Overcoming breastfeeding problems

Recommendations

Breastfeeding (nursing) your baby can be a comfortable and relaxing experience. But it takes time and practice. Start breastfeeding your baby in the hospital, right after birth. Request the help of a lactation consultant or nurse to get you started. Read about breastfeeding before your baby is born.

NIPPLE SORENESS

It is common to have some pain or discomfort when your baby first latches on and begins feeding in the first few days or weeks. Some breastfeeding mothers describe nipple soreness as a pinching, itching, or burning sensation. Over time, you should feel little discomfort or pain when breastfeeding.

Nipple soreness may be caused by many things, including:

• Poor feeding techniques
• Wrong position of the baby when breastfeeding
• Not taking care of your nipples

For many women, there is no clear cause of nipple soreness. A simple change in your baby's position while feeding may relieve nipple soreness.

You might have sore nipples if your baby keeps sucking as he or she comes off the breast. You can help your baby learn to let go (and reduce your discomfort) by gently inserting a finger into the side of the mouth to break the suction.

Skin that is too dry or too moist can also cause nipple soreness. Moisture may be due to wearing bras made from man-made (synthetic) fabrics. These fabrics may increase sweating and slow evaporation. Using soaps or solutions that remove natural skin oils can cause dry skin. Olive oil, expressed milk, and ointments containing lanolin can help soote dry or cracking nipples.

Some baby's chew or bite on the nipples when they start teething. This can cause discomfort. To help prevent this, give the baby something cold and wet to chew on a few minutes before breastfeeding. A clean, wet washcloth from the refrigerator works well. Offer the baby another cold, wet washcloth before feeding on the other breast.

BREAST ENGORGEMENT OR BREAST FULLNESS

Breast fullness is the slow buildup of blood and milk in the breast a few days after birth. It is a sign that your milk is coming in. It will not prevent you from breastfeeding.

Breast engorgement is caused by congestion of the blood vessels in the breast. The breasts are swollen, hard, and painful. The nipples may not stick out enough to allow the baby to latch on correctly.

The let-down reflex is a normal part of breastfeeding. Milk made in the milk glands is released into the milk ducts. Pain, stress, and anxiety can interfere with the reflex. As a result, milk will build up. Treatment includes:

• Learning to relax and finding a comfortable position
• Reducing distractions during nursing, performing a gentle massage, and applying heat to the breast

Nursing often (8 times or more in 24 hours) and for at least 15 minutes at each feeding can also prevent engorgement.

Other ways to relieve breast engorgement:

• Feed more often or express milk manually or with a pump. Electric breast pumps work best.
• Alternate between taking warm showers and using cold compresses to help relieve the discomfort.

NOT ENOUGH MILK FOR THE BABY'S NEEDS

The baby's milk demand determines the mother's supply. Frequent feedings, adequate rest, good nutrition, and adequate fluid intake can help maintain a good milk supply.

Checking weight and growth frequently is the best way to make sure your baby is taking enough milk. If you have concerns about how much breast milk your baby is getting, talk to your health care provider.

PLUGGED MILK DUCT

A milk duct can become plugged if the baby does not feed well, if the mother skips feedings (common when the child is weaning), or if she wears a constricting bra. Symptoms of a plugged milk duct include tenderness, heat and redness in one area of the breast, or a lump that can be felt close to the skin.

Sometimes, a tiny white dot can be seen at the opening of the duct on the nipple. Massaging the area and putting gentle pressure on it can help to remove the plug.

BREAST INFECTION

A breast infection (mastitis) causes aching muscles, fever, and a red, hot, tender area on one breast. Consult your health care provider if you develop these symptoms.

Breast infections often occur in mothers who:

• Are stressed and exhausted
• Have cracked nipples, plugged milk ducts, or breast engorgement
• Have been skipping feedings
• Wear a tight bra

Treatment often includes:

• Antibiotics for the infection
• Moist, warm compresses over the infected area
• Rest
• Wearing a comfortable bra between feedings

Continuing to nurse from the affected breast will promote healing. Breast milk is safe for the baby, even when you have a breast infection.

• It is important to continue breastfeeding from both breasts. This will prevent further breast engorgement.
• If nursing is too uncomfortable, pumping or manual expression is recommended. You can try offering the unaffected breast first until let-down occurs, to prevent discomfort. Consult your physician for help.

THRUSH

Thrush is a common yeast infection that can be passed between the mother and the baby during breastfeeding. The yeast (called Candida albicans) thrives in warm, moist areas.

The baby's mouth and the mother's nipples are perfect places for this yeast to grow. A yeast infection can be difficult to cure, but fortunately this is uncommon. Yeast infections often occur during or after antibiotic treatments.

Symptoms of yeast infection in the mother are deep-pink nipples that are tender or uncomfortable during and immediately after nursing. White patches and increased redness in the baby's mouth are symptoms of thrush (a yeast infection in the baby's mouth).

The baby may also have a diaper rash, a change in mood, and will want to suckle more frequently. Contact your health care provider to get a prescription for an antifungal medication for affected members of your family.

ILLNESS

If you develop a fever or illness, contact your health care provider. You can safely continue breastfeeding during most illnesses, and the baby is likely to benefit from your antibodies.

Alternative Names

Plugged milk ducts; Nipple soreness when breastfeeding; Breastfeeding - overcoming problems; Let-down reflex

References

Payne PA, Tully MR. Breastfeeding. In: Ratcliffe SD, Baxley EG, Cline MK, Sakornbut EL, eds. Family Medicine Obstetrics. 3rd ed. Philadelphia, Pa: Elsevier Mosby;2008:section C.

Eglash A, Montgomery A, Wood J. Breastfeeding Disease-a-Month. 2008;54.

Update Date: 9/13/2011

Updated by: David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc., Susan Storck, MD, FACOG, Chief, Eastside Department of Obstetrics and Gynecology, Group Health Cooperative of Puget Sound, Bellevue, Washington; Clinical Teaching Faculty, Department of Obstetrics and Gynecology, University of Washington School of Medicine.