Breastfeeding Challenges

Breastfeeding can be hard at times, especially in the beginning. Below you will find information on the most common breastfeeding challenges and how to overcome them. If problems continue or become worse, see your doctor or lactation consultant for more help.

Sore Nipples

Poor latch. Many moms may have breast tenderness when they first start breastfeeding. A new mom and baby need to learn together on what is comfortable and what works for them. If it hurts when your baby begins feeding, your baby may be sucking only on the nipple and not have a good latch. If this is happening, gently break the suction on your breast by placing a clean finger in the corner of your baby’s mouth and look at your nipple. If you nipple looks flat or squashed, your baby was sucking only on the nipple. Reposition your baby and try to latch again. If you are still feeling sore or tender nipples after a couple of days ask your doctor or lactation consultant for help.

Help cracked nipples stay moist so you can continue breastfeeding. Try:

  • After breastfeeding, express a few drops of  milk and gently rub the milk on your nipples with clean hands. Human milk  has natural healing properties and oils that sooth.
  • Use purified lanolin cream or ointment that is especially made for breastfeeding.
  • Let your nipples air dry after feeding, or wear a soft cotton shirt.

Get help from your doctor or lactation consultant before using creams, hydrogel pads (a moist covering for sore nipples) or a nipple shield (a plastic device that covers the nipple while breastfeeding). In some cases you should not use these products. Your doctor can help you decide if these products are right for you.

Do not wear bras or clothes that are too tight and put pressure on your nipples.

Change nursing pads (washable or one-use pads you can place in your bra to absorb leaks) often to avoid trapping moisture.

Avoid hard soaps or ointments that contain astringents (like a toner) on your nipples. Washing with clean water and mild soap is all that is needed to keep our nipples and breast clean.

Ask your doctor about using non-aspirin pain relievers for very sore nipples. 

My baby has a weak suck or only makes tiny sucking movements. Your baby may not have a deep enough latch. Gently unlatch your baby and try again. Talk to a lactation consultant if you are concerned about a weak latch or if your baby is getting enough milk.

Could your baby be tongue-tied? Babies with a tight or short lingual frenulum (the piece of tissue that attaches the tongue to the floor of the mouth) are described as tongue-tied. Babies with this condition find it hard to breastfeed because they may be unable to extend their tongue past their lower gum. This results in the baby not being able to cup the nipple with their tongue when they breastfeed. This can cause slow weight gain in the baby and nipple pain in the mother. If you think your baby is tongue-tied talk to your doctor.

Oversupply of Milk

A breast that produces too much milk can make breastfeeding stressful and uncomfortable for both you and your baby. If you are dealing with this, you can:

  • Breastfeed on one side for each feeding and continue to use only that side for at least two hours until the next feeding, gradually increasing the length of time per feeding.
  • If the other breast feels painfully full before you are ready to breastfeed on it, hand express or pump a few moments to relieve some of the pressure. You can also use a cold compress or washcloth to reduce discomfort and swelling. You can also use chilled greed cabbage leaves to help with swelling, but limit their use because they can decrease your milk supply. To use cabbage leaves correctly you should leave them on for 20 minutes, no more than 3 times per day and stop using them as soon as the discomfort or swelling begins to decrease.
  • Feed your baby before they become too hungry to prevent forceful sucking.

Strong Let-Down Reflex

Due to oversupply, some women has a strong let-down. If this is happening to you:

  • Hold your nipple between your first and middle fingers or with the side of your hand. Lightly compress milk ducts to reduce the force of the milk ejection.
  • If your baby chokes or sputters when breastfeeding, unlatch and let the excess spray into a towel or cloth.
  • Allow your baby to come on and off the breast at will.
  • Try positions that reduce the force of gravity, which can intensify milk ejection. These positions include the side-lying position and football hold.

Engorgement

It is normal for your breasts to become larger, heavier and tender when they begin making milk. When milk builds up breasts can feel very hard and painful, resulting in engorgement. It usually happens during the third to fifth day after giving birth. But it can happen at any time, especially if you have an oversupply of milk,  orare not breastfeeding your baby or expressing your milk often enough.

Engorgement can also cause:

  • Breast swelling
  • Breast tenderness
  • Warmth
  • Redness
  • Throbbing
  • Flattening of the nipple
  • Low-grade fever

Engorgement can lead to plugged ducts or a breast infection, so it is important to prevent it before this happens. If treated right, engorgement should fix itself.

To prevent engorgement:

  • Breastfeed often after giving birth. As long as your baby is properly latched and sucking well, allow your baby to breastfeed for as long as they like.
  • Work with a lactation consultant to improve your baby’s latch.
  • Breastfeed often on the affected side to remove the milk, keep the milk moving freely, and prevent your breast from becoming overly full.
  • Avoid using pacifiers or bottles to supplement feedings in the beginning. Try to wait to introduce pacifiers until your baby is 3 or 4 weeks old.
  • Hand express or pump a little milk to soften the breast, areola, and nipple before breastfeeding.
  • Massage the breast.
  • Use a cold compress on your breast in between feedings to help ease the pain.
  • If you are returning to work, try pumping your milk on the same schedule that your baby breastfed at home. Be sure not to let more than four hours pass between pumping sessions.
  • Get enough rest, proper nutrition, and fluids.
  • Wear a well-fitting, supportive bra that is not too tight.

Plugged Ducts

Plugged ducts are common in breastfeeding mothers and happen when a milk duct does not drain properly. Pressure than builds up behind the plug, and the surrounding tissue gets swollen. Plugged ducts feel like a tender or sore lump in you breast. If you are having a problem with plugged ducts, you can:

  • Breastfeed on the affected side as often as every two hours. This will help loosen the plug and keep your milk moving freely.
  • Aim your baby’s chin at the plug. This will focus their suck on the duct that is affected.
  • Massage the area, starting behind the sore spot. Move your fingers in a circular motion and massage toward the nipple. Use a warm cloth on the sore area.
  • Get extra sleep, or relax with your feet up to help speed healing. Often a plugged duct is a sign that you are doing too much.
  • Wear a well-fitting, supportive bra that is not too tight, since this can constrict milk ducts. Consider trying a bra without an underwire.
  • If you have plugged ducts that keep coming back, seek help from a doctor of a lactation consultant.

Breast Infection (mastitis)

A breast infection, also known as mastitis, is soreness or a lump in your breast. It can cause symptoms such as:

  • Fever and/or flu-like symptoms, such as feeling run down or achy
  • Nausea
  • Vomiting
  • Yellowish discharge from the nipple
  • Breasts that feel warm or hot to the touch and appear pink or red.

If a breast infection does not improve on their own within 24-48 hours, if you have a fever, or if your symptoms worsen you might need medicine. See your doctor right away if:

  • You have a breast infection in which both breasts look and feel infected
  • There is pus or blood in your breast milk
  • You have red streaks near the sore area of the breast
  • Your symptoms come on severely and suddenly

Fungal Infections

Also called a yeast infection or thrush, fungal infections can form on your nipples or in your breast. A fungal infection occurs when there is an overgrowth of the Candida organism. Candida lives in our bodies and is kept healthy by the natural bacteria in our bodies. When the natural balance is upset, Candida can overgrow, causing an infection.

The main symptoms of a fungal infection are sore nipples that become sore suddenly or that last more than a few days, even if your baby has a good latch. Your nipples may become pink, flaky, shiny, itchy, cracked or blistered. You could also have achy breasts or shooting pains in the breast during or after feedings.

Causes of fungal infections include:

  • Thrush in your baby’s mouth, which can pass to you
  • An overly moist environment on your skin or nipples that are sore or cracked
  • Use of antibiotics or steroids, perhaps during labor
  • A chronic illness like HIV, diabetes, or anemia

Fungal infections may take several weeks to clear up, so it is important to follow these tips to avoid spreading the infection:

  • Change disposable nursing pads often
  • Wash any towels or clothing that comes in contact with the yeast in very hot water (above 122 degrees F)
  • Wear a clean bra every day
  • Wash your hands often
  • Wash your baby’s hand often, especially if they suck on their fingers
  • Place all pacifiers, bottle nipples, or toys your baby puts in their mouth in a pot of boiling water every day
  • After one week of treatment, throw away all pacifiers and nipples and buy new ones
  • Boil all breast pump parts that touch your milk, every day
  • Make sure other family members are free of thrush or other fungal infections. If they have symptoms, make sure they get treated.

Inverted, Flat, or Very Large Nipplesnipples

Nipples can come in many different shapes and sizes. No matter what your nipples look like, you can still meet all your breastfeeding goals.

Inverted or flat nipples can sometimes make it harder to breastfeed. But remember, your baby latches to both the nipple and breast, so even if you have flat or inverted nipples you will still be able to breastfeed. In fact, flat and inverted nipples will stick out more as the baby sucks more. If you have flat or inverted nipples you can use your fingers to pinch your nipples out. Discuss the use of special devices, such as a nipple shield, with a lactation consultant before using them to help with latching.

Very large nipples can make it hard for the baby to get enough of the areola into their mouth to compress the milk ducts and get enough milk. The latch for babies of moms with very large nipples will improve with time as your baby grows. In some cases, it might take several weeks to get the baby to latch properly. But if you have a good milk supply, your baby will get enough milk even with a poor latch in the beginning.

If you are concerned about the shape or size of your nipples, talk to your doctor or lactation consultant.

Nursing Strike

A nursing strike is when your baby has been breastfeeding well for months and then suddenly begins to refuse the breast. A nursing strike can mean that your baby is trying to let you know that something is wrong, not that they are ready to stop breastfeeding (wean).

Sore of the major causes of a nursing strike are:

  • Having mouth pain from teething, thrush, or a cold sore
  • Having an ear infection, which causes pain while sucking or pressure while laying on one side
  • Feeling pain from certain breastfeeding positions, perhaps from an injury or from soreness from an immunization
  • Being upset about a long separation from the mother or a major change in routine
  • Becoming interested in what is going on around them
  • Having a cold or stuffy nose that makes breathing while breastfeeding hard
  • Getting less milk from the mother after supplementing breast milk with bottles or overuse of a pacifier
  • Responding to mom’s strong reaction if her baby has bitten her
  • Being upset by hearing arguing or people talking in a harsh voice while breastfeeding
  • Reacting to stress, over-stimulation, or having been repeatedly put off when wanting to breastfeed

It can be upsetting and frustrating if your baby is on a nursing strike. Be patient and keep trying by offering your breasts when they show signs of hunger. You may also want to pump your breast milk during the strike to make sure you do not get engorged. You can also:

  • Try a temporary feeding method, such as using a cup, dropper, or spoon, to give your baby breast milkcupfeeding
  • Keep track of your baby’s wet and dirty diapers to make sure they are getting enough milk
  • Try breastfeeding positions where your bare skin is touching your baby’s bare skin
  • Focus on your baby, and comfort them with extra touching and cuddling
  • Try breastfeeding while rocking your baby in a quiet room free of distractions.