Common Breastfeeding Challenges

Nipple Pain

Poor Latch and Positioning

No matter what position you use to feed your baby, it’s important to get a good latch. It takes practice, both for you and your baby. But a good latch will help you feel comfortable, prevent nipple damage, and help your baby get the most milk.

Signs of Good Latch and Positioning

If you are unable to achieve a comfortable latch, there are people who can help.

Some signs of a good latch may be:

If you’re having trouble getting a good latch:

- - - Make sure the baby is calm. If your baby is crying, calm before trying to latch.
    - Move to a quiet, calm place.
    - Hold your baby skin to skin. While both you and your baby are undressed, hold your baby against your chest.

MILK BLISTER/BLEB

A milk blister, or bleb, is a smooth, shiny, white dot on your nipple. It can be caused by a very thin layer of skin growing over a milk duct opening on the nipple causing a blockage.

Treating Milk Blisters/Blebs

- - - Apply moist heat to soften the blister prior to breastfeeding. Several times per day, add a salt solution soak prior to applying the moist heat.
    - A salt soak before breastfeeding helps to open the milk duct and speeds healing. To make a salt soak, add 1/2 teaspoon of salt to 1 cup of water. The salt is first dissolved in a small amount of very hot water, and then cold water is added to cool it down enough to soak in. Try to add this salt soak to your routine at least 4 times per day.
    - Before breastfeeding or pumping (and right after the salt soak) place a warm wet compress on the milk blister/bleb. Be careful not to burn yourself. A cotton ball soaked with olive oil can be used to soften the skin instead of the wet compress.
    - Before you breastfeed, it can be helpful to use breast compression and attempt to hand express back behind and down toward the nipple to release any thickened milk that has backed up in the duct. Sometimes clumps or strings of hardened milk (often of a toothpaste consistency) can be expressed from this duct.

Healing

- - - Apply expressed breastmilk to the nipples to promote healing – this can be done in addition to other treatments.
    - A salt rinse (using the same solution described above, either soak your nipple or dip a cotton ball in the solution and squeeze over the affected area)
    - To promote “moist wound healing” (this refers to maintaining the internal moisture of the skin, not keeping the exterior of the skin wet), apply a medical-grade lanolin ointment, soft paraffin/petroleum jelly or a hydrogel dressing.

THRUSH, PLUGGED DUCTS AND MASTITIS

Thrush

Thrush is a fungal infection that forms on the nipples or in the breast. This infection is also sometimes called a yeast infection. Thrush may have these signs:

Sore nipples that last more than a few days, even after your baby has a good latch.
Sore nipples after several weeks of pain-free breastfeeding.
Redness, or nipples that are flaky, shiny, itchy, or cracked.
Achy breasts or shooting pains deep in the breast during or after feedings.
White spots on the inside of the baby’s cheeks, tongue, or gums.

If you have concerns of a fungal infection, call both your doctor and your baby’s doctor. That way, you both can be correctly diagnosed and treated at the same time. This will help keep you from passing the infection back and forth.

Plugged Ducts

Plugged ducts are a common concern in breastfeeding moms. A plugged milk duct feels like a tender, sore lump or knot in the breast. It happens when a milk duct does not drain properly. Pressure builds up behind the plugged duct, and the tissue around it gets irritated. This usually happens in one breast at a time.

Several things can cause plugged ducts:

Severe engorgement,
Regularly breastfeeding on only one breast,
Skipping feedings or not feeding as often as usual, or
Pressure against the milk ducts. A diaper bag strap or car seat belt pressing across your chest can cause it. So can wearing a bra that is too tight.

Here are a few tips to help you get relief:

Breastfeed from the affected breast first.
Take a hot shower or apply warm moist cloth over the area in your breast where you feel the plugged duct
Massage your breast from the plugged duct down to the nipple before and during breastfeeding.
Breastfeed frequently
Wear no bra at all or a well-fitting, supportive bra that is not too tight. Consider trying a bra without an underwire.

If you have plugged ducts that keep coming back, get help.

Mastitis

Mastitis is a breast infection that is typically caused by an obstruction or infrequent drainage of the breasts. It is not always easy to tell the difference between a breast infection and a plugged duct. The pain, heat, and swelling associated with mastitis is usually more intense.

Mastitis may also include other signs, like these:

Flu-like symptoms (fever, chills, body aches, nausea, vomiting, or fatigue).
Yellowish discharge from the nipple that looks like colostrum.
Breasts that feel tender, warm, or hot to the touch and appear pink or red.

It is safe and important to continue to breastfeed from the affected breast. The milk from the affected breast will not hurt the baby. The same tips for plugged ducts may help with mastitis. Apply heat, get plenty of rest, drink lots of fluids, and breastfeed often. If you have any signs of mastitis, or if you do not feel better within 24 hours of trying these tips for relief, contact your doctor. Your doctor may prescribe antibiotics.

Engorgement

It’s normal for your breasts to feel different after your baby is born. They are making milk and have extra blood flow, so they may feel tender and full. Engorgement is the swelling of breast tissues when they become overly full with fluids, blood, and or milk. Receiving a lot of IV fluids during labor can increase your chances of having excess fluid in your breasts and delay the transition from colostrum to mature milk. This swelling causes the breasts to feel hard and they may even be warm to the touch. Engorgement usually occurs a few days after delivery when your milk is increasing in volume and transitioning from colostrum to mature milk.

What to do if you are experiencing engorgement:

Breastfeed Often

Breastfeed your baby often and on demand (at least 8 to 12 times in 24 hours). That means going no longer than 2 to 3 hours between feeds, including during the night.
Make sure your baby latches well so they can remove milk effectively. Doing reverse pressure softening before latching the baby can help with latching a baby to an engorged breast.
Perform breast compressions when your baby is latched to help remove as much milk as possible
Avoid pacifiers and other artificial nipples until you and baby are comfortable and breastfeeding is going well. That will help regulate your milk supply.
If you are going back to work or school, express milk frequently and at regular intervals while you and baby are apart.
If you are unable to latch the baby, seek help and hand express and or pump to continue to protect your milk supply and alleviate the swelling.

Discomfort Relief

For most moms, engorgement usually goes away in a few days with these tips:

Breastfeed first from the engorged breast
Before feedings, encourage your milk flow. Put a warm, moist washcloth on your breasts or take a warm shower with your back to the spray letting the warm water flow over your shoulders to your breasts (the spray directly on engorged breasts may be uncomfortable). NOTE: If your breasts are warm to the touch, avoid heat. Heat can encourage more blood flow to the area making engorgement worse
Massage your breasts before and during feedings, moving from the chest wall to the nipple.
If your breast is too hard to latch your baby, try reverse pressure softening. If that does not work, try hand expressing or pumping a little milk before breastfeeding. That will soften your breast and make it easier for your baby to latch. Be sure to only express enough milk to soften your breasts or provide comfort. If you express too much milk, you may encourage milk production and keep getting engorged.
Between feedings, put cold compresses on your breasts to help reduce swelling and pain.

OVERSUPPLY AND FORCEFUL LETDOWN

What is milk oversupply?

Milk oversupply happens when a mother makes more milk than her baby uses. It is sometimes called overabundant milk supply or hyperlactation. Many things influence how much milk you produce. The two most important things are how often you breastfeed or pump your breasts and how well your breasts are emptied. So the more often you feed your baby and empty your breasts, the more milk your body produces.

Oversupply symptoms in babies

Crying during feeding.
Refusing or resisting feeding.
Gulping often during feeding.
Rapid weight gain.
Gaining too little weight. This could be because your milk flow is so fast, the baby becomes full before getting the fattiest part of your milk.
Having excessive gas.
Having large, frothy, green stools.

Oversupply symptoms in mothers

Full breasts that keep leaking between feedings. Your breasts may spray.
Breast pain.
Persistent breast engorgement, which could lead to plugged milk ducts and infection.

How is milk oversupply treated?

Many moms feel frustrated when they have too much milk. But there are things you can do to care for yourself and your baby. If you think you have too much milk, there are breastfeeding experts that can help. They may advise you to:

Feed from just one breast during a breastfeeding session or for a block of time (typically 3 hours). Then at the next session or block of time, feed from the other breast. You can remove just a little bit of milk from the unused breast to make you more comfortable.
Try leaning back and breastfeeding “uphill” so that your baby is above the nipple.
Try breastfeeding as you lie on your side so that extra milk dribbles out of your baby’s mouth.
If your breasts still feel uncomfortable after breastfeeding, try a cold compress to reduce swelling. You can use a frozen wet towel, a cold pack, or a bag of frozen vegetables. Apply it to your breasts for 15 minutes at a time every hour as needed. To prevent damage to your skin, place a thin cloth between your breast and the cold pack.

BABY GAINS WEIGHT SLOWLY

If your baby is not gaining weight, get help from the baby’s doctor and an International Board Certified Lactation Consultant (IBCLC). They will evaluate the baby for medical problems, illnesses, and tongue restrictions that may interfere with weight gain.

Here are questions to ask yourself when questioning baby’s weight gain:

Is baby getting enough calories? The pediatrician and/or an IBCLC can help answer this questions.
Is baby eating on-demand a minimum of 8 to 12 times in 24 hours?
Is baby having enough wet and dirty diapers?
Is baby Jaundiced (yellowing of the skin and whites of the eyes? Ask the pediatrician.
Is baby sleepy for longer than 3 hours at a time?
Is baby using a pacifier?
Is baby latched and positioned well?
Is your milk supply adequate? (Pumping output is not a good indicator of milk supply) An IBCLC can help answer this question.

Things you can do to:

Keep baby close, practice skin-to-skin and wear baby in a wrap or carrier throughout the day.
Always offer the second side. It’s OK if your baby does not take or feed for long on the second side. It is more important that they are allowed to completely finish one side before switching.
Once baby is latched and positioned correctly, use breast compression to help transfer milk to the baby.
Get help.