Breastfeeding problems and solutions

Some new moms find breastfeeding easy right from the start. Others find it more challenging, especially in the first few weeks. If you fall into the second category, you will find all kinds of information and solutions in the next few pages.

Discouraged and thinking of weaning your baby?

Some women get discouraged when they can’t find a solution to their breastfeeding problems. When breastfeeding doesn’t go as planned, many new mothers will think about weaning their baby, even if they were originally very determined to breastfeed.

Feeling tired, discouraged, ambivalent or confused? This is probably not a good time to make such an important decision.

If you are experiencing problems, consider these options:

• Consult someone trained in breastfeeding.
• Express milk from one or both breasts so you can temporarily or permanently reduce or stop nursing.
• Try a nipple shield. It can sometimes reduce pain and help your baby latch on (see below Nipple shields).
• Opt for partial (or mixed) breastfeeding by introducing commercial infant formula.

When breastfeeding doesn’t go as planned

Giving birth to and caring for your baby is one of the most intense experiences you will ever have.

In the first few weeks, you may often find yourself crying from fatigue and hormonal changes. Breastfeeding, too, is an emotional time.

Breastfeeding is not always easy and for some women, it can be downright difficult. Even with excellent support and specialized assistance, there is a possibility that your breastfeeding experience simply doesn’t live up to your expectations. Some women feel regret, sadness, frustration and even anger because they are unable to achieve the goal they had set for themselves. Others feel guilty for wanting to stop breastfeeding. Remember, it’s not your fault! Successful breastfeeding depends on a number of factors that you can’t always control.

It’s good to be able to talk about your feelings with someone you trust and who will lend an ear. Every birth and breastfeeding story is unique.

Your baby sleeps a lot

If your baby sleeps a lot, you probably wonder whether you should wake him to nurse. It’s not always easy to know what to do. Follow his rhythm and let him sleep if he

• Wakes on his own to nurse 8 times or more in a 24 hour period
• Is active and sucks and swallows well when nursing
• Pees at least 6 times and passes at least 3 stools a day
• Is calm and seems satisfied after nursing
• Has regained his birth weight and continues to gain weight

Babies each have their own rhythm that changes over time.

Some babies sleep so much they may skip some feedings, especially during the first 2 or 3 weeks. This means they will have a hard time getting all the milk they need. You should stimulate your baby if he sleeps a lot and is not showing the signs described above.

It’s easier to wake a baby who is dozing than one who is in a deep sleep. Babies generally alternate between light and deep sleep.

What to do?

If you have to wake your baby to nurse him, start by observing him.

Is he moving in his sleep, making sucking motions or moving his eyes beneath his eyelids? These are signs that he is in a light sleep phase. Now is a good time to try to stimulate him or change his diaper, as he will be easier to wake.

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If your baby falls asleep while nursing, check the tips on helping him drink more in the section below Your baby is not drinking enough milk during feedings.

Your baby has trouble latching on

Newborns don’t all develop at the same pace. Some take longer to learn how to latch on properly. If your baby has trouble latching on in the beginning, you can continue to breastfeed by expressing your milk. Don’t worry, your baby is not rejecting you! If she gets frustrated and pushes on your breast, it’s because she’s hungry and can’t quite manage to latch on.

Babies may have trouble latching on if they

• Were born prematurely and are less efficient at sucking
• Have a sore head following the delivery
• Have difficulty sucking
• Have a tight lingual frenum (membrane under the tongue is short and impedes tongue movement)
• Prefer the bottle (if they have already been bottle-fed)
• Refuse to take the breast after having been forced to nurse

In other cases, it may be that the mother

• Has flat or inverted nipples
• Has nipples that are usually erect, but that retract when the baby tries to latch on
• Has very hard or engorged breasts

Most of the time, babies have difficulty latching on due to a combination of factors. However, there may be cases when there is no obvious reason.

What to do?

Here are a few tips:

• If your breasts are engorged, try to relieve them (see below Engorgement).
• Breastfeed your baby before she gets too hungry. If she seems too hungry, start by giving her a bit of your milk in a spoon or little cup to calm her.
• Try different positions. Some babies prefer specific nursing positions.
• If your baby gets frustrated, remove her from your breast for a few minutes to calm her down.

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If your baby doesn’t latch on, there’s no point insisting. You can always complete the feeding with expressed breast milk:

• Keep feeding your baby. Don’t skip a feeding because your newborn can’t latch on properly.
• Express milk to keep your milk production up. Babies seem to find it easier to learn to latch on when milk production is plentiful.

This period requires lots of patience, confidence and support. Try to avoid introducing the bottle or using a nipple shield during this time.

Many babies will eventually learn to latch on, especially if they are less than 6 weeks old and milk production is good.

Your baby refuses one breast but takes the other

Some newborns will have no trouble taking one breast, but refuse the other. Don’t worry, this is quite common. If this happens, express some milk from the breast the baby refuses, to stimulate production. Keep offering him the breast in question but don’t force him. He will eventually take it.

Nipple shields

Nipple shields are a breastfeeding accessory made of moulded silicone that adjusts to the shape of the breast. They come in various sizes and models.

They are sometimes recommended when the baby does not take the breast or when the mother’s nipples are painful.

Nipple shields must be used only as a last resort and preferably not in the first few days of breastfeeding. There is almost always an alternate solution. They are best avoided for the following reasons:

• With a nipple shield, the baby doesn’t learn to latch on properly.
• The baby quickly gets used to it and can subsequently refuse to take the breast without a nipple shield.
• Their use results in reduced breast stimulation and can cause a drop in milk production.

If a nipple shield seems to be the solution for you

• Choose one that is closest in size to your nipple
• Use it only on one side, if only one breast is causing problems
• Use it for part of the feeding only
• Express your milk after each feeding several times a day to keep up your milk production
• Stop using it as soon as you can

Nipple shields are generally for temporary use. You should stop using yours as soon as the problem has been solved. If you are finding it hard to breastfeed without it, contact a person trained in breastfeeding. In some cases, nipple shields may be used throughout the breastfeeding period.

Your baby was breastfeeding but now refuses to

Sometimes a baby who was perfectly happy to take the breast will start to refuse it. In some cases this will happen all of a sudden, while in others, the baby gets increasingly impatient while nursing until she eventually refuses the breast altogether.

What if you know your baby is hungry, but she can’t seem to latch on or simply refuses to take the breast? While there may be no obvious reason, there are a number of possible causes:

• Your breasts are engorged, making it difficult for your baby to latch on.
• Your milk flow is slowed by a blocked duct or mastitis.
• Your baby has a growing preference for the bottle.
• Your baby is not feeling well or has a stuffy nose.

This situation usually sorts itself out in a few days.

What to do?

Healthy babies who are at least a few weeks old can easily go for several hours without feeding.

Here are a few tips:

• Try for short periods (10 minutes) when she’s calm and not too hungry.
• Don’t force your baby to take the breast.
• Calm your baby before nursing by offering her a small amount of breast milk in a spoon or small cup.
• Offer your baby the breast just as she’s about to wake up.
• Hold your baby in your arms and offer her the breast while you’re moving or walking.
• Try taking a bath with your baby and nursing her in the water once she’s fully relaxed.

If the situation doesn’t resolve itself after a few feedings, contact someone trained in breastfeeding.

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Your baby is not drinking enough milk during feedings

Some situations can cause your baby to nurse less effectively. In cases like these, she may not get enough milk from your breasts, even if your milk supply is plentiful. This is most often the case with babies who are

• Born before term (between 35 and 37 weeks)
• Exhausted from the delivery
• Suffering from jaundice
• Losing weight or failing to gain weight

If your breasts lack proper stimulation for too long, your milk production is likely to decrease.

What to do?

• Check that your baby is latching on properly and improve his latch, if possible.
• Breastfeed more frequently, at least 8 times every 24 hours. Wake your baby to nurse if need be.
• Offer the breast rather than a pacifier to comfort your baby. Pacifiers don’t provide milk and can mask signs of hunger.
• Compress your breasts at each feeding (see Breast compression).
• Stimulate your baby so that he nurses effectively and swallows regularly throughout the feeding (talk to him; massage his back, legs, arms, etc.).
• Switch breasts once your baby stops swallowing during the feeding.
• Express milk between feedings and offer it to your baby, preferably from a spoon or little cup. Avoid using a bottle.

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If these tips don’t work, or if your milk production drops off, you may have to use a commercial infant formula to fulfill your baby’s milk requirements (see below Insufficient milk production). Contact someone trained in breastfeeding if the situation doesn’t resolve itself quickly or if you are concerned.

Worried you don’t have enough milk?

Many new moms worry they aren’t producing enough milk because their baby cries and wants to nurse often or for long periods. This is highly unlikely so long as your baby is latching on correctly and you nurse her on demand.

Newborns cry for all kinds of reasons that often have nothing to do with a lack of milk (see Temperament). Try not to let yourself be influenced by what other people say. Before concluding that you aren’t producing enough milk or that your milk isn’t nourishing enough, take the time to consider the situation. It’s normal for infants to breastfeed often and for your breasts to be softer after a few weeks of breastfeeding.

What to do?

• Make sure your baby is latching on properly.
• Stimulate your baby to ensure she continues to suck actively. She may get more milk faster if she sucks more effectively
• Breast compression can help (see Breast compression).
• You can also offer both breasts more than once during each feeding.

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Insufficient milk production

Sometimes, milk production is low right from the start of breastfeeding. In other cases, it can drop off suddenly. This may be temporary, and can be due to any of a number of different causes:

• Your breasts are understimulated because:
  • they are not being stimulated often enough (less than 8 times a day);
  • they are not being stimulated correctly by your baby or your pump;
  • you give your baby commercial infant formula in a bottle every day.
• You have undergone breast surgery (breast reduction).
• You suffer from poorly controlled hypothyroidism or another health problem.
• You have an insufficient number of mammary glands, regardless of the size of your breasts (glandular insufficiency).
• You are pregnant again.
• You are taking contraceptives or a decongestant containing pseudoephedrine.

Sometimes insufficient milk supply cannot be explained by any of these reasons. Regardless of the quantity produced, the quality of breast milk is always excellent. Even in small amounts, your breast milk provides your baby with a host of nutrients that are not found in commercial infant formula

If your milk production is insufficient, make sure your baby is drinking enough and continuing to gain weight. Even if you supplement feedings with commercial infant formula, you can still continue to breastfeed.

What to do?

The best way to boost your milk production is to stimulate your breasts often and express as much milk as possible. To help your baby nurse more effectively, see Your baby is not drinking enough milk during feedings.

You can also talk to a trained breastfeeding support person. This can help you

• Assess your milk production
• Increase your production as much as possible

She can also discuss with you the possibility of using a little tube or catheter called a lactation aid that is placed on the breast while you nurse. These aids can help you continue to breastfeed. Your midwife or a nurse at your CLSC can supply the tubes and show you how to use and clean them.

If your milk production is still low, don’t get discouraged. Talk to your doctor, who can recommend a drug that helps boost milk production.

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Milk flow

Your breasts may leak milk between feedings or at night. This is a normal, natural way for your breast to relieve themselves. If it bothers you, you can protect your bed linens with a towel and wear nursing pads during the day.

Very fast milk flow (strong let-down reflex)

After nursing for a few minutes your baby will start swallowing loudly. He may even choke a little or stop nursing and start crying when milk runs onto his face. Your baby is upset because the milk is flowing too quickly. This happens most often around the age of 1 month. As babies grow older, they adapt better.

What to do?

Here are a few suggestions to make nursing more enjoyable. Try the first suggestion, then add the others one at a time to see what works best for you.

• Remove your baby from your breast for a few minutes if the milk starts flowing too fast.
• Try different breastfeeding positions to see if there is one that suits you and your baby better.
• If you have a lot of milk, try offering only one breast per feeding; this may be enough to satisfy your baby. Express just enough milk from the other breast so you’re comfortable.
• If your breasts are very full before nursing, express about 15 ml (1 tablespoon) of milk to trigger the first let-down reflex and slow the initial milk flow

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Painful nipples

During the first week, your nipples may be sensitive, especially at the beginning of a feeding. You and your baby are still in the learning period. After this time, breastfeeding should not be painful.

It is not normal to feel pain after the first 30 seconds of nursing or to be fearful of nursing because of the pain. The most common cause of pain is an incorrect latch. As soon as the cause of the discomfort is corrected, the pain will quickly lessen.

Persistently painful and cracked nipples are one of the main reasons women decide to wean their babies early. The following charts list some of the most common causes of nipple pain, along with advice and recommended treatment.

Poor latch

What is it?

• Most common cause of nipple pain and chapping.
• Pressure on the nipple between the baby’s tongue and palate when he hasn’t taken enough of the areola into his mouth.

Possible Signs

You may feel: More pain at the start of feeding.

You may see:

• A deformed, flat or pinched nipple when the baby releases the breast.
• Chapping or cracks that may bleed.

What to do?

• Improve the latch so it looks like the photo on page Breastfeeding step by step.
• Begin nursing with the less sensitive breast.
• Vary breast-feeding positions.
• Put a few drops of breast milk onto the nipple at the end of a feeding.
• Use an analgesic such as acetaminophen (e.g., Atasol™ or Tylenol™).

You should feel a difference as soon as the baby improves the latch.

N.B.: Over-the-counter ointments and creams provide some relief but won’t solve the problem.

Not feeling any better?

• If nursing your baby is too painful, it’s important to express your milk to prevent engorged breasts and maintain your milk production.
• If you’re in too much pain, promptly ask for help.

Eczema or Dermatitis

What is it?

• Skin reaction to frequent or excessive moisture.
• Allergic reaction to a product or material.

Possible Signs

You may feel: A burning or hitching sensation during and between feedings.

You may see:

• Pinkish or bright red patches, which tend to be most visible on the areola.
• Dry, cracked or peeling skin.

What to do?

• Stop applying any creams, lotions, lanolin or other products.
• Apply a thin layer of over-the-counter 0.5% hydrocortisone after every feeding for 3 to 5 days. There is no need to remove the product before feeding.

Not feeling any better?

• See a doctor for diagnosis and to get appropriate treatment.

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Vasospasm

What is it?

• Spasm or contraction of the blood vessels brought on by the nipple coming into contact with cold air when the baby releases the breast.
• May come and go one or more times between feedings.
• Caused by a poor latch.
• Worsened by nicotine and caffeine.

Possible Signs

You may feel:

• A burning sensation in the nipple or throughout the breast.
• Pain on contact with a cold wind or when you come out of the shower.
• Pain completely disappears a few seconds to a few minutes after nursing.

You may see:

• Part or all the nipple turns white.
• Nipple returns to its normal colour a few seconds to a few minutes after nursing.

What to do?

Vasospasms are harmless, so no treatment is needed if you aren’t in any pain.

To prevent or reduce pain, try these tips:

• Check and correct the latch as needed;
• Apply dry heat, such as the palm of your hand or a magic bag to the nipple immediately after nursing;
• Keep your body warm.

Not feeling any better?

• Vitamin B₆ may provide relief. The dose is 150 mg per day for 4 days, followed by 25 mg per day until the pain disappears. Discontinue use if there is no improvement after a few days.
• See a health professional (see Getting help).

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Milk Blister

What is it?

A thin layer of skin that blocks milk coming out of the end of the nipple.

Possible Signs

You may feel:

• Intense pain in the nipple and sometimes throughout the breast, especially at the start of feeding.
• Possibly a lump or hard area in the breast.

You may see: Small (1–2 mm) white pimple on the tip of the nipple that may protrude slightly.

What to do?

• See a health professional (see Getting help).

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Nipple Thrush

What is it?

Fungal infection that can:

• appear in a baby’s mouth (see Thrush in the mouth);
• cause diaper rash;
• occur in the mother, even when the baby has no visible thrush in his mouth.

Possible Signs

You may feel: Pain in the nipple or inside the breast, which:

• Burns, more intensely at the end of feeding
• Strikes out of the blue
• Comes gradually or in addition to existing pain.

You may see:

• No changes to the nipple or areola.
• Cracked or redder nipple.
• Red, smooth and shiny areola.

What to do?

An ointment is often all you need to treat an infection that is limited to the nipple and areola:

• Choose over-the-counter nystatin (e.g., Nilstat™, Nyaderme™, Mycostatin™) or miconazole (e.g., Micatin™, Monistat Derm™) ointments
• Apply a thin layer after each feeding. You don’t need to remove it before nursing
• Continue treatment for a few days after the pain goes away.

Not feeling any better?

• If there’s no improvement after 5 days or you experience breast pain, see a health professional (see Getting help).

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Painful breast

Breast pain is often accompanied by redness or a lump or hard area on the breast. Any pain or discomfort warrants attention.

Breast pain can affect breastfeeding.

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Engorgement

What is it?

• Surplus of milk or swelling in one or both breasts.
• May occur for one or more reasons (e.g., when your milk comes in, abrupt weaning, baby is feeding less than usual).

Possible Signs

You may feel:

• Heavy, tight, or warm breasts
• Mild to severe breast pain, depending on the severity of the engorgement

You do not have a fever.

You may see:

• Tight skin on breasts.
• Skin that may be red.

What to do?

• Breastfeed your baby according to her needs.
• If your baby hasn’t drunk very much and you are uncomfortable, express a little milk by hand after feeding. Express just enough to be comfortable, without trying to empty your breasts.
• If your baby has trouble nursing, express a little milk by hand to soften the areola.
• Apply cold (e.g., ice or cold washcloth) for 10 to 15 minutes every 1 to 2 hours between feedings to help reduce swelling and pain. Avoid heat.
• Avoid deep massage, which can injure the breasts.
• Take acetaminophen (e.g., Atasol™, Tylenol™) or ibuprofen (e.g., Advil™, Motrin™) as needed to reduce pain. Ask your pharmacist for advice.

Not feeling any better?

• If your breast is very red or becomes very painful or you start running a fever, you may have mastitis (see Mastitis below).

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Blocked milk Duct

What is it?

• Obstruction of multiple milk ducts caused by excess milk or swelling in one or both breasts.

Possible Signs

You may feel:

• A lump or hard area on the breast.

You have no fever or aches.

You may see:

• A lump or hard area on the breast.
• A white dot on the nipple (see Milk blister above).

What to do?

• Breastfeed your baby according to her needs.
• If necessary, express a little milk by hand afterwards. Express just enough to be comfortable, without trying to empty your breasts.
• Avoid massaging the bump or hard or red area.
• Apply cold (e.g., ice or cold washcloth) for 10 to 15 minutes every 1 to 2 hours between feedings to help reduce swelling and pain.
• Take acetaminophen (e.g., Atasol™, Tylenol™) or ibuprofen (e.g., Advil™, Motrin™) as needed to reduce swelling and pain. Ask your pharmacist for advice.

Not feeling any better?

• If your breast is very red or becomes very painful or you run a fever, you may have mastitis (see Mastitis below).
• If you do not experience any pain, redness, or fever, but the lump persists for more than a few days, see a health professional (see Getting help).

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Mastitis

What is it?

• Inflammation or infection of one or both breasts.
• Risk is increased by:
  • Overproduction of milk
  • Prolonged engorgement (see Engorgement above)
  • Fatigue
  • Cracked or injured nipples

Abscess is a possible complication.

Possible Signs

You may feel:

• Aches, shivers, fatigue (flu-like symptoms).
• Fever.
• Breast pain, often worse when breasts are full.

You may see: A lump or an area on the breast that is hard, swollen, or red.

What to do?

• Continue nursing with the affected breast; the milk is fine.
• Breastfeed your baby according to her needs, starting with the unaffected breast.
• Avoid overstimulating milk production in the affected breast. If the baby hasn’t drunk very much and you are uncomfortable, express a little milk by hand—just enough to be comfortable— without trying to empty your breasts.
• Avoid deep massage, which can injure the breasts.
• Apply cold (e.g., ice or cold washcloth) for 10 to 15 minutes every 1 to 2 hours between feedings to help reduce swelling and pain.
• Take acetaminophen (e.g., Atasol®, Tylenol®) or ibuprofen (e.g., Advil®, Motrin®) as needed to reduce inflammation, pain and fever. Ask your pharmacist for advice.
• Cut back on your activities as much as possible. Rest helps to heal mastitis.

It takes 2 to 5 days for mastitis to clear up.

• The fever generally disappears within 24 hours.
• The pain and redness decrease in under 48 hours.
• The hardened area shrinks within a few days.
• Sensitivity in the breast may last longer.

Not feeling any better?

See a health professional (see Getting help) if

• Your symptoms have not started to improve after 24 hours
• The situation gets worse (e.g., redness spreads, the hard area becomes very painful, your fever lasts more than 24 hours or increases)

You may need antibiotics.

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Areola: Darker area of the breast around the nipple.

Diaper rash: Skin irritation and redness in the area covered by the baby’s diaper.

Express: Pump or squeeze milk from the mother’s breast.

Inverted nipple: Nipple that is retracted into the breast.

Mastitis: Inflammation of the breast. May also be an infection

Nutrients: Components of food, including vitamins, minerals, proteins, sugars, and fats.

Weaning: Gradual phasing out of breastfeeding.