Common breastfeeding problems

breastfeeding problems

Breastfeeding your baby is an amazing experience, but it isn’t always easy, particularly at the start. Uncomfortable, heavy breasts, sore nipples and concerns about milk supply are just some of the things breastfeeding mums often worry about. Most of these problems are common and the good news is that they can usually be remedied.

How can I soothe sore nipples from breastfeeding?

If breastfeeding hurts, it can often be an indication that your baby is not latched on correctly. Getting this right can take a bit of practice, for both you and your baby, but keep the basics in mind – tummy to mummy and nose to nipple – and try to remember to bring your baby to the breast not the breast to the baby (that's how you get back ache). If your baby is latched on well, she should have a really good mouthful of boob (not just sucking the nipple).

Whatever you do, don't suffer in silence – there's lots of help and support available. If you're in pain, speak to your health visitor, GP or nearest breastfeeding support group for advice. A breastfeeding expert will be able to observe you breastfeeding and give you advice on what the issue might be and how to solve it.

It took about six weeks for the foot-stomping, toe-curling agony to end. It was worth it, though, and I ended up feeding my daughter for two years. It is possible that the pain you are experiencing is caused by something else such as a tongue tie where the piece of skin that tethers the tongue to the bottom of the mouth is too short, meaning your baby can't suck properly. This can make your nipples really sore as she's not able to latch on properly. If you notice that your baby doesn't stick her tongue out as she goes to latch, tongue tie might be an issue.

Other things that can cause sore nipples are breastfeeding thrush, which can be easily treated (speak to your GP or health visitor) and cracked nipples. This might be because of a bad latch, or simply because your skin is very sensitive and in the early days you're feeding so often. Try to keep your nipples moisturised with a good nipple cream and after a feed, squirt a little milk out and leave it to dry on the nipple (just don't answer the door to the postman while you're doing it) – breast milk is incredibly healing and can work wonders on a cracked nipple.

Mumsnetters have plenty of tried-and-tested tips on how to soothe sore nipples:

  • “Get Lansinoh nipple cream pronto. It will honestly save your life. Apply after every feed and you'll heal up in no time."
  • “Air your nipples as much as possible and get some Multi-Mam compresses. They saved my nipples in the early days."
  • “Savoy cabbage leaves. Leave them in the fridge so they are nice and cold and then pop one leaf in each bra cup. Instant relief. Crazy but true.”
  • “I really would suggest changing feeding positions too. Lying on my side was a Godsend. For some reason the latch didn't hurt so much then.”
  • “I had to use nipple shields for the first few days. The shields enabled me to feed until my nipples healed and my supply was established. After that I successfully fed for months. Midwives advised against the shields in case there was 'nipple confusion' but luckily this didn't happen."

It's worth bearing in mind that pain isn't always a symptom of a problem. Sometimes breastfeeding hurts simply because it's a new sensation. This is especially true for first time mums who can be taken aback by that initial 'letdown' (the moment when your milk comes through in response to suckling). It may take a few days or even weeks for your nipples to become used to the slightly strange feeling that goes with feeding.

Whatever the issue is, make sure you ask for help and advice and don't suffer in silence.

How do I know if my breasts are engorged?

When your milk comes in, about two to three days after birth, your breasts may become painful and swollen. This is known as engorgement. For most women, this subsides once they start feeding regularly but for some the problem can be persistent or recurring. Engorged breasts, left unrelieved, can lead to blocked milk ducts and mastitis which in turn can affect milk production, so it's worth getting on top of as soon as possible.

Feeding your baby frequently and from both breasts will help to relieve painful, engorged boobs. You can also try massaging your breasts towards the nipple to get the milk moving (particularly efficacious when done while standing under a hot shower) and putting a cold flannel or cabbage leaves on the breasts to soothe them.

“If you get a sore lump or blocked duct, get your baby to feed from that boob and massage from behind the blockage/lump to the nipple to try to clear it. It's absolute agony but should clear fairly easily.”

Leaky breasts

How can I prevent or cure mastitis?

About 10% of mums will suffer with mastitis and blocked milk ducts. Good feeding technique and latch can help to prevent blockages. But if you do find yourself with a case of mastitis, you can help to clear blockages through massage and hot baths. However, in severe cases you may need to see your GP who can prescribe antibiotics that are safe for breastfeeding. Don't leave suspected mastitis go untreated as doing so can lead to painful abscesses.
You can talk to other mums about their experiences of dealing with mastitis and other breastfeeding problems on Mumsnet's Infant Feeding Talk forums.

Why does each breastfeed take so long?

It can sometimes feel as though you finish one feed, just in time to start the next, particularly in the early days when your baby may be feeding every hour or two. There aren't really any shortcuts as you establish a routine, and no way to speed things up, so go with the flow and get yourself a good book or a decent box set so you can make the most of being glued to the sofa.

Remember this is as new for your baby as it is for you. As she gets used to the suckling and swallowing action, feeding time should speed up. If, after settling into a feeding routine, your baby is still taking a long time to feed, it could be the case that you are producing an over-supply of milk and they naturally keep feeding as a result. You also might notice longer feeds when your baby is going through a growth spurt.

“When my baby was six weeks, she used to feed for up to an hour at a time. Sometimes longer, sometimes shorter. To get through the nights I co-slept and had my iPad on hand to read. During the day I put my feet up and caught up with some TV. I quite enjoyed it in the end.”

Should my baby be in a breastfeeding routine?

Word of advice: Do NOT follow any routine slavishly – use it as a guide, tweak it here and there and don't expect immediate results! Definitely not in the beginning. Your newborn's stomach is tiny, about the size of their own fist, so it fills with milk and empties quickly. This means that young babies need to feed more frequently. In your baby's first few weeks, it is common for them to want to feed 10-12 times within 24 hours and you should be feeding them 'on demand', ie when they look hungry rather than before they are screaming, ideally (though the screaming works as a handy reminder). Feeding on demand will also help to establish your milk supply.

Breastfeeding on demand is exhausting but, fear not, the frequency will subside. Within a few weeks you will start to see a pattern emerge and your baby will go down to about eight feeds a day. You can then expect to have to feed your baby every two to three hours, eventually going down to every four hours or so once feeding is really well established.

I'm worried I haven't got enough milk

One of the tricky things about breastfeeding is that you don't know exactly how much milk your baby is getting, in the way that you do with bottle feeding. However, as long as your baby is gaining weight, you don't need to worry.

Breastfeeding works on a supply-and-demand basis. If you're feeding your baby on demand your breasts will be stimulated to produce more milk as your baby's sucking stimulates the milk ducts.

If you're concerned about whether your baby is getting enough milk, a good rule of thumb is whether they are producing enough wet nappies. In the first few days, a newborn should produce at least three wet nappies over 48 hours. From about five days old, she should be producing eight wet nappies in a 24 hour period.

If she seems hungrier than usual, she may be going through a growth spurt. Babies have several of these during infancy and each will be marked by an insatiable hunger. Feeding may become more frequent or longer and it's easy to worry that you don't have enough milk. During those times, revert to the 'supply-and-demand' rule. Although it's exhausting, feeding as much as you can, and on demand, will ensure your body produces enough milk.

If you are concerned about your milk supply, speak to your health visitor or contact the National Breastfeeding Helpline for advice.

“The best way to increase your supply is to breastfeed. When they go through ‘fussy’ phases or growth spurts it feels like you have no milk, but that's not really what's happening. Just keep feeding and all will be fine."

I'm worried my milk is drying up

Again, this is unlikely to happen if you are exclusively breastfeeding and doing so on demand. If you are mixed feeding and are concerned your supply will be affected, there are steps you can take to make sure that doesn’t happen:

  • Expressing milk in between feeds is key to maintaining your supply
  • Empty your breasts fully. This sends the signal to your body that it needs to produce more milk
  • If you are introducing formula, do so gradually to allow your milk supply to adjust

Some mothers find certain foods and herbal supplements help increase their milk supply.

“Oats did it for me. A hearty bowl of proper porridge in the mornings and within a few days I was spurting like a fountain.”

My baby is crying and pulling off the breast – what's wrong?

The chances are your milk is coming out too fast for your baby. Imagine waiting patiently for a nice cup of tea, and then someone tipping it down your throat in one go – you'd cry too. Persisting with breastfeeding when this is the case can lead to your baby bringing up milk and being very windy.

Fast flow of milk is also called an overactive or forceful letdown and can be the result of an oversupply. A forceful letdown can be as distressing for a baby as an under-supply of milk, with many mums having constant leakage, upset babies and distressing feed times. There are things you can do to offset the flow of milk, however:

  • Adjust your feeding position. Lying down will help to slow down the flow
  • Feed more frequently
  • Feed your baby before they are hungry and are still relaxed
  • Try expressing a little bit before feeding
  • Breastfeed when your baby is sleepy or give longer night feeds
  • Burp your baby frequently in case he is swallowing air as a result of the fast flow
  • Try block feeding. If your baby finishes the first breast and wants to continue feeding, put them back on the first breast again. If the other breast feels uncomfortable, try expressing a little milk for comfort. At the next feed, do the same with the second breast. See what Mumsnetters have to say about block feeding
  • Try applying reverse pressure to help to soften your breast and move fluids away from the nipple
  • When the letdown occurs take your baby off the breast and catch the milk in a towel. When it slows again you can put your baby back to the breast

If these tips don't provide some relief, then it may be worth speaking to your GP who can prescribe medication in extreme circumstances.

“Block feeding – yes, yes, yes. I did six hour blocks (two to three feeds) on one side, then switched. I didn't express the other side during block feeding but released pressure by dunking my nipple in warm water."

My baby isn't gaining enough weight

Most babies will lose up to 10% of their birth weight in their first few days with 80% regaining this by the time they are two weeks old. From then, a baby should start gaining 110-200g (four to seven ounces) per week until they are about four months.

If your baby is gaining weight at a slower-than-expected rate, it could be for a number of reasons:

  • Poor latch. If your baby is not latched on well during feeding it can limit the amount of milk he is getting at each feed. If this is the case, you’ll notice that your baby is still disgruntled after feeding. It’s worth getting your health visitor to observe you feeding to check the latch is OK
  • He may have been ill recently or had an infection. Any illness, vomiting or diarrhoea may result in some temporary weight loss. Infections in the mouth or even a urinary tract infection will also affect your baby's ability to feed
  • He could have reflux or a digestive issue. Persistent reflux may make feeding uncomfortable for your baby and reduce his desire to feed
  • He may have a medical condition such as a cleft palate or tongue tie.
  • Your baby may be having trouble weaning onto solid foods
  • He could simply be a slow gainer. When all other explanations have been ruled out, it could be the case that your baby is simply gaining weight at a different rate to other babies

If your baby isn't gaining weight – also known as 'failure to thrive' – it's likely they will be monitored more closely and weighed more frequently. This can be stressful but try to remember that all babies are different and your health visitor is there to support you.

“My son lost weight for the first two weeks and didn't get back to birth weight until four weeks. Then at five weeks, he'd only put on 10g in five days. We started supplementing with one formula bottle a day and I pumped until his weight gain stabilised. At 13 weeks I dropped the formula and am still feeding now at 18 months.”

Can I still breastfeed when I'm ill ?

You can still continue breastfeeding through most illnesses. In fact, continuing to breastfeed your baby and pass on antibodies to them can help prevent them from coming down with the same illness.

If you and your baby both come down with thrush, it’s important that you are treated together so that you don’t risk passing it back and forth.
You will need to be cautious with the medicines you take while ill. Many over-the-counter flu and cold medicines contain caffeine and ingredients which can reduce your milk supply.
If you see your GP, make sure to tell them that you are breastfeeding so that they can prescribe a suitable medicine that is suitable for you, as there are a few medicines to avoid while breastfeeding.