Complications & Common Questions
For each of these problems, please consult a professional for advice. Although these are commonly encountered problems, every person’s case is unique and may require different treatments. The following are general descriptions and solutions and we advise seeking professional help for your individual situation.
Painful or Cracked Nipples
The most common cause of painful or cracked nipples is from poor latching to the breast. Incorrect attachment can rub or put pressure on the nipple, causing pain.
It is important to continue breastfeeding, but correcting the positioning and latching of the baby should quickly improve pain. Breastfeeding should not be painful and a professional should be consulted to evaluate and correct the breastfeeding technique.
Breast engorgement occurs when the breast is too full of milk and can feel swollen, hard, and even painful. This can happen when the breast supply is mismatched with infant demand and commonly occurs at the start of the breastfeeding process when initiation is slow, the baby has not learned to effectively suckle, or infrequent feeding.
Mothers should continue to breastfeed from the affected breast. Manual expression or pumping can also relieve pressure. Warm compresses or showers before feeds can help start milk expression. Cold compresses after feeding may help pain and swelling. Acetaminophen and ibuprofen can also be taken for pain relief.
Breast milk travels through ducts to leave through the nipple. A duct can become blocked for a variety of reasons but sometimes people are just more prone to having blocked ducts. A blocked duct can sometimes be felt as a small hard lump and can lead to engorgement in one part of the breast and if left untreated can become mastitis.
Mothers should continue to breastfeed from the affected breast. Warm compresses and massage may help to break up the blockage and move it downstream. You should seek help in resolving this problem quickly as it can develop into mastitis.
Mastitis is the inflammation of the breast. It is most commonly caused by stagnant breast milk, like blocked ducts or infrequent feedings. It can also be a result of bacteria infecting the breast tissue through the skin, like cracked nipples. The affected area of the breast is red, hot, and painful to the touch. You may feel generally unwell and have a fever.
Breastfeeding should continue through mastitis. Warm compresses and frequent feedings can help move the breast milk along. Ibuprofen and Acetaminophen can also be taken for pain relief. If the symptoms have not resolved in 24 hours, you should see a provider for likely antibiotics prescriptions.
Painful breastfeeding, an infant who is having trouble feeding, or doesn’t seem to be satisfied after a feeding are common signs of poor latching. However, there are a multitude of factors that could be affecting a baby’s latching, from different breastfeeding positions, or being tongue-tied, to being premature.
This can be a frustrating situation as baby and mom learn the breastfeeding process. A professional will need to evaluate your current set up to provide advice on how to improve the experience.
Poor Milk Supply or Not Producing Enough
Many mothers feel as though they may not be producing enough milk for their baby, but in fact most are producing enough. Poor milk supply would result in a baby with inadequate nutrition and therefore slowed growth. However there are a multitude of factors, besides poor milk supply, that could result in slow growth.
First the baby needs to be evaluated for inadequate intake. Once that has been confirmed, then the reasons for inadequate intake must be investigated. The most common reason is actually breastfeeding factors. Delayed initiation of breastfeeding can set up mothers for lower milk production (read this article for more information). Poor latching, infrequent or short feeding can result in less intake. Psychological factors can also affect the breastfeeding process such that mom may be less inclined or have a negative feeling about breastfeeding. There are also less common reasons resulting in mom’s inability to produce more milk, such as hormonal imbalances, poor breast development, or other medical conditions. The baby’s physical condition, such as prematurity or congenital abnormalities, may also affect feeding ability.
If you suspect you are not producing enough milk or your baby is not satisfied after feedings and/or not gaining weight appropriately, seek help. Poor milk supply cannot be self-diagnosed. This is something that needs to be evaluated, diagnosed and treated by a professional.
How do I know if my baby is eating enough?
The most reliable method of measuring adequate intake is weight gain and urine output.
When does my milk come in?
Colostrum is the first milk to be produced in the first 2-3 days after delivery. It is usually thicker and yellowish in color and produced in small amounts. Milk is said to have “come in” around days 3-5 when production is increased. Milk continues to be produced and becomes mature milk after 2 weeks.
How long should my baby be feeding?
Baby’s should generally feed as often and as long as the baby wants. Each baby is different and their feeding habits will also be different. However if a baby is feeding for more than 1.5 hrs per feed or more frequently than every hour, this may be a sign of ineffective or insufficient feeding and you may want to evaluate the baby’s positioning and attachment with a lactation consultant.
Should I wake my baby to feed?
Frequent feedings at the beginning of the breastfeeding process is recommended to establish good breast milk production as well as the baby’s weight gain. The recommended rate is 1 feeding every 2-3 hours or 8-12 feedings a day. However, once a regular weight gain pattern has been established, it is usually ok to wait for the baby to wake up on its own. This may be not necessarily true for premature babies, and you should consult their doctor for specific instructions.
Can I breastfeed when I am sick?
In general, yes you can breastfeed when you are sick. Most diagnosis of common infectious diseases come after the baby has already been exposed and the baby is more likely benefitting from any protective factors in the mother's breast milk. However, you should check with a medical professional, as each case is unique and mother or child may have some other medical condition or factor that may be important to consider.
Can I breastfeed on medications?
The short answer is: it depends. A multitude of factors must be considered when answering the question. The ability of the drug to first appear in the bloodstream and then transfer to the milk must be evaluated. Then the amount of milk consumed and the age of the infant would also need to be taken into account, as dosage would vary accordingly. Topical medications have less potential than oral medication to appear in the bloodstream. There is a risk from any medication that may be consumed by the infant, but this must be weighed against the consequences of stopping breastfeeding. Most medications are compatible with breastfeeding, however please consult with your medical professional about any medications and supplements you may be taking.