Overcoming breastfeeding problems
Plugged milk ducts; Nipple soreness when breastfeeding; Breastfeeding - overcoming problems; Let-down reflex
Health experts agree that breastfeeding is the healthiest option for both mom and baby. They recommend that babies feed only on breast milk for the first 6 months, and then continue to have breast milk as a main part of their diet until they are at least 1 to 2 years old.
It is true that breastfeeding is not always easy for moms and babies. It can take a little time for you both to get the hang of it. It is important to know this up front, so that you can make sure you have all the support and commitment you need if a problem does come up.
It's normal during the first week after a baby is born for a mother's breast to become heavy, and tender, and full as the milk is coming in. And even before that as the blood flow is expanding and the lymph flow is expanding to allow the milk to come in. But sometimes that progresses to something we call engorgement. I'm Dr. Alan Greene and I want to talk briefly about engorgement. What causes it, how you can prevent it, and what to do if engorgement does happen. We call it engorgement if the pain becomes really severe because the milk is so full in the breasts that it squeezes shut some of the blood and lymph vessels. So causes swelling in the tissues. It's not just too much milk. It's real swelling of the breasts. And it can be quite painful and make nursing kind of difficult. Probably the best way to prevent engorgement is frequent, early feeding. If you feed as often as the baby wants to, and at least every 2 to 3 hours when the baby is awake during the day, and no longer than 4 or 5 hours one stretch at night during that first week will often prevent engorgement. Engorgement is less common, too, if you don't do supplemental feedings. But even if you do everything perfectly, some women will still become engorged. It's not a guarantee. If you do and don't do anything, the engorgement will likely last for 7 to 10 days. But if you take steps to treat the engorgement, usually it will be gone within maybe 24 to 48 hours, at least the worst part of it. So what does treating engorgement mean? It's a couple of very simple steps. The first one is really to try to empty the breasts completely. Again, going back to frequent feeding and to encourage the baby to nurse to finish the first breast first. Don't try to switch breasts in between, but start and let them empty as much as they can. And then only after they come off it their timing, try the other breast. Then start with the opposite one next time. Then you can do a lot with cool and warm compresses. Doing a cool compress in between nursing can help reduce the swelling and reduce the tenderness. And then a warm compress you want to switch to in the 10 to 15 minutes before nursing to help encourage let down and help the breast drain more fully. You can actually get compresses that are made for this purpose that you can warm or you can cool. And they can fit inside a nursing bra. Another thing that can be very helpful are cabbage leaves. There have been a few studies suggesting this and a lot of personal experience people have had just taking a cabbage leaf out of the refrigerator and wearing it as a compress. There seems to something in there that does help. Whatever you do, you may also want some pain relief, something like acetaminophen. And if that's necessary don't hesitate if that's something that's going to keep you nursing because breast milk is the very best thing for kids.
Breastfeeding (nursing) your baby can be a good experience for both the mother and the baby. It takes time and practice to get comfortable with breastfeeding. Things you can do to help the process include:
- Start breastfeeding your baby in the hospital, right after birth.
- Ask for help from a lactation consultant or nurse to get you started.
- Read about breastfeeding before your baby is born.
Most women are able to breastfeed with no pain. Sometimes, breast tenderness and nipple soreness will occur in the first week. Getting help with a proper latch right away from a breastfeeding support person can help this go away more quickly.
Nipple soreness may be caused by many things, including:
For many women, there is no clear cause of nipple soreness. A simple change in your baby's position while feeding may ease soreness.
You might have sore nipples if your baby keeps sucking as they come off the breast. You can help your baby learn to let go by gently inserting a finger into the side of the mouth to break the suction.
Skin that is too dry or too moist can also cause nipple soreness.
- Bras made from man-made (synthetic) fabrics may cause moisture to collect. These fabrics may increase sweating and slow evaporation.
- Using soaps or solutions that remove natural skin oils can cause dry skin. Olive oil, expressed milk, and ointments containing lanolin can help soothe dry or cracking nipples.
Some babies chew or bite on the nipples when they start teething.
- Giving the baby something cold and wet to chew on a few minutes before breastfeeding can help avoid this problem. A clean, wet washcloth from the refrigerator works well.
- Offer the baby another cold, wet washcloth before feeding on the other breast.
BREAST ENGORGEMENT OR BREAST FULLNESS
Breast fullness is the slow buildup of blood and milk in the breast a few days after birth. It is a sign that your milk is coming in. It will not prevent you from breastfeeding.
Breast engorgement is caused by back up in the blood vessels in the breast. The breasts are swollen, hard, and painful. The nipples may not stick out enough to allow the baby to latch on correctly.
The let-down reflex is a normal part of breastfeeding. Milk made in the milk glands is released into the milk ducts. Pain, stress, and anxiety can interfere with the reflex. As a result, milk will build up. Treatment includes:
- Learning to relax and finding a comfortable position
- Reducing distractions during nursing, performing a gentle massage, and applying heat to the breast
Nursing often (8 times or more in 24 hours) and for at least 15 minutes at each feeding can also prevent engorgement.
Other ways to relieve breast engorgement:
- Feed more often or express milk manually or with a pump. Electric breast pumps work best.
- Alternate between taking warm showers and using cold compresses to help ease the discomfort.
NOT ENOUGH MILK FOR THE BABY'S NEEDS
Almost all women can produce enough milk for their babies. Though many women are very worried about this, it is quite rare that a mother will produce too little milk.
Making too little milk can happen for a few reasons, including using infant formula to feed your baby in addition to breastfeeding. If you are worried about how your baby is growing, you should talk with the baby's doctor right away before starting to supplement with formula.
The mother's supply is based on the baby's demand for milk. Frequent feedings, adequate rest, good nutrition, and drinking enough fluids can help maintain a good milk supply.
PLUGGED MILK DUCT
A milk duct can become plugged. This may happen if the baby does not feed well, if the mother skips feedings (common when the child is weaning), or if the mother's bra is too tight. Symptoms of a plugged milk duct include:
- Heat and redness in one area of the breast
- A lump that can be felt close to the skin
Sometimes, a tiny white dot can be seen at the opening of the duct on the nipple. Massaging the area and putting gentle pressure on it can help to remove the plug.
A breast infection (mastitis) causes aching muscles, fever, and a red, hot, tender area on one breast. Call your health care provider if you develop these symptoms.
Treatment often includes:
- Taking antibiotics for the infection
- Applying moist, warm compresses to the infected area
- Getting rest
- Wearing a comfortable bra between feedings
Continuing to nurse from the infected breast will help healing take place. Breast milk is safe for the baby, even when you have a breast infection. This will prevent further breast engorgement.
If nursing is too uncomfortable, you may try pumping or manual expression to move milk out of the breast. You can try offering the unaffected breast first until let-down occurs, to prevent discomfort. Talk to your provider about ways to manage the problem.
Thrush is a common yeast infection that can be passed between the mother and the baby during breastfeeding. The yeast (Candida albicans) thrives in warm, moist areas.
The baby's mouth and the mother's nipples are good places for this yeast to grow. Yeast infections often occur during or after antibiotic treatments.
Symptoms of yeast infection in the mother are deep-pink nipples that are tender or uncomfortable during, and right after, nursing. White patches and increased redness in the baby's mouth are symptoms of a yeast infection in the baby's mouth.
The baby may also have a diaper rash, a change in mood, and will want to suckle more frequently. Call your provider to get a prescription for an antifungal medicine for affected members of your family.
If you develop a fever or illness, contact your provider. You can safely continue breastfeeding during most illnesses. The baby is likely to benefit from your antibodies.
How you feed your baby is a personal decision, but if you breastfeed you're choosing to give your child a natural, nutritional food source that can benefit you AND your baby. Let's talk about breastfeeding. Many women ask me, What's so good about breastfeeding? Breast milk is the best source of nutrition for a baby. It contains just the right amounts of carbohydrates, protein, and fat. And they vary over time within each feeding and over the months as your baby grows, tailored. Breast milk also gives your baby the digestive enzymes, minerals, vitamins, hormones and flavors they need. Plus your baby gets antibodies and other immune factors from YOU that can help your baby resist some infections. Infants who breastfeed are less likely to have allergies, ear infections, gas, diarrhea, and constipation, skin problems, stomach or intestinal infections...and are also less likely to experience wheezing, pneumonia, and bronchitis. Breastfeeding helps mom too! You form a unique bond with your baby. You might lose pregnancy weight faster and, you have a lower risk of breast cancer, some types of ovarian cancer, and osteoporosis. Your baby will need to be fed a lot, often nearly around the clock during the first few weeks after birth. It's perfectly normal. Some mothers find that bringing the baby in bed for feedings at night or placing a bassinet within reach, allows them to meet the child's needs while losing minimal rest. During the day, nap after feedings if you can. If you need to return to work soon after your baby is born, or you're a stay-at-home mom that needs some time to herself, there are plenty of pumping and storage systems available that let you continue to breastfeed your baby as long as you want. Breastfeeding goes smoothly for most people, once mother and baby get the hang of it. For others, it may take time and practice. If you run into any problems, contact a lactation consultant, a person who specializes in breastfeeding.
Furman L, Schanler RJ. Breastfeeding. In: Gleason CA, Juul SE, eds. Avery's Diseases of the Newborn. 10th ed. Philadelphia, PA: Elsevier; 2018:chap 67.
Newton ER, Stuebe AM. Lactation and breastfeeding. In: Landon MB, Galan HL, Jauniaux ERM, et al, eds. Gabbe's Obstetrics: Normal and Problem Pregnancies. 8th ed. Philadelphia, PA: Elsevier; 2021:chap 25.
Rosen-Carole C, Stuebe AM. Practical management of the nursing “dyad”. In: Lawrence RA, Lawrence RM, eds. Breastfeeding: A Guide for the Medical Profession. 9th ed. Philadelphia, PA: Elsevier; 2022:chap 7.
Last reviewed on: 8/10/2021
Reviewed by: Neil K. Kaneshiro, MD, MHA, Clinical Professor of Pediatrics, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.