Breastfeeding problems solved

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  • Common causes of sore nipples and breast engorgement.
  • Remedies for plugged ducts and sore nipples.
  • Concerns about milk supply.
  • Tips and advice to help your baby latch on.

Breastfeeding is well worth the practice and patience that it may need. Here are some common concerns that breastfeeding moms have, and solutions to remedy them.    

Sore nipples

Your nipple is sometimes red but always painful during most of or the entire feeding. It’s common during early post-partum feedings to experience a slight discomfort for the initial suckling that resolves within a minute of feeding.   


Common causes 

  • Improper latch-on because of poor positioning. 
  • Tight latch because of bottle and pacifier use. 
  • Use of a pump with a flange that doesn’t fit.   


Basic remedies 

  • Practice skin-to-skin positioning between feedings. If your baby is crying between feedings and seems stressed, this will help her relax. 
  • Wait until your baby is calm and begins to look around. This will be a perfect time to help guide her to your breast. 
  • A small change in feeding position can make a world of difference. Experiment with the “cross-cradle hold” and “football hold” which provide a little more head and neck support. This may help encourage the wide latch. 
  • If her nose is smashed into your breast, slightly lower her body to help her nose come out and chin come into your breast for a better latch. Her head should not be overly tilted in or back. 
  • Feed her from the least sore breast first to minimize an aggressive feeding on a sensitive nipple. 
  • Don’t pull her off your breast before breaking the suction of the latch. Break your baby’s suction by placing your finger between your breast and her gums before taking her off your breast. 
  • Use a very thin coat of 100% lanolin on your areola and nipples after a feeding to help protect and soothe tender nipples. Allow your nipples to air dry before applying the ointment. It will not need to be wiped off before the next feeding.
  • If you’re using a breast pump, it may come with different flange sizes that will fit better. The lactation consultant at your local hospital or health department may be able to assess and find a properly fitted flange for you. 
  • Wear cotton clothing next to your breasts (a breastfeeding bra or a loose-fitting top). Take plastic liners out of your bra. 
  • If your nipples are too sore to have your bra or clothing touch them, use breast shells with large nipple openings and holes for air circulation over your nipple and under your bra.  

We're here to help

Contact an IBCLC who can help you assess why you developed sore nipples.

Breast engorgement

Hard and swollen breasts, usually in both breasts during early post-partum days.
    

Common causes

  • Infrequent or delayed feedings.
  • Over-production of milk.
  • Poor or inefficient milk removal.
  • Supplemental feedings.
  • Rapid or sudden weaning.
  • Breast edema.   


Basic remedies

  • Relieve the pressure in your breast as soon as possible by either breastfeeding, hand expressing your milk, or using a breast pump. If your breasts are too full for her to latch on, express a little milk by hand or pump first.
  • Breastfeed or pump every two hours to help build a good milk supply while relieving the engorgement. Remember, your newborn baby should be breastfed at least 8 to 12 times per 24 hours.
  • Take a warm shower or place a warm, wet cloth on breasts.
  • If your baby doesn’t breastfeed long enough to soften them, use a breast pump until both breasts feel comfortable.
  • Use cold packs between feedings.
  • If your hands and/or ankles are swollen due to retaining extra fluids, your breasts might also be swollen from retained fluids. Try pushing the excess fluid away from the nipple and areola. Do this by placing your fingers and thumb right at the neck of your nipple and press into your chest for about a minute. The nipple should become more elastic to allow either breastfeeding or pumping to be more effective. 

Call your physician if your breasts are painful, hot, have an area of spreading redness, or you feel feverish (your temperature is over 100° F).

Painful breasts

Full but not swollen breasts during the early post-partum days.
    

Common causes

  • Transition from first milk to the surge of mature milk—about 2 to 5 days after birth.   


Basic remedies

  • Gently massage the upper part of your breasts.
  • Apply a warm or cool relief pack.
  • Take warm showers.
  • Breastfeeding frequently—at least 8 to 12 times per 24 hours.
  • Make sure she’s positioned correctly during each feeding. She should be lying with her whole body facing you. 
  • Make sure your nipple and as much of the area around the nipple is covered almost completely with her mouth, her tongue on the underside of your areola. When removing her from your breast, remember to break the suction by gently sliding your finger in between your nipple and her gums.


Rapid milk ejection

Forceful spraying of your milk resulting in your baby coughing, gagging and even pulling of the breast.

Common causes

  • Individual hormone response.
  • Overactive milk supply.


Basic remedies

  • Increase your baby’s control of the milk flow by adjusting her feeding positioning to an upright football hold, side-lying hold or a laid-back feeding position.
  • Expressing some milk to catch the initial forceful flow before putting your baby to your breast may be helpful.
  • Use of a breast shield to allow for a slight barrier from the milk spray during the initial forceful “let-down” is another option. Proper use of the breast shield is very important and should be discussed with a lactation consultant as to not cause additional concerns due to improper use.


Tingling breasts

You may experience some tingling as your breasts adjust to breastfeeding.


Common causes 

  • You may experience some tingling as your breasts adjust to breastfeeding. 


Basic remedies 

  • If tingling only lasts a few seconds and occurs when she starts breastfeeding, it's a normal sign of "let-down” (release of milk from your breast).

If your temperature is higher than 100° F or if one of your breasts is sore and hot, call your doctor. You may have a breast infection and require medication.

Chapped nipples

Breastfeeding may leave your nipples chapped and tender.

Common causes

  • Initial breastfeeding adjustments.
  • Washing nipples with soap or using other drying agents such as alcohol.


Basic remedies

  • Gentle moisturizing balm will also soothe chapped and tender breasts. It's a lanolin-free, hypoallergenic blend of natural emollients. The balm is safe for both of you, so there's no need to wipe it off before feeding.
  • Gently wash breasts and nipples with mild soap and water. Do not overuse soap or use rubbing alcohol, which dry the skin and cause cracking.
  • Apply some expressed breastmilk on your nipples and allow them to air dry.
  • Place a soothing gel patch inside your bra to prevent friction. The patches cool on contact.


Concerns about breast size

  • The size or shape of your breasts has nothing to do with the quality and quantity of milk you’ll produce. Your level of milk production will increase in direct proportion to the amount she’s comfortably feeding.     

 

Plugged milk ducts

A tender-to-the-touch lump anywhere on your breast or in your underarm area is most likely plugged milk ducts.

Common causes

  • Inadequate feeding drainage/emptying.
  • Scar tissue in the breast.
  • Underwire bras, tight-fitting bras, or tight-fitting sleeveless tops.
  • Feeding in the same position for all feedings.
  • Plugged pore.


Basic remedies

  • Apply dry or moist heat to the area by taking a hot shower or applying a warm wet cloth. Nurse or hand-express some milk while your breast is still warm.
  • Offer the sore breast first, and encourage her to feed longer on that side.
  • Massage the area during and between feedings.
  • Alternate feeding positions.
  • Avoid wearing a tight breastfeeding bra or one with underwire that may hold back milk flow.

If the lump persists and becomes red and the redness spreads, you may develop a breast infection and fever, which will require immediate attention from your physician.

Slow-milk-ejection reflex

Milk “let-down” (release) from your breasts taking longer than 10 minutes to occur.  

Common causes

  • You’re feeling stressed or anxious about feedings.In an uncomfortable feeding position.
  • Painful feedings.   


Basic remedies
 

  • Stay relaxed by singing or humming a song, reading a book, or calmly talking to your baby during feedings.
  • Gently massage your breast with your hand before putting her to your breast.Breastfeed her in a calm, stress-free environment.
  • Adjust to a more comfortable feeding position. 

Leaking milk

Milk leaking from your breasts between feedings.


Common causes

  • Almost feeding time
  • Hormonal response to hearing a crying baby.


Basic remedies

  • Use an absorbent breastfeeding pad or clean folded handkerchief inside your bra to catch the drip. Don’t forget to change the pad or handkerchief often. A clean pad prevents growth of bacteria, which thrive where it’s warm and moist.
  • Place some direct pressure over the nipple of your breast to minimize the response. 


Milk reduction

Decreasing milk supply by seeing that your baby is not satisfied and not gaining proper weight.


Common causes

  • Formula supplementation.
  • Return to work or school.
  • Taking medications with a side effect of decreasing milk production.
  • Significant increased sudden stress.
  • You may be a little dehydrated. 


Basic remedies

  • Add an extra feeding or pumping session to your daily routine.
  • Practice skin-to-skin contact between feedings.
  • Practice breast massage before and during feedings.
  • Try to relax with your baby and get some rest.
  • Take it easy and drink more fluids to prevent thirst. 


Over milk supply

Your breasts are very full and not “emptied” after full feedings, milk may spray after your baby comes off your breast satisfied, and your baby may seem uncomfortable after just a few minutes of feeding and come off your breast frequently. 


Common causes

  • Initial 4 to 6 weeks post-partum supply adjustment to your baby’s feeding needs.
  • Over-pumping.
  • Hormonal response. 

Basic remedies

  • Increase your baby’s control of the milk flow by adjusting her feeding position to an upright football hold, side-lying hold or a laid-back feeding position.
  • Feed from one breast per feeding session and pump the other breast only to provide comfort if it becomes uncomfortable between feedings. This may only be less than a minute of pumping.
  • Continue to offer the same breast if she’s interested within two hours after her last feeding, then resume to the other breast for the next feeding for up to two hours. 

Difficulty latching on

Your baby opens her mouth for your breast, but doesn’t latch on to feed. 

Common causes 

  • Using bottles or pacifiers.
  • A sleepy baby.
  • Flat or inverted nipples.


Basic Remedies 

  • Avoid pacifiers and bottle-feeding the first three to four weeks to firmly establish breastfeeding.
  • Practice skin-to-skin as often as possible between feedings to help your baby get a nice deep sleep and be more rested and interested in the next feeding.
  • Offer your breast during early hunger cues.Express some milk to have a few drops on your nipple before offering your breast.
  • Try different feeding positions. 
  • Express a small amount of milk from your breast by hand or with a breast pump before feeding to soften the areola and stimulate milk flow, so she will receive milk flow right away.
  • Consider a nipple shield for flat or inverted nipples if the nipple does not stay stimulated even after the use of a breast pump. Ask your lactation consultant about the proper use of a nipple shield. Improper use can result in additional concerns.

We're here to help

Talk with your doctor or a Certified Lactation Consultant if you would like to learn more.
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