Common breastfeeding challenges facts*
*Common breastfeeding challenge facts medical author: Melissa Conrad Stöppler, MD
Common breastfeeding challenges overview
Breastfeeding can be challenging at times, especially in the early days. But it is important to remember that you are not alone. Lactation consultants are trained to help you find ways to make breastfeeding work for you. And while many women are faced with one or more of the challenges listed here, many women do not struggle at all! Also, many women may have certain problems with one baby that they don't have with their second or third babies. Read on for ways to troubleshoot problems.
Sore nipples
Many moms report that nipples can be tender at first. Breastfeeding should be comfortable once you have found some positions that work and a good latch is established. Yet it is possible to still have pain from an abrasion you already have. You may also have pain if your baby is sucking on only the nipple.
Ask a lactation consultant for help to improve your baby's latch. Talk to your doctor if your pain does not go away or if you suddenly get sore nipples after several weeks of pain-free breastfeeding. Sore nipples may lead to a breast infection, which needs to be treated by a doctor.
What you can doLow milk supply
Most mothers can make plenty of milk for their babies. But many mothers are concerned about having enough.
Checking your baby's weight and growth is the best way to make sure he or she is getting enough milk. Let the doctor know if you are concerned. For more ways to tell if your baby is getting enough milk, visit the How to know your baby is getting enough milk section.
There may be times when you think your supply is low, but it is actually just fine:
When your baby is around 6 weeks to 2 months old, your breasts may no longer feel full. This is normal. At the same time, your baby may nurse for only five minutes at a time. This can mean that you and baby are just adjusting to the breastfeeding process - and getting good at it!
Growth spurts can cause your baby to want to nurse longer and more often. These growth spurts can happen around 2 to 3 weeks, 6 weeks, and 3 months of age. They can also happen at any time. Don't be alarmed that your supply is too low to satisfy your baby. Follow your baby's lead - nursing more and more often will help build up your milk supply. Once your supply increases, you will likely be back to your usual routine.
What you can doAsk for help! Let your baby's doctor know if you think the baby is not getting enough milk.
Oversupply of milk
Some mothers are concerned about having an oversupply of milk. Having an overfull breast can make feedings stressful and uncomfortable for both mother and baby.
What you can doSome women have a strong milk ejection reflex or let-down. This can happen along with an oversupply of milk. If you have a rush of milk, try the following:
Ask for help! Ask a lactation consultant for help if you are unable to manage an oversupply of milk on your own.
Engorgement
It is normal for your breasts to become larger, heavier, and a little tender when they begin making more milk. Sometimes this fullness may turn into engorgement, when your breasts feel very hard and painful. You also may have breast swelling, tenderness, warmth, redness, throbbing, and flattening of the nipple. Engorgement sometimes also causes a low-grade fever and can be confused with a breast infection. Engorgement is the result of the milk building up. It usually happens during the third to fifth day after birth, but it can happen at any time.
Engorgement can lead to plugged ducts or a breast infection, so it is important to try to prevent it before this happens. If treated properly, engorgement should resolve.
What you can doAsk for help! Ask your lactation consultant or doctor for help if the engorgement lasts for two days or more.
Plugged ducts
It is common for many women to have a plugged duct at some point breastfeeding. A plugged milk duct feels like a tender and sore lump in the breast. It is not accompanied by a fever or other symptoms. It happens when a milk duct does not properly drain and becomes inflamed. Then, pressure builds up behind the plug, and surrounding tissue becomes inflamed. A plugged duct usually only occurs in one breast at a time.
What you can doAsk for help! If your plugged duct doesn't loosen up, ask for help from a lactation consultant. Plugged ducts can lead to a breast infection.
Breast infection (mastitis)
Even if you are taking medicine, continue to breastfeed during treatment. This is best for both you and your baby. Ask a lactation consultant for help if needed.
Mastitis (mast-EYE-tiss) is soreness or a lump in the breast that can be accompanied by a fever and/or flu-like symptoms, such as feeling run down or very achy. Some women with a breast infection also have nausea and vomiting. You also may have yellowish discharge from the nipple that looks like colostrum. Or, the breasts may feel warm or hot to the touch and appear pink or red. A breast infection can occur when other family members have a cold or the flu. It usually only occurs in one breast. It is not always easy to tell the difference between a breast infection and a plugged duct because both have similar symptoms and can improve within 24 to 48 hours. Most breast infections that do not improve on their own within this time period need to be treated with medicine given by a doctor.
What you can doAsk for help! Ask your doctor for help if you do not feel better within 24 hours of trying these tips, if you have a fever, or if your symptoms worsen. You might need medicine. See your doctor right away if:
Fungal infections
A fungal infection, also called a yeast infection or thrush, can form on your nipples or in your breast because it thrives on milk. The infection forms from an overgrowth of the Candida organism. Candida exists in our bodies and is kept at healthy levels by the natural bacteria in our bodies. When the natural balance of bacteria is upset, Candida can overgrow, causing an infection.
A key sign of a fungal infection is if you develop sore nipples that last more than a few days, even after you make sure your baby has a good latch. Or, you may suddenly get sore nipples after several weeks of pain-free breastfeeding. Some other signs of a fungal infection include pink, flaky, shiny, itchy or cracked nipples, or deep pink and blistered nipples. You also could have achy breasts or shooting pains deep in the breast during or after feedings.
Causes of thrush include:
Thrush in a baby's mouth appears as little white spots on the inside of the cheeks, gums, or tongue. Many babies with thrush refuse to nurse, or are gassy or cranky. A baby's fungal infection can also appear as a diaper rash that looks like small red dots around a main rash. This rash will not go away by using regular diaper rash creams.
What you can doFungal infections may take several weeks to cure, so it is important to follow these tips to avoid spreading the infection:
Ask for help!
If you or your baby has symptoms of a fungal infection, call both your doctor and your baby's doctor so you can be correctly diagnosed and treated at the same time. This will help prevent passing the infection to each other.
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. This does not usually mean that the baby is ready to wean. Not all babies will react the same to the different situations that can cause a nursing strike. Some babies will continue to breastfeed without a problem. Others may just become fussy at the breast, and others will refuse the breast entirely. Some of the major causes of a nursing strike include:
If your baby is on a nursing strike, it is normal to feel frustrated and upset, especially if your baby is unhappy. It is important not to feel guilty or think that you have done something wrong. Keep in mind that your breasts may become uncomfortable as the milk builds up.
What you can doAsk for help if your baby is having a nursing strike to ensure that your baby gets enough milk. The doctor can check your baby's weight gain.
Inverted, flat, or very large nipples
Some women have nipples that turn inward instead of protruding, or that are flat and do not protrude. Nipples can also sometimes be flattened temporarily due to engorgement or swelling while breastfeeding. Inverted or flat nipples can sometimes make it harder to breastfeed. But remember that for breastfeeding to work, your baby has to latch on to both the nipple and the breast, so even inverted nipples can work just fine. Often, flat and inverted nipples will protrude more over time, as the baby sucks more.
Very large nipples can make it hard for the baby to get enough of the areola into his or her mouth to compress the milk ducts and get enough milk.
What you can doAsk for help if you have questions about your nipple shape or type, especially if your baby is having trouble latching well.
Breastfeeding a baby with health problems
There are some health problems in babies that can make it harder to breastfeed. Yet breast milk and early breastfeeding are still best for the health of both you and your baby - even more so if your baby is premature or sick. Even if your baby cannot breastfeed directly from you, it's best to express or pump your milk and give it to your baby with a cup or dropper.
Some common health problems in babies are listed below.
JaundiceJaundice is caused by an excess of bilirubin, a substance that is in the blood usually in very small amounts. In the newborn period, bilirubin can build up faster than it can be removed from the intestinal track. Jaundice can appear as a yellowing of the skin and eyes. It affects most newborns to some degree, appearing between the second and third day of life. The jaundice usually clears up by two weeks of age and is not harmful.
Two types of jaundice can affect breastfed infants - breastfeeding jaundice and breast milk jaundice.
Your baby's doctor may monitor your baby's bilirubin level with blood tests. Jaundice is best treated by breastfeeding more frequently or for longer periods of time. It is crucial to have a health care provider help you make sure the baby is latching on and removing milk well. This is usually all that is needed for the infant's body to rid itself of excess bilirubin.
Some babies will also need phototherapy - treatment with a special light. This light helps break down bilirubin into a form that can be removed from the body easily. If you are having trouble latching your baby to the breast, it is important that you pump or hand express to ensure a good milk supply. The same is true if the baby needs formula for a short time - pumping or hand expressing will make sure the baby has enough milk when you return to breastfeeding.
It is important to keep in mind that breastfeeding is best for your baby. Even if your baby experiences jaundice, this is not something that you caused. Your health care providers can help you make sure that your baby is eating well and that the jaundice goes away.
Ask for help! If your baby develops jaundice once at home, let your baby's doctor know. Discuss treatment options and let the doctor know that you do not want to interrupt breastfeeding if at all possible.
Reflux diseaseSome babies have a condition called gastroesophageal (GASS-troh-uh-SOF-uh-JEE-uhl) reflux disease (GERD), which occurs when the muscle at the opening of the stomach opens at the wrong times. This allows milk and food to come back up into the esophagus, the tube in the throat. Some symptoms of GERD can include:
Many healthy babies might have some of these symptoms and not have GERD. But there are babies who might only have a few of these symptoms and have a severe case of GERD. Not all babies with GERD spit up or vomit. More severe cases of GERD may need to be treated with medication if the baby refuses to nurse, gains weight poorly or is losing weight, or has periods of gagging or choking.
Ask for help! See your baby's doctor if he or she spits up after every feeding and has any of the other symptoms mentioned here. If your baby has GERD, it is important to continue breastfeeding. Breast milk is more easily digested than infant formula.
Cleft palate and cleft lipCleft palate and cleft lip are some of the most common birth defects that happen as a baby is developing in the womb. A cleft, or opening, in either the palate or lip can happen together or separately and both can be corrected through surgery. Both conditions can prevent babies from forming a good seal around the nipple and areola with his or her mouth, or effectively remove milk from the breast. A mother can try different breastfeeding positions and use her thumb or breast to help fill in the opening left by the lip to form a seal around the breast.
Right after birth, a mother whose baby has a cleft palate can try to breastfeed her baby. She can also start expressing her milk right away to keep up her supply. Even if her baby can't latch on well to her breast, the baby can be fed breast milk by cup. In some hospitals, babies with cleft palate are fitted with a mouthpiece called an obturator that fits into the cleft and seals it for easier feeding. The baby should be able to exclusively breastfeed after his or her surgery.
Ask for help! If your baby is born with a cleft palate or cleft lip, talk with a lactation consultant in the hospital. Breast milk is still best for your baby's health.
Premature and/or low birth weightPremature birth is when a baby is born before 37 weeks gestation. Prematurity often will mean that the baby is born at a low birth weight, defined as less than five and a half pounds. Low birth weight can also be caused by malnourishment in the mother. Arriving early or being small can make for a tough adjustment, especially if the baby has to stay in the hospital for extra care. But keep in mind that breast milk has been shown to help premature babies grow and ward off illness.
Most babies who are low birth weight but born after 37 weeks (full term) can begin breastfeeding right away. They will need more skin-to-skin contact with mom and dad to help keep them warm. These smaller babies may also need more frequent feedings, and they may get sleepier during those feedings.
Many babies born prematurely are often not able to breastfeed at first, but they do benefit from expressed milk. You can express colostrum by hand or pump as soon as you can in the hospital. You can talk to the hospital staff about renting a hospital grade electric pump. Call your insurance company or local WIC Office to find out if you can get reimbursed for this type of pump. You will need to express milk as often as you would have breastfed, so around 8 times per a 24-hour period.
Once your baby is ready to breastfeed directly, skin-to-skin contact can be very calming and a great start to your first feeding. Be sure to work with a lactation consultant on proper latch and positioning. Many mothers of premature babies find the cross cradle hold helpful. It may take some time for you and the baby to get into a good routine.
Did you know? If you leave the hospital before your baby, you can express milk for the hospital staff to give the baby by feeding tube.
Sore nipples
Many moms report that nipples can be tender at first. Breastfeeding should be comfortable once you have found some positions that work and a good latch is established. Yet it is possible to still have pain from an abrasion you already have. You may also have pain if your baby is sucking on only the nipple.
Ask a lactation consultant for help to improve your baby's latch. Talk to your doctor if your pain does not go away or if you suddenly get sore nipples after several weeks of pain-free breastfeeding. Sore nipples may lead to a breast infection, which needs to be treated by a doctor.
What you can doLow milk supply
Most mothers can make plenty of milk for their babies. But many mothers are concerned about having enough.
Checking your baby's weight and growth is the best way to make sure he or she is getting enough milk. Let the doctor know if you are concerned. For more ways to tell if your baby is getting enough milk, visit the How to know your baby is getting enough milk section.
There may be times when you think your supply is low, but it is actually just fine:
When your baby is around 6 weeks to 2 months old, your breasts may no longer feel full. This is normal. At the same time, your baby may nurse for only five minutes at a time. This can mean that you and baby are just adjusting to the breastfeeding process - and getting good at it!
Growth spurts can cause your baby to want to nurse longer and more often. These growth spurts can happen around 2 to 3 weeks, 6 weeks, and 3 months of age. They can also happen at any time. Don't be alarmed that your supply is too low to satisfy your baby. Follow your baby's lead - nursing more and more often will help build up your milk supply. Once your supply increases, you will likely be back to your usual routine.
What you can doAsk for help! Let your baby's doctor know if you think the baby is not getting enough milk.
Oversupply of milk
Some mothers are concerned about having an oversupply of milk. Having an overfull breast can make feedings stressful and uncomfortable for both mother and baby.
What you can doSome women have a strong milk ejection reflex or let-down. This can happen along with an oversupply of milk. If you have a rush of milk, try the following:
Ask for help! Ask a lactation consultant for help if you are unable to manage an oversupply of milk on your own.
Engorgement
It is normal for your breasts to become larger, heavier, and a little tender when they begin making more milk. Sometimes this fullness may turn into engorgement, when your breasts feel very hard and painful. You also may have breast swelling, tenderness, warmth, redness, throbbing, and flattening of the nipple. Engorgement sometimes also causes a low-grade fever and can be confused with a breast infection. Engorgement is the result of the milk building up. It usually happens during the third to fifth day after birth, but it can happen at any time.
Engorgement can lead to plugged ducts or a breast infection, so it is important to try to prevent it before this happens. If treated properly, engorgement should resolve.
What you can doAsk for help! Ask your lactation consultant or doctor for help if the engorgement lasts for two days or more.
Plugged ducts
It is common for many women to have a plugged duct at some point breastfeeding. A plugged milk duct feels like a tender and sore lump in the breast. It is not accompanied by a fever or other symptoms. It happens when a milk duct does not properly drain and becomes inflamed. Then, pressure builds up behind the plug, and surrounding tissue becomes inflamed. A plugged duct usually only occurs in one breast at a time.
What you can doAsk for help! If your plugged duct doesn't loosen up, ask for help from a lactation consultant. Plugged ducts can lead to a breast infection.
Breast infection (mastitis)
Even if you are taking medicine, continue to breastfeed during treatment. This is best for both you and your baby. Ask a lactation consultant for help if needed.
Mastitis (mast-EYE-tiss) is soreness or a lump in the breast that can be accompanied by a fever and/or flu-like symptoms, such as feeling run down or very achy. Some women with a breast infection also have nausea and vomiting. You also may have yellowish discharge from the nipple that looks like colostrum. Or, the breasts may feel warm or hot to the touch and appear pink or red. A breast infection can occur when other family members have a cold or the flu. It usually only occurs in one breast. It is not always easy to tell the difference between a breast infection and a plugged duct because both have similar symptoms and can improve within 24 to 48 hours. Most breast infections that do not improve on their own within this time period need to be treated with medicine given by a doctor.
What you can doAsk for help! Ask your doctor for help if you do not feel better within 24 hours of trying these tips, if you have a fever, or if your symptoms worsen. You might need medicine. See your doctor right away if:
Fungal infections
A fungal infection, also called a yeast infection or thrush, can form on your nipples or in your breast because it thrives on milk. The infection forms from an overgrowth of the Candida organism. Candida exists in our bodies and is kept at healthy levels by the natural bacteria in our bodies. When the natural balance of bacteria is upset, Candida can overgrow, causing an infection.
A key sign of a fungal infection is if you develop sore nipples that last more than a few days, even after you make sure your baby has a good latch. Or, you may suddenly get sore nipples after several weeks of pain-free breastfeeding. Some other signs of a fungal infection include pink, flaky, shiny, itchy or cracked nipples, or deep pink and blistered nipples. You also could have achy breasts or shooting pains deep in the breast during or after feedings.
Causes of thrush include:
Thrush in a baby's mouth appears as little white spots on the inside of the cheeks, gums, or tongue. Many babies with thrush refuse to nurse, or are gassy or cranky. A baby's fungal infection can also appear as a diaper rash that looks like small red dots around a main rash. This rash will not go away by using regular diaper rash creams.
What you can doFungal infections may take several weeks to cure, so it is important to follow these tips to avoid spreading the infection:
Ask for help!
If you or your baby has symptoms of a fungal infection, call both your doctor and your baby's doctor so you can be correctly diagnosed and treated at the same time. This will help prevent passing the infection to each other.
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. This does not usually mean that the baby is ready to wean. Not all babies will react the same to the different situations that can cause a nursing strike. Some babies will continue to breastfeed without a problem. Others may just become fussy at the breast, and others will refuse the breast entirely. Some of the major causes of a nursing strike include:
If your baby is on a nursing strike, it is normal to feel frustrated and upset, especially if your baby is unhappy. It is important not to feel guilty or think that you have done something wrong. Keep in mind that your breasts may become uncomfortable as the milk builds up.
What you can doAsk for help if your baby is having a nursing strike to ensure that your baby gets enough milk. The doctor can check your baby's weight gain.
Inverted, flat, or very large nipples
Some women have nipples that turn inward instead of protruding, or that are flat and do not protrude. Nipples can also sometimes be flattened temporarily due to engorgement or swelling while breastfeeding. Inverted or flat nipples can sometimes make it harder to breastfeed. But remember that for breastfeeding to work, your baby has to latch on to both the nipple and the breast, so even inverted nipples can work just fine. Often, flat and inverted nipples will protrude more over time, as the baby sucks more.
Very large nipples can make it hard for the baby to get enough of the areola into his or her mouth to compress the milk ducts and get enough milk.
What you can doAsk for help if you have questions about your nipple shape or type, especially if your baby is having trouble latching well.
Breastfeeding a baby with health problems
There are some health problems in babies that can make it harder to breastfeed. Yet breast milk and early breastfeeding are still best for the health of both you and your baby - even more so if your baby is premature or sick. Even if your baby cannot breastfeed directly from you, it's best to express or pump your milk and give it to your baby with a cup or dropper.
Some common health problems in babies are listed below.
JaundiceJaundice is caused by an excess of bilirubin, a substance that is in the blood usually in very small amounts. In the newborn period, bilirubin can build up faster than it can be removed from the intestinal track. Jaundice can appear as a yellowing of the skin and eyes. It affects most newborns to some degree, appearing between the second and third day of life. The jaundice usually clears up by two weeks of age and is not harmful.
Two types of jaundice can affect breastfed infants - breastfeeding jaundice and breast milk jaundice.
Your baby's doctor may monitor your baby's bilirubin level with blood tests. Jaundice is best treated by breastfeeding more frequently or for longer periods of time. It is crucial to have a health care provider help you make sure the baby is latching on and removing milk well. This is usually all that is needed for the infant's body to rid itself of excess bilirubin.
Some babies will also need phototherapy - treatment with a special light. This light helps break down bilirubin into a form that can be removed from the body easily. If you are having trouble latching your baby to the breast, it is important that you pump or hand express to ensure a good milk supply. The same is true if the baby needs formula for a short time - pumping or hand expressing will make sure the baby has enough milk when you return to breastfeeding.
It is important to keep in mind that breastfeeding is best for your baby. Even if your baby experiences jaundice, this is not something that you caused. Your health care providers can help you make sure that your baby is eating well and that the jaundice goes away.
Ask for help! If your baby develops jaundice once at home, let your baby's doctor know. Discuss treatment options and let the doctor know that you do not want to interrupt breastfeeding if at all possible.
Reflux diseaseSome babies have a condition called gastroesophageal (GASS-troh-uh-SOF-uh-JEE-uhl) reflux disease (GERD), which occurs when the muscle at the opening of the stomach opens at the wrong times. This allows milk and food to come back up into the esophagus, the tube in the throat. Some symptoms of GERD can include:
Many healthy babies might have some of these symptoms and not have GERD. But there are babies who might only have a few of these symptoms and have a severe case of GERD. Not all babies with GERD spit up or vomit. More severe cases of GERD may need to be treated with medication if the baby refuses to nurse, gains weight poorly or is losing weight, or has periods of gagging or choking.
Ask for help! See your baby's doctor if he or she spits up after every feeding and has any of the other symptoms mentioned here. If your baby has GERD, it is important to continue breastfeeding. Breast milk is more easily digested than infant formula.
Cleft palate and cleft lipCleft palate and cleft lip are some of the most common birth defects that happen as a baby is developing in the womb. A cleft, or opening, in either the palate or lip can happen together or separately and both can be corrected through surgery. Both conditions can prevent babies from forming a good seal around the nipple and areola with his or her mouth, or effectively remove milk from the breast. A mother can try different breastfeeding positions and use her thumb or breast to help fill in the opening left by the lip to form a seal around the breast.
Right after birth, a mother whose baby has a cleft palate can try to breastfeed her baby. She can also start expressing her milk right away to keep up her supply. Even if her baby can't latch on well to her breast, the baby can be fed breast milk by cup. In some hospitals, babies with cleft palate are fitted with a mouthpiece called an obturator that fits into the cleft and seals it for easier feeding. The baby should be able to exclusively breastfeed after his or her surgery.
Ask for help! If your baby is born with a cleft palate or cleft lip, talk with a lactation consultant in the hospital. Breast milk is still best for your baby's health.
Premature and/or low birth weightPremature birth is when a baby is born before 37 weeks gestation. Prematurity often will mean that the baby is born at a low birth weight, defined as less than five and a half pounds. Low birth weight can also be caused by malnourishment in the mother. Arriving early or being small can make for a tough adjustment, especially if the baby has to stay in the hospital for extra care. But keep in mind that breast milk has been shown to help premature babies grow and ward off illness.
Most babies who are low birth weight but born after 37 weeks (full term) can begin breastfeeding right away. They will need more skin-to-skin contact with mom and dad to help keep them warm. These smaller babies may also need more frequent feedings, and they may get sleepier during those feedings.
Many babies born prematurely are often not able to breastfeed at first, but they do benefit from expressed milk. You can express colostrum by hand or pump as soon as you can in the hospital. You can talk to the hospital staff about renting a hospital grade electric pump. Call your insurance company or local WIC Office to find out if you can get reimbursed for this type of pump. You will need to express milk as often as you would have breastfed, so around 8 times per a 24-hour period.
Once your baby is ready to breastfeed directly, skin-to-skin contact can be very calming and a great start to your first feeding. Be sure to work with a lactation consultant on proper latch and positioning. Many mothers of premature babies find the cross cradle hold helpful. It may take some time for you and the baby to get into a good routine.
Did you know? If you leave the hospital before your baby, you can express milk for the hospital staff to give the baby by feeding tube.
Source: http://www.rxlist.com
Checking your baby's weight and growth is the best way to make sure he or she is getting enough milk. Let the doctor know if you are concerned. For more ways to tell if your baby is getting enough milk, visit the How to know your baby is getting enough milk section.
There may be times when you think your supply is low, but it is actually just fine:
When your baby is around 6 weeks to 2 months old, your breasts may no longer feel full. This is normal. At the same time, your baby may nurse for only five minutes at a time. This can mean that you and baby are just adjusting to the breastfeeding process - and getting good at it!
Growth spurts can cause your baby to want to nurse longer and more often. These growth spurts can happen around 2 to 3 weeks, 6 weeks, and 3 months of age. They can also happen at any time. Don't be alarmed that your supply is too low to satisfy your baby. Follow your baby's lead - nursing more and more often will help build up your milk supply. Once your supply increases, you will likely be back to your usual routine.
Source: http://www.rxlist.com
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