Common Concerns??

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SORE NIPPLES

  • Sore nipples are a common concern among breastfeeding mothers. This usually occurs when the baby does not take enough breast tissue into his mouth. This causes the baby to only take in (latch on to) and suck on the nipple.
  • In the first week, mothers may feel some nipple tenderness, mostly at the beginning of a feeding. This tenderness should improve daily. Initial pain or tenderness at the beginning of the feed should disappear as your baby sucks. If it doesn’t, then the position and latch needs to be changed.
  • Sore nipples are not related to the length and/or frequency of breastfeeding, or skin colour, and cannot be prevented prenatally.

How to Help

  • Try using different positions when breastfeeding. This will stop the baby from putting too much pressure on the same spot each time.
  • Make sure your baby is taking a large amount of breast tissue into his mouth and not just the nipple.
  • If the pain continues, see a lactation professional for assistance with the latch. He/she can also explore additional reasons for the pain.

NOT ENOUGH MILK

  • Mothers often worry that they may not have enough milk and about how much milk the baby is getting. In the early days, a mother produces colostrum in small amounts that match the size of her baby’s tummy.
  • By day 3 or 4, the mother’s milk changes to meet the baby’s needs. The milk changes into mature (white) milk through frequent stimulation and milk removal. The more the baby breastfeeds, the more milk the breasts produce.
  • If the mother starts to supplement with formula at this time, it may decrease her overall milk supply.

GROWTH SPURTS

Babies have some days when they are hungrier than usual. These times are called growth spurts and commonly occur at around 10 days, 2-3 weeks, 6 weeks, 3 months and 6 months of age. When this happens some mothers worry that they are do not have enough milk. There is no need to worry. The more you feed your baby, the more milk you will produce. There are times when mothers worry they do not have enough milk when their child is feeding frequently during growth spurts.How to Help

  • Allow your baby to breastfeed when he shows hunger signs through feeding cues.
  • Do not limit the time the baby feeds at the breast. Remember to offer both breasts for sufficient stimulation.
  • Make sure that your baby takes in (latches on to) more breast tissue, not just the nipple.
  • Check your baby for signs of appropriate nutrition and hydration, such as the amount of wet and dirty diapers. Your baby should feed at least 8 times in 24 hours.
  • Hold your baby skin-to-skin between breastfeeding sessions.
  • Avoid using pacifiers or artificial nipples at this time. Allow your baby to suck at the breast.
  • Increase milk removal with hand expression or pumping after breastfeeds.

THRUSH

  • Thrush is an infection caused by yeast called Candida Albicans. Candida thrives in dark, warm, and moist areas such as the mother’s nipples, milk ducts, and vagina. It also thrives in the baby’s mouth and diaper area.
  • Thrush can cause significant pain and burning to a breastfeeding mother. This pain does not decrease when a mother changes her feeding position or ensures a proper latch.
  • Sometimes there may be a shooting pain that lasts throughout the feeding and continues after the feeding is over.
  • Her nipples and areola may look normal or appear red and shiny, or there may be a rash with tiny blisters.
  • The baby may show signs of infection, such as white patches on the gums, cheeks, top of the mouth, and tongue that cannot be wiped off. The baby may pull off the breast frequently because his mouth is sore.
  • The baby may have a diaper rash around his bottom and genitals.

How to Help

  • Mothers experiencing these symptoms should seek medical attention immediately. Mother and baby will both need to be treated to eliminate the infection. Treatment may involve an ointment and/or oral medication.
  • If using breast pads, remember to change them after each feeding or more often, as they become wet.
  • Continue to breastfeed with short frequent sessions, beginning on the least sore side first.
  • Keep nipples clean and dry as much as possible.
  • Avoid using pacifiers, artificial nipples, or infant toothbrushes at this time. This will decrease the risk of re-infection. If you choose to use these products, remember to clean and sanitize them after each use.

Click here for more information:THRUSH FACTS

CALMING A FUSSY BABY

  • Crying is a normal newborn behaviour. All babies cry and some cry more than others for many different reasons. Babies do not cry to make you angry or to try to control you. You will not spoil a baby by responding to his needs.
  • Crying is the only way that babies can speak to us. But figuring out why your baby is crying can be challenging.
  • Babies might cry because they are hungry, tired, or over stimulated, or sick. They may want to be comforted or need a diaper change. They may be uncomfortable or bored. Most babies cry more at night, sometimes for an hour or more. Most babies have at least one fussy period each day, often in the evening.
  • Most parents find that crying begins to increase when babies are around 2 weeks of age and decreases around 3 months of age. It is normal to worry about your baby crying in the first few months. You may feel angry, frustrated, tired, and overwhelmed when your baby cries.

How to Help

  • Responding to your baby’s cries is very important. Babies in the first 6 months of life who are picked up when they cry tend to cry less in the second 6 months of life. With time, you will learn to know what your baby’s different cries mean.
  • Remember to try different techniques to help calm your baby. Each baby will respond differently to different techniques.
  • Meet your baby’s basic needs first. Feed your baby at least 8 times in 24 hours. Change your baby’s diaper often. Burp your baby, comfort your baby, and adjust your baby’s clothing. Speak softly or sing your baby a lullaby. Most babies will feel safe when they are held close.
  • Use self-calming strategies such as counting to 10 or taking a few deep breaths. You can go for a walk with your baby or move to a quiet, dark room.
  • If your baby’s needs have been met and he continues to cry, ask for help from a support person (partner, family, friend, or neighbour) while you take a break.
  • There may be times when you cannot settle your baby. This is normal and can be frustrating. If at any time you feel you cannot cope with your baby’s crying, put your baby safely and calmly in his crib. Call on someone to help if you are having a hard time coping with your baby’s crying.
  • No matter how upset you might feel, never shake your baby.

WAKING A SLEEPY BABY

  • Most newborn babies are sleepy. They typically sleep 11 to 18 hours per day in the first few weeks. In the first days your baby might not wake up on his own to feed at least 8 or more times in 24 hours. Until your baby is waking up regularly on his own and gaining weight, you may have to wake up your baby to feed.
  • In the early days, your baby might fall asleep while breastfeeding or shortly after breastfeeding. During this time, the longest stretch of sleep should be no more than 4 hours. During the newborn period, most babies will breastfeed for 20 to 45 minutes. As most newborns are often sleepy while at the breast, it is helpful to be patient and persistent with breastfeeding.

How to Help

  • Babies feed best when they first start to show signs of hunger. Keep your baby close to you so you notice when he is showing signs of hunger.
  • Keep your baby skin-to-skin and undress him before you start to breastfeed. Remember to change his diaper if it is wet or soiled.
  • Change your baby’s position by lifting him on your shoulder or rubbing his back. You can talk to your baby or sing songs.
  • Express a little bit of milk when you bring your baby to the breast. This will tempt him and let him know that there is milk present.
  • Ensure baby is latched deeply and positioned comfortably. If the baby’s sucking and swallowing starts to slow down while breastfeeding, you can compress the breast to remind him that there is milk and encourage him to keep feeding until full. Once the baby starts sucking again, you can stop breast compressions.

For more information on sleep and your baby, click here:SLEEPING BABY

BABY WILL NOT LATCH

  • A latch is when the baby attaches to the breast. When the baby takes in the whole or most of the areola (the pink or dark area around the nipple), this is considered a good or deep latch.
  • In the first week, you may feel some nipple tenderness particularly at the beginning of a feeding. The tenderness should improve daily.
  • Initial pain/tenderness at the beginning of a feed should disappear as baby sucks. If it does not disappear, then the baby needs to be repositioned and re-latched.
  • Some babies may have difficulty with latching and sucking from the breast if artificial nipples and/or pacifiers have been introduced before breastfeeding is well established.
  • If your baby is not latching or drinking at the breast you will want to make sure your baby is being well fed and your milk supply is maintained. Pumping your breast at least 8 times in 24 hours and feeding your baby your expressed milk may be necessary as you work to get your baby onto the breast. Speak to a lactation professional or your health care provider about ways to feed your baby which will not negatively impact breastfeeding. Spend time with your baby skin-to-skin and keep trying to latch the baby and breastfeed. Remember that most babies will eventually take the breast. Be sure to get breastfeeding help if you find you are in this situation.

How to Help

  • Place your baby skin-to-skin and observe for feeding cues prior to feeding.
  • Get into a comfortable position and make sure your back is supported.
  • Position your baby so that his tummy is against you and his ears, shoulders, and hips are in a straight line and supported by a pillow or by you leaning back.
  • Support the breast, keeping fingers away from the areola. Tickle the baby’s upper lip gently with the nipple or breast until he opens his mouth very wide.
  • Bring your baby to breast, with the chin and lower jaw first.
  • Try to avoid moving the breast once your baby has latched on. Keep your baby’s body supported and do not push the baby’s head into the breast.
  • If the feed continues to feel painful, break the suction by pressing down on the breast near the baby’s mouth, pulling down on the baby’s chin, or inserting a finger into the corner of the baby’s mouth.
  • If you continue to experience challenges with latching, contact your primary health care provider or go to the ‘Getting Help’ page of this website to search for breastfeeding support services near you.

ENGORGEMENT

  • Engorgement is a complication that can occur in the first few days after birth. The breast becomes very hard due to the sudden increase of milk, blood flow, and interstitial fluid, and a decrease in milk removal from the breasts.
  • Breasts may look shiny and tight and milk flow may be impacted due to swelling. The areola and nipple may also appear swollen causing the baby to have difficulties latching on correctly. Mothers may experience pain throughout the feed.
  • Other complications that can occur if no treatment is used includes decreased milk supply, early weaning, slow weight gain, sore nipples related to poor latch, risk of mastitis related to pressure within the breast, and/or damage to the milk-producing cells.
  • The best way to prevent and/or treat engorgement is to remove the milk.

How to Help

  • Due to swelling, you may have to soften the areola and nipple before the baby can latch on. This can be done with reverse pressure softening. You can also hand express milk before starting to feed to soften the areola and nipple.
  • Allow your baby to breastfeed when he shows hunger signs through feeding cues.
  • Make sure that your baby takes in (latches on to) more breast tissue, not just the nipple.
  • Do not limit the time your baby’s feeds at the breast. Let your baby completely empty the first breast until it feels softer and more comfortable. The other breast can be offered at this time. If the baby does not remove enough milk for you to feel comfortable, hand express or pump to comfort. Leave some milk in the breast as this will help the body know it has made more milk then the baby needs and the breast will respond by making less milk.
  • Use breast compressions to help move the milk.
  • The baby should feed at least 8 times in 24 hours.
  • Avoid using pacifiers or artificial nipples at this time. Allow your baby to suck at the breast.
  • Apply a wrapped ice pack or cold compress to the breasts between feedings. If using a bra, make sure it is not too tight and does not have underwire.
  • If engorgement does not improve, continue to express milk and contact your primary health care provider or go to the ‘Getting Help’ page of this website for breastfeeding support services near you.

PLUGGED DUCTS

  • A plugged or blocked duct means there is a blockage in one or more milk ducts. When a milk duct is blocked the milk cannot flow from the breast towards the nipple.
  • There is no specific cause of plugged ducts, but it occurs more often in women with a greater milk supply, when wearing tight fitting bras or clothing, when the breasts are not fully emptied, or when a feeding is skipped.
  • A plugged duct does not go away when you breastfeed and usually affects only one area of one breast. If the blockage does not clear it may develop into a breast infection called mastitis.

A plugged duct might feel like:

  • A painful lump with swelling in one area.
  • A tender spot with redness and little or no warmth.

How to Help

  • Breastfeed at least 8 or more times in 24 hours. Make sure the baby is latched deeply and positioned with his nose to the nipple and tummy-to-tummy.
  • Start all feedings with the breast that has the plugged duct until the plugged duct is gone.
  • Apply wet or dry heat to the breast and gently massage the area to help milk flow. You can use a warm wet towel, a warm shower or bath, a heating pad, or a hot water bottle.
  • Try breastfeeding your baby in different positions to help remove milk from all areas of your breast.
  • Remove any tight fitting clothing or bras and get plenty of rest. Wear a bra without underwire.
  • Look for signs of mastitis. This is a breast infection with the following symptoms: fever, chills, and feeling unwell.
  • See your health care provider if you have a lump in your breast that will not go away.

For more information:DUCTS FACT SHEET

OVERSUPPLY OF MILK

  • It is normal for some women to make more milk than their babies need. This might be normal for your body. Expressing breast milk and feeding your baby regularly might also cause it.
  • It is common in the early days of breastfeeding to make more milk. This will slow down over the next few weeks and months.
  • When a mother makes more milk than her baby needs, the baby might latch well at first, and then start to gag, choke, gulp, gasp, or cough, and/or pull away from the breast. The baby may be trying to change his position at the breast.
  • The baby may also clamp down on the nipple to try to stop or slow down the flow of breast milk. The baby might come off the breast fully and you might see milk run out of the corners of baby’s mouth. The baby may spit up, be gassy, or have watery green stools.

How to Help

  • If you are expressing your breast milk, try to decrease the amount of times that you are expressing or pumping, until you are no longer making more milk than your baby needs.
  • If you are not expressing your breast milk and you have a lot of milk, try breastfeeding from only one breast per feeding.
  • You can also try breastfeeding in different positions, such as with your baby on your tummy while you are lying down, or leaning back while feeding.
  • If the second breast becomes too full and uncomfortable, try expressing enough breast milk just to soften the breast. Do not empty the breast while expressing.
  • Remember to burp your baby often during a feeding.

MASTITIS

  • Mastitis is an inflammation of the breast tissue with many signs and causes.
  • It is more common in the first 6 weeks and usually happens in one breast, but both breasts can be affected.
  • If left untreated, mastitis can become an infection and may lead to an abscess.

Signs may include:

  • Pain, redness, and swelling at the breast.
  • The breast may feel warm or hot to touch.
  • Red streaks in the breast.
  • Fever and flu-like symptoms.
  • Feeling tired and achy.

Causes may include:

  • Damaged or cracked nipples.
  • A shallow latch. Milk is being made faster than the baby can remove it. When the breast milk is not removed from the breast it might cause a plugged duct or engorgement.
  • Tight fitting clothing or bras with underwire.
  • A change in your baby’s feeding habits. Your baby may not be breastfeeding as often or suddenly refuses to take the breast.

How to Help

  • Continue to breastfeed frequently, including from the affected breast. If it is too painful to breastfeed, you can remove the milk by hand expression or pumping.
  • Apply a warm, moist compress to the breast before you begin to breastfeed. You can massage the affected breast to help remove the milk while your baby is breastfeeding.
  • Ensure your baby is latched deeply. You can try breastfeeding the baby in different positions.
  • Wear loose fitting clothing and underwire-free bras.
  • Drink fluids and get plenty of rest. Ask for help from your partner, family, friends, or neighbours.
  • Call your health care provider. You might need treatment with antibiotics and a pain reliever.
  • If the mastitis is related to a plugged duct, refer to the plugged duct section.

For more information:MASTITIS FACT SHEET

JAUNDICE

  • Jaundice is a condition where a newborn baby’s skin and the whites of the eyes turn a yellow colour. It usually can be found on the baby’s face and chest. Jaundice occurs when the baby has high level of bilirubin. Bilirubin is made when the liver breaks down red blood cells. Babies get rid of bilirubin in their stool (poo).
  • Jaundice usually appears between day 1 and 4. Most jaundice is not harmful. But, in some babies there is too much bilirubin and it can be harmful. The baby will need to have blood tests done to determine his bilirubin levels. This test is done at the hospital. Depending on the bilirubin levels some babies will need treatment.
  • Treatment is done by phototherapy light. This light treatment decreases the amount of bilirubin in the baby’s blood. Sunlight is not an effective treatment.
  • Babies with higher levels of bilirubin tend to be sleepy and hard to wake up. Therefore, it is important to wake him up and attempt to breastfeed at least 8 times in 24 hours.

How to Help

  • Feed the baby often, especially in the first hour and days after birth. At least 8 or more times in a 24-hour period. This will help you build your milk supply. Colostrum is a natural laxative and will help your baby’s body get rid of bilirubin. Your baby’s bowel movements should turn from dark green to yellow over the first few days.

Contact your health care provider if your baby shows any of the following:

  • Your baby refuses to breastfeed or has a decreased appetite.
  • Your baby is sleepy all the time and you are having a hard time waking him up.
  • Your baby is urinating (peeing) less than expected for his age.
  • Your baby looks more jaundiced (yellowing of skin and whites of the eyes).
  • Your baby’s bowel movements have not changed from dark green to yellow by day 4.

MULTIPLE BABIES

  • A mother can make enough milk for more than one baby. The more milk removed, the more milk the breasts will make.
  • While learning to breastfeed, you may enjoy feeding your babies one at a time. At other times, you may enjoy feeding the babies at the same time.
  • Breastfeeding enables you to spend time with your babies. Because you may spend a lot of time in the early days breastfeeding, accept help from friends and family and be sure to rest when you have a chance.

Click on the links for more information on breastfeeding multiple babies:MULTIPLES FACT SHEETMULTIPLEBIRTHSCANADA.ORG

PREMATURE BABIES

  • Breast milk is very important for premature babies, as it contains the nutrients they need and is easily digested.
  • The breast milk of a mother who has delivered early is different and specifically designed to meet the needs of preterm babies. The milk is higher in proteins, fats, sodium, iron, chloride, and other nutrients.
  • Holding your premature baby skin-to-skin is very good for both you and your baby and it will help your body produce the hormones that impact your milk supply. This is sometimes called Kangaroo Mother Care.
  • Hand expression and pumping breast milk will also help you to build your milk supply and provide it to your growing baby.
  • A lactation professional can help you and your baby learn to breastfeed once your baby is big enough to go to the breast.
  • Preterm babies often have a weak suck, which will get stronger with age. For this reason, you may want to continue to use alternative methods of milk removal, such as pumping, which will help build your milk supply for your baby.

Click on the link for more information on expressing milk for your premature baby:BREASTFEEDING PREMATURE BABIES

CAESAREAN SECTION

Many mothers who breastfeed have given birth by caesarean section (C/S).
Here are some tips to help get breastfeeding off to a good start:

  • Take the pain medication in the early days; ask your doctor for a medication that is safe to take while breastfeeding.
  • Breastfeed your baby early after the birth, in the recovery room if possible.
  • Breastfeed your baby often, at least 8 times in 24 hours.
  • Find breastfeeding positions that are comfortable for you.
  • Hold your baby skin-to-skin often and between breastfeeds.
  • Get plenty of rest and spend time with your baby.
  • Get up and walk around periodically, a little movement will help the recovery.
  • Ask friends and family for help with meal preparation and housework.