Breastfeeding problem solving

Many mums feel as though their babies are always hungry or not satisfied, especially in the early days of breastfeeding.

In the early days it is completely normal for babies to feed regularly.  They have tiny tummies, and they need refilling often, day and night!

Babies also like to breastfeed for reasons other than hunger.  Breastfeeding means they are close to you, can hear your heartbeat and feel your skin.  It is a safe and comforting place.  This is a good thing!

Frequent feeding in the early days also helps your body to learn to produce more milk and set you up for breastfeeding your baby as they grow.

Sometimes babies ‘cluster feed’ which means they want another feed almost as soon as they have finished one. This might happen at a particular time of day (such as the evening) or might be part of a developmental phase, often called a growth spurt.  If this only happens for a day or two, or only at a particular time of day (and is not all day long) then it is nothing to worry about.

If you still feel concerned, then it might be that a change of position could help baby to attach to the breast more effectively.  You might wish to review our information about positioning and attachment or speak to a breastfeeding supporter, health visitor or your midwife.

Sadly, it is common for women to experience painful, sore or cracked nipples when breastfeeding, but this is not how breastfeeding should feel and it can usually be easily resolved.

Some sensation  as the baby attaches is normal in the early days of breastfeeding. The nipple is stretching out as it has never done before, the ducts are opening up and the cells which make the milk are suddenly firing away.

But if feeding is painful, or discomfort continues throughout the feed, then you do not have to put up with it!

Pain when breastfeeding makes it hard for you, but it is also a sign that baby’s attachment could be improved. It could also be a sign that your baby might not be getting enough milk.

Pain is usually because baby does not have the nipple far enough back in her mouth.  You might wish to review our information about positioning and attachment or speak to a breastfeeding supporter.

You may have been told that your baby has tongue-tie.  This is where the baby’s tongue is tightly attached to the bottom of his mouth, and this restricts its movement. Sometimes this can interfere with attachment to the breast. (Emond et al., 2014; Griffiths, 2004)

This picture shows you what it looks like.

There are different types of tongue-tie, and it is not always as obvious as in this picture.  If you think your baby might have a tongue-tie that is making breastfeeding difficult, then talk to your midwife or health visitor and ask for a referral to a specialist.

Thrush is a fungal (yeast) infection that can make feeding very painful.  It can pass between the mother’s breasts and the infant’s mouth.

The good news is that you can both be treated so if you think you might have thrush speak to your health visitor or GP straight away. The information from the Breastfeeding Network which is written by a specialist pharmacist, urges mothers to have swabs taken for thrush before embarking on treatment, as it is somewhat overdiagnosed.

Symptoms in you:

• Burning sensation in your nipples, especially after feeds.
• Itchy nipples, which can be very sensitive to touch. They may be sensitive to the feel of loose clothing.
• Change in colour of your nipples or areola.  They may lose colour, or look red and shiny.
• Nipple pain which:
  • gets worse during the feed and can last for up to an hour after the feed;
  • is in both nipples;
  • does not get better with improved attachment, applying heat, or expressing milk rather than feeding at the breast.

It can sometimes be difficult to be sure that thrush is the cause of nipple pain.  If you have never had pain-free feeds, then improving attachment may be the first step.

Symptoms in baby:

• White plaques inside the cheeks and bottom lip. They may also be on the tongue, but a white tongue is normal in a breastfed baby.
• Nappy rash.
• Your baby keeps pulling off the breast.

Your baby may have no signs or symptoms, but may still need treating as well as you.

Nipple shields might be tempting, but there is some evidence that they interfere with milk supply and although feeding may be less painful, they do not solve the underlying problem.

So do check out our positioning and attachment information first!

When your breasts first fill with milk, you might find they feel full, warm, heavy and tender. This is normal, but should only last a day or two.

Sometimes too much milk can build up in the breast, causing them to become engorged.  This is usually because either milk is not removed often enough, or because not enough milk is being removed.

Engorged breasts may feel:

• Very full
• Hot
• Painful
• Skin might be taut and shiny
• You might have a raised temperature

Massage and Expression

Continuing to breastfeed is important to maintain supply and help reduce engorgement.

• Gentle massaging of the breast and some hand expression of milk before a breastfeed will help soften the breast and may help baby to attach.
• Expressing milk after a feed will also help to ensure that milk has been removed.
• If it is too difficult to attach your baby, hand express milk instead.

Some mothers find it helpful to use a warm compress before feeding and a cold one afterwards.

Mastitis is inflammation of the breast tissue.  In most cases it is caused when milk is produced faster than it is removed by breastfeeding or breast milk expression.  The pressure in the breast builds up and causes milk to ‘overflow’ into surrounding breast tissue. If this is untreated it can sometimes lead to an infection of the breast.

Symptoms:

• Hot, red, swollen area of the breast
• Breast pain
• Flu-like symptoms

If you have these symptoms then keep breastfeeding, as this will help to resolve the problem.  If you are struggling to breastfeed then keep expressing breast milk regularly.

You might also find that painkillers (ibuprofen or paracetamol) are helpful.

You should also try to improve milk removal by improving positioning and attachment. You can get some extra help with this from experts such as your midwife or health visitor, or go to your local support group. See the info section for details of how to find these.

Concern about not having enough milk is one of the most common reasons mums give for stopping breastfeeding. The truth is that most mums are physically able to produce plenty of milk for their baby, providing that breastfeeding is managed well.

The following signs indicate that your baby is getting plenty of milk:

• Your baby is content and satisfied after most feeds.
• Baby is gaining weight after the first week of life, is back to birth weight by three weeks of age, and continues to remain roughly at the same centile on the UK-WHO Growth chart found in your baby’s ‘red book’.
• You don’t experience soreness in your breasts or nipples after the first few sucks.
• Your baby produces plenty of wet nappies- at least 6 per day from a week old.
• Your baby has at least 2 mustardy poo nappies a day (after the first few days and for the first few weeks at least).

The following suggestions may help you improve your milk supply:

• Have skin to skin contact with your baby.
• Increase the amount of milk removed from your breasts.  This stimulates your body to produce MORE milk.
• Check positioning and attachment.
• Increase the number of feeds per day – feed more often, including at night.
• Express milk after every feed to ensure as much milk as possible is removed from  both breasts.
• Give extra breast massage or stimulation.
• Avoid supplementation with formula milk if possible.  This tends to reduce milk supply further because baby feeds less from the breast meaning that the signals that tell your body to produce milk are reduced.

If you are still worried about your milk supply then speak to your midwife or health visitor, or contact a local breastfeeding support group.

In the very early days babies sometimes seem reluctant to feed, possibly because they are themselves recovering from being born or because they still have some of their mothers’ labour pain relief in their systems.

Having skin-to-skin contact with your baby is a good way to encourage him to attach, through being close to you, hearing your heartbeat and being stimulated by the smell of your milk.

It is helpful to hand express a little milk, so that this can be given to baby to tempt them to feed. This also sets mum’s lactation off to a good start.

Some mums find that having a warm bath with their babies can be really helpful. If “co-bathing”, lay your baby on your tummy so that his legs and body are in the warm water but his head is clear.

If baby latches on but falls asleep very quickly trying these things can encourage them to feed a bit more:

• Changing their nappy.
• Taking off layers of clothing, baby may only need to be in a vest, or only a nappy, if in close contact with you.  Being warm can make babies sleepy. A general rule is that babies should be in only one more layer of clothing than their mother.
• Always offer the other breast – swapping sides can help baby re-awaken and take some more milk. You could put baby’s head up on your shoulder to burp them between feeds.