Top Solutions for Nursing Difficulties
You’ve given birth and you’re committed to giving your baby your own breast milk. But although nursing is natural, it doesn’t always come naturally. The good news is with the right support, you can get past the first few days (or weeks, or sometimes even months) of breastfeeding fumbling.
With a little luck, and a lot of persistence, you and baby can drift off into the realm of nursing bliss. In the meantime, here’s a look at some of the most common breastfeeding problems you may experience — and how to swiftly solve them.
Most common breastfeeding problems
While it’s unlikely you’ll encounter all these pitfalls, don’t expect complete smooth sailing, either. Most women experience some breastfeeding discomfort and one or two problems along the way; some experience more (although a few lucky ones do nurse without a single holdup). Here are the most common obstacles:
What causes sore nipples? Sore nipples is a common reason women throw in the towel on breastfeeding. Many women report a “pins and needle” tingling in the first 30 seconds or so of nursing. But if your sore nipples are caused by trauma from your baby, the uncomfortable sensation will persist during breastfeeding, and often get worse. The good news is that this is often short lived — within a few weeks, your nipples often “toughen up.” But if it persists, you most likely have nipple injury, caused by a baby with a poor latch, and/or a barracuda suck, as well as possibly too high of a setting on a breast pump.
How to treat sore nipples: The best treatment is to teach your baby how to latch on properly (a lactation consultant can help). But in the meantime, to allow your nipples to heal, begin nursing with the breast that doesn’t have the sore (or as sore) nipple. Let your nipples air dry after feeding, then dab an ointment like lanolin on them, and cover with a nonstick nursing pad. You can also apply cool wet tea bags or cool compresses on your nipples. Talk to your doctor about taking an OTC pain reliever such as acetaminophen or ibuprofen before feeding.
Poor breastfeeding latch
What is a poor latch? A proper latch can be tricky to nail down at first, but it’s key to ramping up your milk production and keeping baby well-fed. Your baby needs a good latch to encompass both the nipple and the areola (the dark area surrounding the nipple), so that the milk ducts underneath the areola are compressed to begin milk flow. When baby is latched on correctly, you’ll know it: baby’s chin and tip of her nose are touching your breast, her lips are flanged out (like a fish) instead of being tucked in and she falls right into the rhythmic suck-swallow-breath pattern of suckling.
Symptoms of a poor latch: The top sign is nipple pain, usually because your baby is chewing on your nipple instead of gumming the areola. Ditto if you hear clicking noises, which indicate the baby’s not latched on properly (and is likely only sucking the nipple). Sometimes your baby is so eager to suck that she grabs onto any part of the breast and continues to suck even if no milk is forthcoming, leaving a painful bruise. Other signs include your baby fussing, chewing, rooting and gaping, or even turning red because she’s so frustrated.
How to fix a poor latch: Practice (and a bit of help from an expert) really will make perfect. Get into the right breastfeeding position, then compress your areola between your fingers. Tickle baby’s cheek to stimulate the rooting reflex, which gets her to open wide, then bring your baby right up to the breast. When she latches on, her mouth should cover the nipple and the areola (though it may not cover all of it if yours is larger), and her chin and nose should touch your breast with her lips flaying outward.
What is breast engorgement? They grew and grew during pregnancy, but just when you thought they couldn’t get any bigger (at least without the help of a plastic surgeon) your milk came in. About three days after giving birth, your breasts will become rock hard as your milk supply ratchets up — so much so that even putting on a bra can hurt. Around two-thirds of all women experience breast engorgement those initial days postpartum. This tends to be more of an issue for first-time moms than seasoned ones, possibly because your breasts have been there, done that before, and are better prepared.
How to treat breast engorgement: The good news is that breast engorgement only lasts 24 to 48 hours as you and baby get into a breastfeeding groove. The worst pain should subside within a couple of days and be virtually gone within a few weeks of breastfeeding. Until then, ease discomfort by nursing frequently, using a warm compress before feeding and a cold compress after, massaging your breasts while feeding, hand expression, switching up positions and wearing a well-fitting nursing bra.
What are leaking breasts? Those first few weeks of nursing are almost always very damp ones, as your milk’s supply-and-demand cycle gets up and running. These leaks can spring up anytime, anywhere, but you’re most likely to leak when you hear or even think about your baby, which can stimulate letdown.
How to treat leaking breasts: This problem should get better within four to six weeks, as your baby’s milk demands begin matching up with your supply. But while you’re waiting for a dryer day to dawn, wear nursing pads (and keep a few extras on you). Don’t use ones with plastic or waterproof liners, as they can cause nipple irritation. Disposables, or washable cotton pads, are better bets. Don dark-colored tops or prints, which camouflage milk stains. You may be tempted to pump to prevent leaking, but this will just stimulate your breasts to make more milk. Once your supply is well-established after the first few weeks, you can try applying pressure to your breasts to stem the tide.
Clogged milk ducts
What are clogged milk ducts? Sometimes a milk duct can become clogged, causing milk to back up and resulting in a red and tender lump. Although a clogged duct itself isn’t serious, it can lead to a breast infection if you ignore it.
How to treat clogged milk ducts: Don’t give up! Breastfeeding keeps milk flowing, which will eventually unclog the duct. In the meantime, apply a warm compress before each feeding, and massage the lump while you’re nursing. Once your baby is done, drain the affected breast, either manually or with a breast pump. You can help prevent blocked ducts by soaking your breasts several times a day with warm water.
What is mastitis? Mastitis is an infection of breast tissue that causes fever, muscle and breast pain, and redness. It usually occurs when a milk duct gets clogged, and the trapped breast milk gets infected with bacteria from your baby’s mouth. Up to 10 percent of all women may experience it, usually within the first six weeks of delivery.
How to treat mastitis: Your doctor will prescribe antibiotics that will make you feel better quickly. You can (and are even encouraged to) continue breastfeeding even while you’re treating the infection. You can also take an OTC pain reliever like acetaminophen or ibuprofen, and apply warm compresses to the sore area to relieve pain.
What is thrush? If your nipples are pink, burning and/or crusty, it may be due to a yeast infection called thrush. While it’s not clear why women get thrush, it is typically related to your baby’s mouth. Signs of oral thrush include white or yellow irregularly-shaped patches or sores that coat her gums and tongue along with the sides and roof of the mouth).
How to treat thrush: If you think you may have thrush, see your medical provider. They’ll prescribe a topical antifungal cream or gel, which will kill the yeast. If you use one, you should wipe any remaining medication off your nipples before nursing, and reapply it right afterwards. If that doesn’t work, you’ll probably need to be put on prescription antifungal pills, which are safe to use while nursing. You should also involve your pediatrician to confirm thrush for your baby and have her treated as well.
What are uneven or lopsided breasts? Some babies play favorites with breasts. As a result, you may notice that one starts to look more lopsided than the other. But a breast that’s skimped on can become skimpier in milk production, which means there’s even less for baby to snack on.
How to fix uneven breasts: You can try to increase production on the less-favored side by pumping daily, as well as offering it first to baby with every feeding. (Your baby may or may not take the bait — once a favorite, it tends to always be a favorite.) The good news is once you wean, the lopsidedness should go away.
Milk bleb or blisters
What are milk blebs or blisters? These are nipple pores that become blocked when a milk duct becomes clogged. Your breast milk becomes thick and hard as a result, which blocks milk flow near your nipple opening. Sometimes, a small amount of skin even grows over the bleb. They’re usually a tiny white or yellow spot on your nipple. The skin surrounding it may be red and inflamed, and you may notice severe pinpoint pain while nursing.
How to treat milk blebs or blisters: The milk bleb will usually go away on its own within about 48 hours. But to make it vanish faster, you can apply moist heat like a warm wet washcloth for 10 to 15 minutes, then nurse your baby. The act of suckling may actually open the blister. Don’t try to open the blister yourself, because it could become infected. If these steps don’t work after about two days, see your doctor, who can use a sterile needle to open the blister and clear it out.
What is nipple vasospasm? Nipple vasospasm is when the blood vessels in the nipples tighten and constrict and don’t let enough blood through, causing pain, burning or numbness. They can also turn white or blue and then return to pink when the blood returns to normal. Women who have Raynaud’s disease — a rare disorder that causes blood vessels in the fingers and toes to narrow when you’re cold or stressed — are often more susceptible.
How to treat nipple vasospasm: Try to keep your whole body warm and dress warmly. Cover your nipple immediately after feeding and use warm heat if you feel symptoms starting. You can also massage your areola with olive oil and stretch the muscles around your breasts several times a day to help blood flow to your nipple area. You can try an OTC pain reliever such as ibuprofen or acetaminophen, both of which are safe to use during breastfeeding. Review vasospasm with your doctor and make sure you are not taking any medications that can cause this phenomena.
Low milk supply
What is low milk supply? The most common reason moms stop breastfeeding is that they think their baby is not getting enough milk. That’s usually not the case. But if you’re supplementing with formula, or stretching out the time between feeds, especially with a newborn, your breasts won’t be stimulated enough to produce enough milk. Women who have medical conditions that aren’t under control, such as thyroid disease, may also have trouble producing enough milk. The best way to tell if you have an adequate milk supply is to monitor your baby’s weight. By the time they’re around 14 days old, babies should return to their birth weight and start gaining 4 to 7 ounces on average per week. If your baby isn’t gaining enough or is losing weight, that’s an indication she’s not getting enough.
How to treat low milk supply: If you and your pediatrician suspect your baby isn’t getting enough milk, you should be referred to a lactation consultant, who can watch as you breastfeed to check your baby’s latch. If that isn’t the issue, you can try to feed more often to stimulate more milk production. Make sure you’re feeding your baby on demand, rather than following a strict schedule. You can also pump between feedings to stimulate more milk production.
What is oversupply? Believe it or not, you can have too much of a good thing. Some women, especially first-time moms, actually make too much milk. This means that the rush of your milk is so strong your baby chokes and coughs, which makes it harder for her to feed. It can also lead to painful nipples, because baby may actually bite down to clamp the nipple to stop overflow. Your baby may also fuss a lot and seem hungry, even if she’s constantly eating. This is because she can’t get the last of the milk in the breast, which has the most calories.
How to treat oversupply: If you think you have oversupply, let your medical provider know. They can check you for a hormonal condition like an over- or under-active thyroid, and also check your meds (some psychiatric drugs that treat schizophrenia or bipolar disorder can also raise prolactin levels, which causes you to overproduce breast milk). In the meantime, make it easier for your baby to nurse by holding her in an upright position, and use your fingers to reduce the flow of your milk. Let your baby interrupt feedings, and burp her often. Try not to pump, because it can stimulate even more milk production. You can apply cold water or ice to your nipples to decrease leaking.
What is tongue-tie? The term is often used to describe someone who’s too shy to get words out, but it’s also a very real medical condition that affects about four percent of all infants. Known in doctor speak as ankyloglossia, it means that the frenulum — the band of tissue that connects the bottom of the tongue to the floor of the mouth — is too short and tight. This means your baby can have trouble nursing, since her tongue movements are so restricted.
How to fix tongue-tie: A tell-tale sign is a clicking sound when baby nurses, and trouble latching on and staying latched onto your nipple. If you think your baby might have tongue-tie, see your pediatrician or lactation consultant, who can diagnose it. A pediatrician or ENT doctor may perform a simple procedure called a frenotomy, where the frenulum is clipped so your baby can move her tongue freely.
What is lip-tie? It’s similar to a tongue-tie, but less common, and involves the upper lip and gum. The upper lip has a connective tissue attachment called the maxillary labial frenum, and if that’s too short and tight, it can restrict the movement of the upper lip, making it hard for baby to latch on properly.
How to fix lip-tie: If you’re having trouble nursing but your baby doesn’t have a tongue-tie, you can check for a lip-tie by lifting her upper lip. If it’s attached low on the gum, she may have one. Check in with a lactation consultant, who can work with you on specific positional techniques. If that doesn’t work, your pediatrician can perform a quick procedure to revise the lip-tie.
High or arched palate
What is a high or arched palate? This is when the roof of the mouth is shaped in a way that is too high or narrow. Your baby can just be born with it, or it can worsen with behaviors such as chronic thumb-sucking. But the shape of the roof of the mouth can cause your baby not to be able to latch correctly. This can lead to sore nipples, as well as too-short feedings.
How to fix a high or arched palate: There’s no magic solution, but you can work with a lactation consultant to adjust your position so that baby can achieve a better latch. One way to do this is to hold your baby lower, so she can meet the nipple from below.
Exaggerated tongue thrust
What is an exaggerated tongue thrust? All young babies have a tongue thrust, which means that when their lips are touched, they thrust their tongue out of their mouth. But sometimes, they can push their tongue out so far that they unintentionally push your nipple out of their mouth. This can make it hard for them to get a good seal, which can make breastfeeding more difficult for them. While it’s usually hereditary, bottle-fed babies are more likely to develop this behavior (which is why it’s a good idea not to introduce a bottle until your baby has gotten the hang of nursing).
How to fix an exaggerated tongue thrust: You can work with a lactation consultant to come up with better positions. When you nurse, wait for your baby to open wide, then put your index finger on the center of her tongue and push down. Now gently pull your finger out before she tries to latch. It’s also a good idea to let your baby suck on your finger so she develops rhythmic sucking rather than biting.
Cleft palate or lip
What is a cleft palate or lip? A cleft palate is when there’s an opening in the palate of the mouth that doesn’t close before birth, while a cleft lip occurs when there’s an opening at the lip which can expose the mouth to the nasal passages. (Some babies are born with both.) Depending on the size of the cleft and its location, it can prevent your baby from generating suction on the nipple. This makes it much harder for her to stimulate milk production and letdown.
How to fix a cleft palate or lip: Both cleft palates and cleft lips are easily treatable with surgery. It may make breastfeeding impossible, but pumping breast milk and bottle-feeding with a specially-designed bottle can do the trick until your little one can have surgery.
How to get breastfeeding support
While you may not believe it when you’re in the thick of it, most breastfeeding problems are fixable. So when (or if) you encounter them, don’t give up. That said, you don’t have to go it alone. Help from others can be invaluable, including support from:
- Your doctor or midwife
- Your baby’s pediatrician
- A lactation consultant (whose consultation, by the way, may be covered by your insurance at no cost to you). You can find one at the International Board of Lactation Consultant Examiners (iblce.org) or the International Lactation Consultant Association (ilca.org)
- A local La Leche League representative (find one at llli.org)
- Your partner, if you have one
- Other moms in your local mommy group
- Friends, family or anyone else you trust who’s ever nursed
No matter how challenging breastfeeding may be in the beginning, with plenty of patience and lots of practice there will come a day when breastfeeding becomes second nature — just as Mother Nature intended.