Overcoming Common Breastfeeding Problems: The Ultimate Guide

Breastfeeding is the first step in keeping babies healthy. The World Health Organization suggests breastfeeding for two years and beyond, starting with solid foods around six months.

Breast milk is the best food for most babies. It provides numerous health benefits, reduces the risk of illness, protects against infections and dental issues, improves IQ, and probably may lower the risk of obesity and diabetes later in life.

Breastfeeding provides essential nutrients for the growth and development of your baby. Additionally, nursing mothers can benefit from breastfeeding. It helps with birth spacing by delaying the return of ovulation and menstruation, which can be especially useful for mothers who want to space out their pregnancies.

Studies have shown that breastfeeding can lower the risk of breast and ovarian cancers in nursing mothers. This is because it helps suppress ovulation and the production of estrogen, both of which can contribute to the development of these types of cancers.

Apart from these physical health benefits, breastfeeding can also help strengthen the emotional bond between you and your baby. The skin-to-skin contact and close physical proximity during breastfeeding promote feelings of closeness and connection that can positively affect the mother-child relationship in the long term.

Many mothers face breastfeeding challenges. A study involving 422 mother-infant pairs in Kinshasa found that cracked or sore nipples, low milk production, and breast engorgement were the most common issues faced by lactating mothers, mainly in the first week and month after birth. In the UK survey, concerns about low milk supply, latch problems, and nipple pain were common reasons cited for discontinuing breastfeeding.

Breastfeeding should be a comfortable and enjoyable experience for both you and your baby. However, many new moms often complain of sore nipples.

In the first few days of nursing, you might feel a bit uncomfortable when your baby first latches onto your breast. But this discomfort should go away, usually within about 30 seconds after your baby starts suckling. The pain shouldn’t last throughout the whole feeding. It also decreases by the fourth day after giving birth and should completely disappear by the time your baby is around a week old. If you ever find the “pins and needles” sensation during milk let-down uncomfortable, don’t worry; this discomfort also tends to go away during the first few weeks of nursing.

On the other hand, if nipple pain is due to trauma, it’s typically more severe and continues or gets worse after your baby starts nursing. Reasons include a poor latch, incorrect position, infections, tongue-tied in the baby, inadequate breast pump use, etc.

Nipple injuries often occur when breastfeeding isn’t done correctly, especially if the baby doesn’t latch on properly. This can lead to sore and painful nipples over time.

The good news is that fixing how your baby latches onto your breast can usually relieve the pain immediately. It’s vital to get the correct nursing technique from the start to avoid pain and the risk of infection from cracked nipples.

● Ensure a proper latch: Make sure your baby latches on well. If it hurts, gently break the latch by putting a clean finger in your baby’s mouth’s corner, and then try again.

● Seek help: A midwife, health visitor, or breastfeeding supporter can watch and help you with the right position and latch. 

● Let your nipples air dry: Keep your nipples dry and let them air out after feeds. 

● Avoid harsh soaps: There’s no need for soaps or cleansers; water is enough for your nipples.

● Breast pads: Limit the use of breast pads with plastic backing.

● Tongue-tie: If your baby has mouth issues like tongue tie, get them checked early, sometimes surgery can help them latch better.

● Dealing with biting: If your baby bites, make sure their mouth is wide open during feeds, use your fingers to stop biting, and say ‘’no’’ firmly. Then, put the baby down safely; they’ll learn not to bite. 

If your nipples are already injured, here’s what you can do to ease discomfort and aid healing. Start nursing on the breast without injury. For cracked or sore nipples, apply expressed breastmilk (not in case of thrush) or a safe ointment like purified lanolin and cover them with a nonstick pad to prevent sticking to your bra. 

If you suspect infection or rash, consult your healthcare provider for guidance. Use cool or warm compresses (avoid using ice) and consider taking a mild pain reliever like acetaminophen or ibuprofen before feeding. Continue nursing, but if nipple pain makes it hard, use a pump or hand expression to empty your breasts and feed your baby. This will help your nipples heal and avoid engorgement. Treating the injury is essential, as the risk of infection may increase.

Thrush, a yeast infection caused by the Candida fungus, can also affect your nipples and breasts.

Common signs include:

1. Sore nipples: Even with a proper latch, you may experience soreness, especially if it occurs after pain-free breastfeeding for weeks.

2. Other symptoms may include:

● Red, flaky, cracked, shiny, or itchy nipples.

● Sometimes, stabbing breast pain.

● You may have a history of vaginal yeast infection.

3. Additionally, white spots inside your baby’s tongue, inner cheeks, or gums, and diaper rash can appear.

If you suspect a fungal infection, consult your or your baby’s doctors for treatment to avoid passing it back and forth. Treatment usually involves using an antifungal cream on your nipples or taking antifungal tablets.

During treatment, if possible, continue nursing. Otherwise, consider giving your baby fresh or frozen expressed milk. Avoid using milk expressed during the infection period, as freezing doesn't eliminate yeast spores.

Another cause of nipple and breast pain is vasospasm, a condition known as Raynaud’s phenomenon of the nipple. This occurs when blood vessels in the nipple get narrow, reducing blood flow. People with this issue, when exposed to cold, nursing, or injury, may feel pain that goes deep into the breast, a burning sensation, or numbness in the nipples. The nipples might also change color, becoming white or blue and then turning pink again when blood flow returns.

To manage nipple vasospasm, keep your body warm, dress warmly, and breastfeed in warm conditions if possible. Avoiding nicotine and caffeine can also help, as they can worsen the problem. Some women find relief by keeping their nipples warm, using heat packs or special breast pads, and taking a magnesium supplement.

Breastfeeding can be challenging because it’s not as easily measured as formula feeding. Many new moms worry about not having enough milk, especially at the beginning, and this can be a reason for stopping nursing.

It’s important to note that it may sometimes seem to mothers that they have low milk, but that might not necessarily be the case.

Here are some situations when you shouldn’t worry:

1. Initial Milk Production: Don’t worry if you produce a small amount of colostrum in the days after having your baby; it’s normal. After a few days, your milk supply will increase.

2. Breast Texture: Your breasts may become softer as your milk adjusts to your baby’s needs, but it doesn’t mean you have a low supply.

3. Feeding Duration: If your little one nurses for a short time, like just 5 minutes on each breast, that’s okay as nursing becomes routine.

4. Cluster Feeding: Sometimes, your baby might have feeding sessions close together, which we call cluster feeding. It usually happens in the evenings or during growth spurts. Just keep nursing frequently, and your breasts will adjust to produce more milk to meet your baby’s needs.

5. Low Milk Expression: If you’re not getting much milk when you use a breast pump or hand expression, remember that your baby is more effective at getting milk out.

You can be confident that your milk supply is enough if your baby feeds approximately 8–12 times a day (some babies might need even more frequent feedings), steadily gains weight by day four or five, and has around 6-8 wet diapers daily.

However, if your baby isn’t gaining weight or seems dehydrated, there are common causes of low milk supply to consider. These include not nursing frequently enough, latch issues, starting solid foods too early, medications, lack of sleep, alcohol, smoking, past breast surgery, and certain medical conditions. It’s wise to consult with a doctor for guidance.

You don’t need to give up breastfeeding, as you can often solve these problems.

One of the primary reasons why mothers switch or supplement their baby's diet with formula is due to concerns about their milk supply. These worries can be caused by a variety of factors, such as a baby's difficulty in latching, a decrease in milk production, or an insufficient milk supply to meet the baby's needs. These concerns can lead to stress and anxiety for the mother, which can further affect breast milk production.

Here are some tips to help increase milk supply:

1. Early Contact: Holding your baby skin-to-skin early on helps establish milk supply and increase the duration of exclusive breastfeeding, as confirmed by a systematic review of 30 studies. If you can’t do this, try regular hand expression.

2. Feed Often: Breastfeed whenever your baby is hungry, especially in the first weeks. Skip strict schedules and follow your little one’s cues; your body adapts to your baby’s needs. Remember, more feeding means more milk.

3. Relax and Massage: Before feeding, take a moment to relax and gently massage your breasts.

4. Good Latch: Ensure your baby latches onto your breast correctly.

5. Use Both Breasts: Offer both breasts during each feeding.

6. Empty Your Breasts: After feeding, also when you’re apart from your baby, hand express or pump to signal your body to produce more milk.

7. Limit Bottles: Try to avoid bottles and pacifiers in the early weeks; focus on direct breastfeeding.

8. Self-care: Get enough sleep, eat well, and stay hydrated. Allow others to help.

9. Stress Less: Stress can hinder milk flow, so stay calm and relaxed.

10. Supplements: Consult your healthcare provider, and if needed, give your baby small supplements of formula, or expressed milk. You may use a syringe, cup, spoon, or supplemental nursing system rather than a bottle to avoid nipple confusion.

Newborns need to breastfeed a lot, usually 8–12 times a day, during their first few weeks of life. Sometimes, especially in the evening, your baby might get fussier and want to nurse even more often, known as cluster feeding. This is normal. It often happens because of growth spurts. Don’t worry; this behavior helps them prepare for longer sleep at night and increases your milk supply. Ask your partner and family for extra help during this time. 

In the first year of a baby's life, their growth is characterized by several phases of rapid development, known as growth spurts. Typically, these phases can be observed at approximately a few days old, 2 to 3 weeks, six weeks, three months, and six months old, with subsequent spurts occurring every other month throughout the year. It's important to note that while these milestones tend to occur at the aforementioned intervals, the timing of each spurt can vary from baby to baby.

During these times, your baby may nurse longer and more frequently; it’s their way to help you produce enough milk. Trust your baby’s cues, and your body will adjust to meet their needs. When your supply goes up, you’ll return to your normal routine.

You might feel hungrier and thirstier during this time, so eat well and hydrate enough. Let your loved ones lend a hand with tasks like cooking and diaper changes during this period.

Engorgement happens when your breasts get too full of milk and become hard, warm, and painful. It often occurs when you don’t remove milk properly, typically during the transition from colostrum to mature milk or when there is a sudden decrease in nursing frequency.

According to a study, expressing colostrum for 25–30 minutes once or twice within 1–2 days after vaginal birth or 2–3 days after cesarean delivery can help prevent engorgement.

● Engorged breasts may come with a low fever called milk fever.

● They can hinder your baby’s latch, worsening the situation, as they may not fully empty the breast.

● Engorgement can lead to discomfort and potential complications like plugged ducts or breast infection.

● It can also decrease your milk production because your body isn’t receiving a signal to make more milk.

Plugged milk ducts occur when a milk duct doesn’t empty properly, causing localized issues. As pressure builds up behind the blockage, the surrounding tissue becomes irritated. Typically, this happens in one breast at a time.

When the milk ducts close to the surface of the nipple become blocked, a milk bleb forms, which we will discuss later.

The symptoms of blocked ducts develop slowly, and they feel like a sore, warm, tender lump or knot in the breast.

● Inadequate breast emptying: This can happen due to a poor latch, nipple pain, or if the baby has tongue-tie, or struggles with coordinating sucking and swallowing. Regular breastfeeding from one breast can also lead to engorgement and blockages in the other. Not expressing milk while being away from your baby can also contribute.

● Milk oversupply

● Skipping feedings or longer gaps

● Abrupt weaning

● Pressure on milk ducts: External factors like tight bra straps, car seat belts, or lying on the stomach can apply pressure to the milk ducts, causing blockages.

● Severe engorgement, with overly full breasts, itself can lead to blocked ducts.

Prevention strategies involve frequent breastfeeding, ensuring a good latch, avoiding pacifiers, expressing milk when you’re apart from your baby, wearing a supportive but not too tight bra, etc.

Tips for relief:

● Don’t stop breastfeeding, as it may worsen the situation. Breastfeed from the affected breast first.

● Gently massage your breasts, moving from the base of your breast to the nipple.

● Use warm compresses or take a warm shower before the feeding to ease the milk flow. Apply cold compresses between feedings to reduce swelling and pain.

● Ensure a good latch, frequently nursing in various positions to help with drainage. You can try positioning the baby so that their chin is close to the blocked area because it helps clear the blockage more effectively.

● Hand express or pump a little milk if needed to make your breasts softer for easier latch and drainage. Just express enough to ease the discomfort, as expressing too much may stimulate more milk production.

● Wear a supportive, comfortable bra, preferably without an underwire.

● Get extra sleep and relaxation with the help of others.

● Take care of your health with proper nutrition, hydration, and sleep.

● Use lanolin for sore, cracked nipples to heal them and prevent infection.

● Consider using a mild pain reliever like acetaminophen or ibuprofen.

● Seek advice and support from your healthcare provider.

Nipple blebs, also known as milk blisters, are smooth, shiny, raised white or yellow dots on the nipple caused by blocked milk ducts near the surface.

Nipple blebs can indicate an oversupply of breast milk, improper latch, or inflammation in the breast.

● Continue breastfeeding; if your baby breastfeeds effectively, they may clear the bleb during a feeding, and milk may start flowing through that duct again.

● It’s important not to pick at or scrape the white spot, as this can worsen the condition.

● Apply warm washcloth compresses, gently massage, and express some milk to clear the blockage.

● Apply a food-safe oil like olive oil or coconut oil to the affected nipple to soften the bleb. Be sure to wipe it away before breastfeeding.

● Seek a doctor if no improvement or additional concerns.

Mastitis is a breast infection more commonly occurring in the early months of nursing, especially in individuals with a history of blocked milk ducts. When milk flow is blocked for a long time alongside sore and cracked nipples, it creates an opportunity for bacteria to enter through the skin and thrive in the milk-rich environment.

● Flu-like symptoms appear quickly, including fever, chills, fatigue, nausea, and body aches.

● Breasts may feel tender, warm, or hot to the touch and appear pink or red.

● The pain is usually worse than that of a blocked duct, and yellowish fluid may come from the nipple like colostrum.

The same strategies used for the treatment of engorgement and blocked ducts can help with mastitis. Additionally, your doctor may prescribe antibiotics.

Yes, you should keep breastfeeding, which is the most effective way to reduce swelling and prevent more blockages. Otherwise, use a breast pump or hand expression. Stopping nursing suddenly could lead to abscess formation.

The baby suddenly refuses to breastfeed and showing signs such as crying, arching their back, or turning away from the breast can be distressing for the mother.

Common reasons for this behavior include:

● The baby feeling unwell or having pain, such as from an ear infection, injury, upset stomach, teething, or thrush.

● Changes in the nursing routine, long separations from the mother, or an uncomfortable breastfeeding setup.

● Distractions by things around while breastfeeding.

● Decreased milk supply.

● Changes in the mother’s smell due to new soap, deodorant, or perfume.

● Stress from accidentally biting the nipple and causing a strong reaction.

● Flow preference, such as the baby preferring to suck on a bottle over nursing due to the faster flow of milk, when you try to combine two feeding methods.

Mothers reported these as possible reasons for their babies to refuse the breast: a playful baby, pain from vaccinations, flat nipples, engorgement, labor injuries, and teething.

Don’t worry. If your baby is on a nursing strike, you can help them return to breastfeeding with patience, especially if they are under a year old and have breastfed well before.

Here’s what to do:

★ If you identify a reason for the refusal, try to fix it.

★ Keep offering your breasts to your baby when they seem hungry or sleepy, and just after they wake up. If they get frustrated, take a break, and try again later. You can also put some milk in their mouth.

★ Avoid shaking your breast or forcing your baby onto the breast.

★ Experiment with various positions.

★ Pump at times your baby used to breastfeed and feed them, ideally with a cup until the strike is over. This will help you make enough milk and avoid breast engorgement and plugged ducts.

★ Nurse in a quiet, peaceful place to reduce distractions.

★ Give your baby extra love by cuddling, touching, and comforting them more. Hold them close to your skin.

★ Keep their routine as usual.

★ Talk to your baby’s doctor to rule out any medical problems and ask for advice.

Normally, your body makes the right amount of milk for your baby, but in some cases, it may produce too much. This issue often happens early in breastfeeding, especially for first-time moms.

Here are some factors that can cause milk oversupply:

● Sticking to a strict feeding schedule and switching sides too frequently.

● If your baby cries a lot or feels unwell and wants to nurse for comfort, it can make your breasts produce extra milk.

● Expressing milk too frequently in the early days to ensure you have enough milk supply can lead to an oversupply.

● Using a silicone milk catcher to collect leaking milk or relieve the feeling of overly full breasts can remove more milk than your baby needs, causing an oversupply.

● Some moms take medicines or herbs that are supposed to boost milk production, even if it’s not necessary, due to concerns about their milk production or their baby’s hunger.

For those with too much milk, it can have the following effects:

➔ The milk may flow too fast, making the baby fussy, cry, and struggle during feeding.

➔ It can cause the baby to choke, cough, or even bite down on the nipple to control the flow.

➔ Babies may either gain weight rapidly or not gain enough because of the overwhelming milk flow or missing out on calorie-rich hindmilk, which is the term for the richer, higher-fat milk that comes towards the end of a nursing session.

➔ An excess of lactose-rich foremilk, which is the thinner, lower-fat milk that is released at the beginning of a nursing session, can lead to frequent loose, green stools, gas, and fussiness in the baby.

➔ Feedings might be short but frequent because the baby takes in air quickly along with foremilk, missing out on the hindmilk.

If you’re dealing with an oversupply problem, don’t worry; it often gets better on its own. But inform your doctor about it, so they can check for any underlying issues.

Here’s what you can do to manage it:

1. Hold your baby upright while nursing, lean back, or lie on your side.

2. Use your fingers to slow the milk flow by applying pressure to your breast or areola.

3. Let your baby take breaks and burp.

4. Offer one breast per feeding to ensure the baby gets more of the fatty hindmilk.

5. Avoid pumping too much.

6. Apply cold water or ice to your nipples to reduce leaking.

7. Be cautious, as oversupply can lead to plugged ducts and mastitis.

Every mom and baby are different, and their mouth and nipple shapes are one-of-a-kind. While most nipples come in different shapes, usually without causing problems for breastfeeding, sometimes flat, large, or long nipples can make it hard for a baby to latch on.

Most flat nipples can be stretched out by the mother just before feeding to ease the suckling. Some inverted nipples can’t be stretched out, which can be challenging for the baby. During pregnancy and the first week after birth, these nipples might change. If a nipple is large or long, it might also make it tough for the baby to get enough breast into their mouth. Sometimes, the nipple’s base can be seen even when the baby has their mouth wide open.

The same strategies work for flat, inverted, large, or long nipples:

➢ Trying to fix nipple shape before birth usually doesn’t help, and most babies can breastfeed just fine with different-shaped nipples. After your baby is born, getting skilled help is essential.

➢ Have plenty of skin-to-skin time with your baby near your breast. Let them figure out how to latch on in their unique way, something many babies can do.

➢ Keep trying different breastfeeding positions and let your baby practice. For example, if you have flat or inverted nipples, it may help to lean over your baby’s, so your breast and nipple are closer to their mouth.

➢ If your baby can’t latch on in the first week or two, you can use a cup to feed them expressed breast milk. You can express milk into your baby’s mouth and gently touch your baby’s lips to encourage a wider mouth opening. Avoid using bottles or pacifiers that don’t make your baby open their mouth wide.

➢ As your baby grows, their mouth gets bigger, making it easier for them to latch on.

If you are struggling with flat or inverted nipples while breastfeeding, there are several strategies you can try. One helpful technique is to adopt a laid-back feeding position, making it easier for your baby to latch on. Another approach is gently squeezing your breast between your thumb and fingers to create a "breast sandwich" and help your baby latch deeply. 

The "nipple tilt" technique can also be effective. Before feeding your baby, you can use a breast pump to draw out the nipple and make it more accessible. Finally, a "nipple everter" or nipple shield may be helpful if used according to instructions.

For those with large nipples, different positions, such as the cradle hold, football hold, or side-lying position, may be more comfortable. You can learn more about these positions and techniques by clicking here.

As experienced parents, we completely understand the challenges that come with breastfeeding. Please know that it's completely normal to take some time to get used to it, and every struggle and discomfort can teach you something new for the next time.

If you are experiencing any difficulties with breastfeeding, we are here for you. Our friendly and knowledgeable support team is always available to provide expert assistance. 

Our team of medical professionals has written and reviewed articles specifically on breastfeeding, and we are confident that we can help you find the solutions you need.

In summary, knowing how to handle common breastfeeding issues is key to a successful nursing experience. With proper guidance, you can navigate these challenges and provide the best care for your baby. 

For additional resources and support, you can check out “The Milky Box” website. Wishing you a happy and rewarding breastfeeding journey!

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