milk).
- Experiment with different positions, some will be less painful than others (see click here for suggestions).
- Try short, frequent feedings to encourage a less vigorous suck.
- Apply freshly expressed breastmilk to your nipples (if a yeast infection is not present).
- Expose your nipples to air as much as possible.
- Use a nipple ointment, like pure lanolin, after breastfeeding and do not wash it off.
- Do not wash your nipples frequently. Daily bathing is more than enough.
- Apply a warm, moist compress to your nipples (if a yeast infection is not present).
If you are unable to breastfeed at all because of pain, in spite of trying all the above methods, try taking a short (2-5 day) break from breastfeeding to allow the nipples to heal. During this time, it is best for you and the baby if the baby is fed your expressed milk (click here for a guideline). That way you can keep your milk supply up and continue breastfeeding once your nipples have healed.
Spit-up and reflux
Almost half of young babies spit up regularly or vomit occasionally without apparent reason, and it peaks around 4 months. It occurs because they take in air when feeding, drink too much and their digestive system isn’t yet fully developed. Reflux occurs when babies spit up and vomit so much that it affects their growth or causes throat pain or breathing problems. Other symptoms may include coughing or gagging during feedings or showing signs of stomach pain, like arching their back, drawing up their legs, and waking up screaming. Both breastfed and formula-fed babies spit up and have reflux but studies have shown breastfed babies have shorter and less frequent occurances.
Tips to minimize spit-up and reflux:
- Nurse often so baby’s meals are smaller.
- Nurse baby in an upright position.
- Burp her regularly but gently, making sure she does burp after feeding.
- Keep her upright for 20 minutes after feeding.
- Limit time in car seats as this puts pressure on baby’s stomach.
If your baby’s symptoms persist and are particularly bothersome for him, see a doctor as there are some medications that can help (however reaserch shows thickened feeds or simethicone drops are not effective).
Thrush is a common and harmless yeast infection in your baby's mouth that can affect your nipples during breastfeeding. Breastfeeding can and should be continued throughout a thrush outbreak, although it will likely be painful. Improving your baby’s position and latch (click here for instructions) will help.
"Common signs of a yeast infection in nursing mothers are: 1) itchy, pink, red, shiny, or burning nipples (may be cracked); 2) deep, shooting breast pain during or after feedings. Most young babies have symptoms, but older babies might not. Those who do may: 1) have white patches on the inside of the lips and cheeks that look like cottage cheese and aren't easily washed off. If you notice a white coating on your baby's tongue but nowhere else, it's probably just milk residue. 2) cry when nursing or sucking on a pacifier or bottle. The white patches mentioned above may be painful and make feeding uncomfortable if the infection is severe. 3) have raised, patchy bright or dark red diaper rash with distinct borders. Small, red spots frequently appear around the edges of the main rash. The affected area is red and may be tender or painful, and the rash can creep into the folds of skin around your child's genitals and legs. It almost never appears on the buttocks. If you suspect thrush, contact your doctor for diagnosis and treatment.” Source: babycenter.com, http://www.babycenter.com/0_thrush-in-breastfeeding-moms_8486.bc?showAll=true
“Thrush can be very difficult to treat. It is essential for both you and your baby to be treated for thrush as not only is it easily spread but it also thrives in warm moist environments such as your baby's mouth and your nipples. After treatment for thrush begins, the symptoms may appear to get worse for a couple of days before improving. While the pain continues, offer your baby short, frequent feedings, beginning of the least painful side. Be sure to rinse your nipples and let them air dry after each feeding.” Source: La Leche League International, http://www.llli.org/faq/thrush.html
Other steps to reduce the spread of thrush include: 1) if using pacifiers/bottles, boil for 20 minutes per day and replace every week; 2) if pumping, boiling any part that comes into contact with breastmilk; 3) washing hands in warm soapy water for at least 20 seconds after diaper changes; 4) washing all clothing that comes into contact with your nipples in hot water with bleach.
We gratefully acknowledge the following sources that were used to develop the information in this section: La Leche League International, BabyCenter, International Breastfeeding Center and March of Dimes.
Category: Common Problems & Solutions