Breastfeeding

Why breastfeed?

Breastfeeding can benefit both the newborn and the mother, but it may not be right for every new mom.

Breastfeeding can give your baby the right balance of nutrients. Breast milk also contains antibodies, which help your infant fight viruses and bacteria. Studies have shown that breastfed babies have a lower rate of conditions like ear infections, respiratory tract infections, sudden infant death syndrome (SIDS), allergies, celiac disease, obesity, asthma, and neurodevelopment issues.

The American Academy of Pediatrics (AAP) recommends that women exclusively breastfeed for about 6 months. After that, the AAP recommends breastfeeding for a year or longer (if that’s what the mother wants to do) as different foods are introduced.

Breastfeeding may also be good for mothers. It releases a hormone called oxytocin, which helps reduce bleeding after birth and returns the uterus to its pre-pregnancy size. Breastfeeding can help you lose pregnancy weight and may improve bonding with your newborn.

But breastfeeding can also be challenging. Your infant may have trouble latching to your breast, or you might have sore or cracked nipples or a breast infection called mastitis. And there are other things that can make it difficult to nurse your baby, like your job situation.

Is breastfeeding right for you and your baby?

You might have heard that “breast is best” when it comes to feeding your baby. An equally important slogan is “fed is best.” The best thing for your baby is to gain weight and thrive, whether from breast milk or formula.

Not all women can or want to breastfeed. You may have had a bad experience nursing a previous child, can’t get enough time off work to breastfeed, or nursing may hurt. Your infant may have difficulty latching on and drinking enough milk. You should never feel ashamed or guilty for not breastfeeding—any reason is okay.

Latching problems while breastfeeding

It’s common to have latching problems while breastfeeding, especially in the first few days. A good latch means the infant can take the whole nipple and a good portion of the areola into their mouth and maintain a sucking motion.

When there’s a latching problem, the baby can’t attach to the nipple in a way that they can get enough milk. Latching problems can be painful for the mother and may lead to decreased milk supply, engorgement, clogged milk ducts, or mastitis.

Sometimes the causes are easy to fix, like changing the position of the baby’s mouth on the nipple or not breastfeeding when your infant is sleepy or overtired.

Other causes include issues with the infant such as tongue-tie (this limits tongue movement), prematurity, jaundice, infection, heart disease, cleft palate, or cleft lip. Issues for the mother include medications you are taking, and the shape and size of your breasts and nipples.

Treating latching issues

Depending on the cause, there are different ways to treat latching issues.

• Medical issues with the baby. Treating infections or other conditions can help the baby latch.
• Tongue-tie. Your pediatrician may recommend a procedure called a tongue clip to improve range of motion.
• Overtired and fussy baby. Try to breastfeed when your baby is calm, awake, and isn’t too hungry. The smell of breast milk can encourage your baby to feed, so try squeezing a few drops of milk on your nipple before your baby latches.
• Sleepy baby. If your baby is tired, experts suggest waking them up every 2-3 hours. This helps establish the mother’s milk supply, and it helps the baby gain enough weight. Turn on the lights, remove their clothes, talk to and kiss them, and change their diaper.
• Large nipples. If the nipple is so large that it fills the baby’s mouth, they won’t get any of the areola, making it hard for them to get milk. This is only an issue in the first few weeks of breastfeeding, as latching becomes easier as the baby grows. Using a nipple shield—a silicone sheath that goes over your nipple—can help because the silicone nipple is smaller and may fit more easily in the baby’s mouth.
• Large breasts. Women with large breasts may have a hard time seeing their nipple and the baby’s mouth. It may also be more difficult to hold the breasts and position them correctly. A nurse or lactation consultant can suggest different positions to make breastfeeding easier for you and your baby.
• Flat or inverted nipples. Some babies can still latch and feed even if the mother’s nipples are flat or inverted. But if it’s a problem, try pumping for a few minutes before feedings to help draw out and lengthen nipples. If that doesn’t work, use a nipple shield.
• Forceful milk let-down. Some mothers have a strong release of milk when the baby starts to nurse that the baby may gag or choke. Certain positions are better for a fast let-down, such as the cradle hold and side-lying position. Nursing more often reduces the amount of milk that builds up between feedings or hand express for a few minutes before nursing to slow the flow of milk.

Finding the right position

There are many different breastfeeding positions, such as the football hold and the cross-cradle hold, and the best one is different for everyone. When you’re still at the hospital, a nurse who specializes in breastfeeding can help you find the one that’s right for you and your baby.

Most hospitals also have lactation consultants who can help you position your baby and find solutions to any issues. They also provide emotional support and encouragement, which can be very helpful to a mom struggling with breastfeeding.

If you are having nursing problems at home, a lactation consultant can come to your house, or you may be able to make an appointment to go back to the hospital for support. You can also hire a private lactation consultant. Search for one near you at the United States Lactation Consultant Association’s website.

Sore or cracked nipples

It’s very common for new mothers to have sore or cracked nipples during the first few weeks of breastfeeding. Newborns may take longer and work harder at latching on. This can make the nipple more sensitive and irritated, and you may notice a tender, aching, burning, or stinging sensation. The nipple may even scab and bleed.

Treating sore or cracked nipples

• Apply emollient creams, such as lanolin-based creams or coconut oil, to the nipples after breastfeeding to soften the skin.
• Expressing some breast milk and applying it to nipples can help because it has antibacterial properties.
• Avoid tight-fitting bras, which may irritate the nipples.
• Avoid using anything that can dry out the nipples, like harsh soaps or powders.
• Ask your doctor about All-Purpose Nipple Ointment. This prescription ointment contains three ingredients (an antibiotic, anti-inflammatory, and antifungal) to soothe pain and soreness.

Not enough or too much breast milk

Some nursing mothers have problems with milk production. Not producing enough milk can lead to babies who are underweight and lack nutrients. Too much milk can lead to feeding difficulties, excess weight gain, pain, and gas in babies. For nursing mothers, too much milk can lead to a painful milk letdown, excess leaking, and engorged and uncomfortable breasts that may become infected.

Causes of low milk supply include latching or sucking issues, supplementing with formula, skipping night feeds, and taking hormonal birth control or other medications. Other issues, such as having a low amount of breast tissue or hormonal problems, may also contribute to low milk supply.

If you’re producing too much milk, it may be because you’re feeding the baby on a set schedule, overpumping, or your baby prefers one breast. Sometimes, producing too much milk may be genetic. Or you may have too much prolactin, a milk-producing hormone.

Treating milk issues

Trying one or more of these tips may help when your milk supply is low. (Though there are some medical causes of low milk supply that need to be treated.)

• Nurse every time your baby is hungry.
• Make sure your baby is latching properly.
• Offer both breasts at each feeding.
• Empty each breast during a feeding, which will trigger your body to produce more milk. Pumping or expressing milk frequently between feedings can also help build up your milk supply.
• Avoid bottles and pacifiers in the first few weeks.

Follow these tips if you’re producing too much milk. (Though some medical causes of overproducing milk need to be treated individually.)

• Try block feeding, which helps reduce milk supply within a few days. Choose a time frame from 3–4 hours, and only feed your baby from one breast during that time. Then wait another 3–4 hours and only feed the baby from the other breast. If you feel pressure or discomfort in the full breast, hand-express a small amount of milk without emptying the breast. This extra milk in the breast will slow your milk production.
• Listen for your baby’s cues for when they’ve finished feeding. You don’t have to breastfeed for a specific amount of time.
• Try not to excessively pump, especially in the first 2–3 months before milk production is established.

Breast engorgement

Breast engorgement is when your breasts are so full of milk that they feel painful and swollen. It can happen when your milk first comes in, if you don’t pump or breastfeed as often as usual (like when your baby begins eating solid foods), and if you suddenly stop breastfeeding. Other symptoms of engorgement include:

• Firm breasts
• Breasts that feel warm and lumpy
• Flattened nipples
• Mild fever
• Enlarged lymph nodes in your armpits

Treating breast engorgement

Breast engorgement should be treated right away because it may prevent your baby from getting enough milk and can lead to blocked milk ducts and mastitis.

Massaging your breasts or applying warm compresses before nursing may help relieve it. Try breastfeeding more often or pumping to empty your breasts. Taking ibuprofen (Advil, Motrin) can decrease the pain and inflammation. If your breasts still feel engorged, apply a cold compress to reduce swelling.

Thrush

Thrush is caused by an overgrowth of a fungus (candida) that lives on the skin. If it occurs on the nipples, it may spread it to your baby’s mouth while breastfeeding. It can sometimes cause breast and nipple pain.

If the nipples become cracked or damaged, the candida fungus that causes thrush can enter your nipple or breast. A thrush infection may also occur after the mother or baby was on antibiotics.

Signs of thrush of the breasts include:

• A new pain in nipples or breasts after feedings
• Severe pain that can last up to an hour after feedings

Signs of oral thrush in breastfed infants include:

• Creamy white patches or spots on the tongue, gums, or roof of the mouth, or a white film on the lips that doesn’t come off with gentle wiping
• Agitation or discomfort when feeding

Preventing and treating thrush

Since most thrush infections are caused by cracked and damaged nipples, try applying a nipple cream or breastmilk to your nipples between feedings. Making sure the baby has a good latch and wearing loose bras and clothing is also helpful.

If you think you or the baby has thrush, see your healthcare provider. Thrush spreads easily, so both of you need treatment even if only one of you has it.

You can still breastfeed while you and your baby are being treated. Treatment for babies includes an antifungal gel or liquid. Mothers are usually treated with an antifungal cream or oral antifungal medication. Symptoms should start to improve within 2–3 days and should be gone soon after.

Blocked milk duct

Milk ducts sometimes become blocked or may drain poorly, preventing milk from being expressed. This might occur if the breast isn’t emptied completely or the baby skips a feeding. Symptoms usually start gradually and affect only one breast. They include:

• A lump in one area of your breast
• Engorgement around the lump
• Pain or swelling near the lump
• Pain or discomfort that feels better after feeding or pumping
• Pain during let-down
• A blister (bleb) at the opening of the nipple
• Movement of the lump
• A temporary decrease in milk supply

Treating a clogged milk duct

Treat a clogged duct right away so it doesn’t get infected. Continue to breastfeed or pump the affected breast to unblock the clog. Start your feedings on the affected breast because babies usually suck the hardest when they are most hungry.

Changing nursing positions may help get rid of the clog. To relieve pain, apply warm compresses, gently massage the breast while pushing toward the nipple, and soak the breast in warm water. Taking ibuprofen will help with inflammation and pain.

Mastitis

Mastitis is an inflammatory infection of the breast tissue that causes pain, swelling, warmth, and redness of the breast.

It can occur at any time while breastfeeding, but is more common in the first 6 months. Mastitis affects about 10% of nursing women, according to an article in the American Family Physician Journal.

It is usually triggered by a blocked milk duct, which causes bacteria to multiply, or by bacteria entering through a cracked nipple. It can also be caused if you go for long stretches between nursing sessions or are not emptying the breast completely.

Symptoms of mastitis include:

• A painful area in one breast
• Warm or redness to the touch
• Fever, chills, and body aches
• Swollen, enlarged, and painful lymph nodes in the armpit
• Fast heart rate
• Breast abscess (hard and painful lump)

Treating mastitis

Mastitis is often treated with antibiotics, and acetaminophen (Tylenol) or ibuprofen to reduce inflammation and pain. You can safely breastfeed your baby while taking these medications.

Before breastfeeding, place a hot pack or hot washcloth over the affected breast for 10–15 minutes, or massage the breast. If nursing is too painful, empty the breast by hand-expressing or pumping. You may need a lactation specialist to help adjust your breastfeeding technique.