15 breastfeeding problems and how to solve them

"Skin to skin is the way to go," says Millbrook, Ont.-based lactation consultant Melisande Neal. It’s like a magical cure for the non-latching baby (and helps with other issues too). Get naked from the waist up, strip baby down to just a diaper, and get yourself comfortable in a semi-reclining position with baby on your chest. When your baby is ready, he’ll scoot down to the breast and latch on. (You may need to provide your baby with expressed milk in a cup or syringe until he figures it out, and pumping or hand-expressing during this time will also help build up your milk supply.)

The best wake-up-and-eat signal for your baby is a mouthful of milk, and you can encourage your milk to flow by doing breast compressions. Just squeeze your breast (gently, not so that you get bruises) between your thumb and fingers, and your baby will respond by sucking and swallowing. Let go when the sucking stops, then squeeze again. Stroking the baby under his chin can also sometimes encourage sucking in a sleepy baby.

New mothers may experience some sensitivity or tenderness, but you shouldn’t feel outright pain," says Neal. Pain as the baby latches on usually means the baby is not getting a big enough mouthful of breast at the start. You want the baby’s mouth to be open wide as she latches on, with her chin pressed into your breast and her head tipped back so that her nose is away from the breast. Make sure your hand is not behind her head, as that can prevent a good latch. If making these adjustments doesn’t help, consult a lactation expert.

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It’s time to check with your doctor, midwife or lactation consultant because these breastfeeding problems are symptoms of thrush, an infection with a yeast organism called candida albicans. The baby may also have this infection in his mouth or on his bum, so usually you both need treatment. A non-prescription remedy that is often helpful is gentian violet, which is swabbed on the mother’s nipples right before feeding the baby (so that the baby gets some too) once or twice a day for three or four days. (Gentian violet is available in pharmacies; ask for a one-percent solution and remember that it will turn any clothes or fabric it touches permanently purple. Don’t be alarmed — baby’s lips and mouth will turn purple too.) Your caregiver may also recommend prescription medication if the gentian violet doesn’t do the trick.

"This may just be a perfectly normal baby," says Neal. "Babies have small stomachs and they really do need filling up frequently. Imagine if you were asked to double your weight in the next six months, as an average baby will do. What would you have to do? You’d eat a lot." Some mothers also have less storage capacity in their breasts, so while they produce plenty of milk over 24 hours, the baby needs to eat frequently (it's called cluster feeding) to get enough. If the baby is otherwise gaining well, having at least two or three poopy diapers each day and your nipples are not sore, frequent feedings may just be the norm for your baby. If baby is not gaining well, speak to your paediatrician or family doctor.

Some mothers produce more milk than their babies really need and often the milk flows so fast and forcefully that the baby seems to be trying to drink from a firehose. These babies often have frothy green poops as well. A couple of strategies that can work: try switching sides every two or three minutes, to equalize the flow. If this isn’t helping, try what’s called "block feeding:" Pick a block of time —say, four hours —and every time the baby wants to nurse during that time, give him the left breast. The right breast will become quite full, but that’s the idea —the fullness signals the breast to make less milk. Then switch and use the other breast for the next four hours.

This normally happens when milk production ramps up about three days after baby is born. Soreness and swelling can be worse than normal if you had intravenous fluids during labour —you’ll have edema (swelling caused by fluid in your body) in your breast tissue as well as the extra milk. Cleaned cabbage leaves tucked into your bra between feedings can help reduce the swelling and you can use your fingers to press on the fluid-filled tissue around your nipple, then latch the baby on right away. Frequent breastfeeding or hand-expression will help to relieve the discomfort. (Avoid using a pump which will pull more fluid into the breast.)

"This is not normal," says Neal. She encourages mothers to first try to improve the baby’s latch. Still not working? The problem may be with the anatomy of baby’s mouth —for example, he may have a tight frenulum that is restricting the movement of his tongue which prevents a good latch. Or you may have an infection on your nipple that needs to be treated. Call your caregiver and have it checked out.

It could be a plugged duct, Neal says. There are a number of possible causes for this, but the cure is the same: get the milk flowing again in this area. Try to position the baby so that her chin points towards the tender area and massage the breast in that spot while the baby nurses. Apply heat between feedings. If it persists, ask your midwife or doctor about ultrasound treatments.

A plugged duct that isn’t resolved or a cracked or damaged nipple can sometimes turn into mastitis or a breast infection. Treat it like a plugged duct, with frequent nursing, gentle massage and heat—here are some more easy home remedies for mastitis to try. And get as much rest as possible. If there is no improvement in 24 hours, or if you develop a fever, you may need to see your doctor or midwife for antibiotics.

"This is known as a milk bleb or milk blister," says Neal. "It’s caused by layers of skin forming over a duct opening and trapping milk behind it. It feels like there is a large grain of sand or a piece of glass stuck in the nipple and it can really hurt." Keep nursing and try to massage the bleb out. It may be necessary to sterilize a needle and pierce the skin over the bleb to allow the blockage to be released and get the milk flowing.

This vasospasm is caused by the sudden change in temperature as the nipple is moved from baby’s warm mouth to the cold air (the condition is also known as Raynaud’s Phenomenon). The blood flows out of the nipple abruptly (causing the whiteness and the pain). Try applying a warm damp washcloth to the nipple, or massage olive oil into the nipple to get the blood flowing back. For severe cases, a prescription medication can be used.

Most babies spit up sometimes, and some spit up a lot. If you have overactive letdown, your baby may just be getting too much milk and this is how he gets rid of it. If your baby is a "happy spitter" —that is, he spits up but doesn’t seem distressed and gains weight well, don’t be concerned. Just keep a towel handy. If your baby is spitting up and miserable, is not gaining weight or vomits so forcefully that the milk hits the wall six feet away, consult with your doctor or midwife to rule out medical problems.

This usually happens somewhere from six to ten weeks and mothers are often concerned that their milk production has faltered for some reason. In most cases it’s actually good news, Neal says. "It means your breasts have adjusted to meet the actual appetite of your baby." Instead of filling up between feedings, the milk doesn’t start to flow until the baby is nursing. Just keep an eye on your baby’s weight gain and diaper contents to be sure everything is going well.

"Most babies will try out their gums or teeth at some time," says Neal. Try pulling the baby in close so that your breast blocks his nose and he has to let go to breathe, rather than trying to pull back which can make him clamp down harder. If you’re alert when the baby is nursing, you may be able to catch the moment when he pulls his tongue back in order to bite down. Be ready to stick a finger in the corner of his mouth and prevent him from chomping on you. Be gentle —he doesn’t mean to hurt you!

So there you have some quick breastfeeding problem-solvers that may help you past some of the common breastfeeding challenges. Still having problems? Don’t hesitate to seek out more assistance from some of the lactation experts in your community, who can tailor their advice to your situation.

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