Breastfeeding Problems and Solutions
[Check out Breastfeeding Basics for more tips on the mechanics of breastfeeding]
1) Oversupply
Problem:
Though it may sound like a good thing to produce lots of milk, it actually comes with a host of issues. It is often associated with fast let down, and if baby isn’t fully draining breast during feeds, you might feel full or engorged after, and possibly get clogged ducts or mastitis
Women often pump after feeds to relieve the excess pressure, but this sends a signal to continue producing the same amount, perpetuating the issue
Solution:
Within the first month or so, supply is still adapting so no need to implement any changes
But if experiencing oversupply beyond that point, consider block feeding:
Nurse only on one breast for a period of time (~3-4 hours to begin, increasing to 6 hours)
Other breast will experience fullness, triggering inhibition of milk production (since not receiving “demand” signals). If full breast feels painful, pump a small amount until comfortable and/or apply cool compresses
Then switch sides for the next block of time
This may take a few days to start helping
Nurse in the laid-back position so baby is working against gravity, which will slow the flow
2) Undersupply
Problem:
This is actually quite uncommon - women sometimes suspect they have a supply problem if baby is feeding more frequently than usual or if their breasts feel soft, but both are normal and fine
If baby isn’t gaining weight or having enough wet diapers, it’s possible he needs a better latch or more frequent nursing sessions, not anything wrong with mother’s supply
Solution:
The best way to boost milk supply is to nurse/pump often and switch sides multiple times to ensure baby drains each breast
Doing skin-to-skin or massaging the breasts can also help get things flowing
3) Fast Let Down
Problem:
If baby is coughing, sputtering milk or pulling off after the initial let down, probably due to a strong or fast let down (often a by-product of an oversupply of milk)
This can upset or overwhelm baby, and cause gas when they swallow more air while crying or popping on or off the breast
Baby may adjust latch to slow the flow of milk, which can cause nipple pain
Solution:
During let-downs, pull baby off the breast and just catch the spray into a burp cloth; once it’s subsided, resume nursing
Nurse in the laid-back position so baby is working against gravity
Let baby have breaks to catch his breath, but ensure you burp baby frequently to compensate for them potentially swallowing more air
4) Slow Let Down
Problem:
If it takes a while for milk to be released, your baby may grow impatient or frustrated
May be caused by alcohol, caffeine, certain medications, stress, or bad latch
Solution:
Anything that helps you relax: warm compress, shower or tea; massage, skin-to-skin
Try pumping a little bit before nursing (I’d use a manual pump for this) so milk already flowing by the time you put baby on
5) Engorgement
Problem:
Breasts (both or just one) become rock hard, feel like bricks!
This is very common in the first week of breastfeeding, and also tends to occur if baby’s feeding schedule changes, such as when they sleep longer stretches at night
Ironically, even though breasts are super full, it becomes harder to nurse - the nipples become stretched and flattened, affecting latch
Solution:
Prevent engorgement by nursing as much as possible and try to drain breast fully
If engorged and baby is having trouble nursing, pump and massage first to get milk moving
Relieve discomfort/swelling with cold compresses and massage (if recurs often, consider a vibrator-like device like the La Vie)
6) Clogged/Plugged Ducts
Problem:
Each breast has around 10 milk ducts that bring milk to the nipple - when the flow is blocked in a particular duct, it creates a painful backup, that can lead to mastitis if unresolved
This can happen when feedings are skipped or there is too much time between them; it can also be exacerbated by wearing too tight bras or clothing
Feels like a tender lump in the breast, causing redness & swelling in a particular area of the breast (vs. engorgement which is the whole breast)
Can sometimes cause a “milk bleb” - a white spot on the nipple
Solution:
Apply heat and massage to the clogged area before nursing
Nurse often, starting on the breast with the clog and trying leaned-over positions where gravity will help move the milk
Usually resolves within a couple days
7) Mastitis
Problem:
This is an infection of the breast tissue that can result in a painful, red, swollen breast, plus fever, aches, and chills
It can be caused by a clogged duct or by bacteria entering the breast, especially through cracked nipples
Most common in the first few months of breastfeeding, and more likely to occur in breasts that are engorged or if milk hasn’t been fully drained (stagnant milk can become a breeding ground for bacteria)
Solution:
Continue nursing normally- the infection is not contagious, it won’t pass on to your baby. You might notice a dip in your supply as your body fights off the infection, but it will return to normal eventually
Call your doctor to get a prescription for antibiotics (these will be safe for breastfeeding obvi)
Take a painkiller like Advil or Tylenol
Apply ice packs to the inflamed area - some people recommend alternating hot and cold compresses
You should feel better within a couple of days
8) Sore Nipples
Problem:
While it’s common for nipples to be sore in the first few days of nursing, if it continues beyond that it may be a sign of poor latch or positioning.
Clicking sound is a common indication of a poor latch
Solution:
Most important thing to troubleshoot the latch - set up a home visit with a lactation consultant if you’re feeling unsure
Apply nipple creams after nursing sessions; breast milk itself also has healing properties, so dab a bit of that on
Sometimes the cause can be a tongue tie or a lip tie - this is when the tissue that connects the tongue to the mouth (the “frenulum”) is too short or tight and restricts movement of the mouth. A simple surgery called a frenectomy can correct this issue and improve breastfeeding.
In the Bay Area, Dr. Yazdi comes up often as the best doc for this
A recent NYT piece has cast skepticism over the efficacy of this procedure, which is currently being heavily promoted
Another possible cause of sudden painful nipples is thrush: a yeast infection that can pass from your baby’s mouth to your nipple. Thrush in their mouth looks like white, cottage cheese- like spots that don’t wipe away (not to be confused with milk curds, which look similar but do wipe away). An antifungal can be used to treat thrush.
9) Sleepy Baby
Problem:
It is very normal for babies (especially newborns) to become sleepy as soon as they start nursing - there are actually chemicals in the breast milk that contribute to this
But if they fall asleep before they are truly full, might not be getting enough milk and will need to nurse again very shortly. This is especially annoying if it’s in the middle of the night - you want a full feed so you can go back to sleep until the next cycle.
It can be very frustrating: baby sleeps when you want them awake, but at other times is awake when you want them asleep!
Solution:
Different things work better for every baby, but some common techniques for keeping baby awake during a nursing session include: tickling them, blowing cool air onto them, doing a diaper change (I like to do this halfway before changing boob sides), rubbing your nipple onto their mouth with a drop of milk on it so it smells enticing!
10) Gassy Baby
Problem:
In the first few months, many babies experience painful gas from feeding - might be feeding too quickly, swallowing too much air, or have an allergy/sensitivity to something in your diet
Signs of this include arching their back, excessive burping or sitting up, farting, bloating
Solution:
Nursing positions that slow the flow of milk can help prevent this issue (e.g. laid back position)
In addition to holding the baby upright and burping after the feed, try also doing this in between sides
Gas drops may help break up gas bubbles in their tummy so you can give it a shot - some people find it effective, others find it does nothing. Another product that gets mixed reviews but may be worth a try is the Windi Gaspasser.
Baby might have a real allergy to something in the breastmilk, but don’t leap too quickly to this conclusion and make major changes to your diet until trying other solutions first
Lots of gassiness tends to subside on its own after first 4 months, so know that it won’t last forever!
11) Snacking Baby
Problem:
You may have fallen into the habit of nursing your baby a little bit practically all day long, rather than having full feeds spaced a few hours apart (this was me 100% with my first baby)
Can happen if you are interpreting any crying as hunger and going straight to nursing, rather than distinguishing between true hunger cues. “Nursing on Demand” doesn’t mean nursing whenever baby cries, but nursing when you see true signs of hunger.
Snacking can also result from baby falling asleep partway through the feed, before they’ve had the full amount
Snacking might not be too much of a problem when it occurs during the day, but it’s going to be rough when the pattern continues at night, resulting in less sleep for everyone!
Short snacking sessions can also lead to baby failing to get enough hindmilk, since that richer, fattier milk comes later in a nursing session
Solution:
Remember the signs of hunger: smacking lips, bringing hands to mouth, opening/closing mouth, etc. If baby is crying but isn’t showing these other cues (or it hasn’t been 2-3 hours since last feed), first try other options for consoling: shushing, bouncing, pacifier, changing rooms/going outside.
Check out the tips for sleepy babies if you think that is the cause of the snacking
12) Distracted Baby
Problem:
As your baby starts to wake up to the world, they will become more interested in the sights and sounds surrounding them - which is a great thing! But this may mean they are frequently “popping off” your breast during a nursing session to look around, which can make it take much longer and require re-latching many times.
Solution:
Instead of nursing wherever you happen to be hanging, you may need to start moving to a dark and quiet room (maybe with white noise) where there are fewer distractions
If you’re out and it’s not possible to find such a space, consider wearing a nursing cover (the Amma Cocoon is really stylish and nice)
13) Bottle Preference
Problem:
If you are both breastfeeding and bottlefeeding, some babies figure out that they have to work a lot less hard with the bottle (since it’s immediate gratification rather than needing to suck for the let-down)
These smart/lazy babies might start rejecting the breast (turning away, fussing) and ‘demanding’ the bottle
Solution:
This is only a problem if it’s a problem for you - you may be perfectly happy moving towards exclusive pumping and bottle feeding, or switching to formula bottle feeding
But if you do wish to continue breastfeeding, it can be demoralizing (I have personal experience with this one!). Thankfully, there are a few things you can try to get back on track with nursing:
Ensure you are using the slowest flow nipple size and consider switching to a brand where the nipple more closely resembles the shape of a real nipple (e.g. Lansinoh)
Try feeding your baby when a little sleepy (e.g. just woke from nap) and thus not paying as close attention
“Bait and switch” - start your baby with a little bit of milk in the bottle (or even sucking on the pacifier) and then swap it out for your breast
Use a hand pump or hand express to get the milk flowing before putting baby on - squeeze some into their mouth to entice them with a ‘free sample’
Nurse while bouncing - movement can soothe a fussy baby, so try to nurse while standing and bouncing, on a bouncy ball, or while baby is in a carrier
Try a nipple shield on your breast so it feels more like a bottle for baby
Bay Area Resources
Bay Area Breastfeeding: very active Facebook group moderated by lactation experts
Breastfeeding Class and weekly Lactation Support Circle at Natural Resources
Lactation Consultants: (note: visits are usually at least partially reimbursable through insurance):
