Common Concerns

Sore Nipples

• Some mothers find that their nipples can feel tender or sore especially in the early days. Soreness can 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. Be sure to find a position where you are comfortable and baby can easily reach the breast.
• When the baby takes in the breast tissue surrounding the nipple, which includes areola (the pink or dark area around the nipple), this is considered a 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.
• 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. See video below.
• 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.
• Mother’s milk is always changing to best meet her baby’s needs. On day 3 or 4 most mothers notice that their milk looks whiter and the amount increases. 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.
• As babies grow, some days they seem hungrier than usual and parents may worry there is not enough milk. These times are called growth spurts. There is no need to worry if your baby is content, has a normal amount of output (pees and poos) and is growing and gaining well. The more you feed your baby, the more milk you will produce.

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.
• If your baby needs to be supplemented, it is best to give your baby expressed breast milk. In this case, work with a care provider to maintain and increase your supply of breast milk. Click here for information on where to get help. If you need to supplement your breastfeeds with formula, click here for more information.

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.

Please review the Thrush Fact Sheet provided by Best Start for more information.

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 a 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. Mother-baby togetherness will help you learn about your baby’s cues and allow you to respond in a timely way. Crying is actually the last hunger cue.
• Remember to try different techniques to help calm your baby. Each baby will respond differently to different techniques.
• If baby is to experience a painful procedure such as an injection, being skin-to-skin and breastfeeding can help to reduce baby’s pain and decrease crying.
• Feed your baby in response to baby’s early hunger cues and at least 8 times in 24 hours. Change your baby’s diaper whenever it becomes wet or soiled. Burp your baby if he is showing signs of restlessness during or after a feeding. Spend time skin-to-skin with you baby. Comfort your baby by gently massaging him, singing to him, or speaking softly to him. Make sure baby’s clothing is not restricting his movements. Most babies will feel more relaxed and secure when 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 an adult you trust) 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.

Using a Pacifier (Soother)

Many breastfed babies never use a pacifier. When a baby is fussy, offer the breast first. See page 28 for information about soothing a fussy baby. It is important to make an informed decision if you are thinking about offering a pacifier to your baby. Offering a pacifier to delay a feeding can result in your baby not getting enough breast milk and slow weight gain patterns. This can also lead to a reduction in your milk supply. There is limited research that suggests pacifier use can increase the risk of your baby getting an ear infection. Babies who use pacifiers over the long term may develop dental problems.

There are also safety considerations with the pacifier itself such as cleanliness and the pacifier not having any damage. If you made an informed decision to use a pacifier, try to only give it to your baby for a short time after your baby has fed. You can also let your baby suck on your clean finger. If a short time of sucking does not settle your baby, offer them your breast again.

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.
• During a feeding when you observe that your baby sleepy and no longer swallowing, try switching to the other breast. Switching breasts can be done several times during the same feeding. You can also use waking techniques such as burping and upright breastfeeding positions to encourage your baby to breastfeed longer.
• 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 watch the video below.

Breast Compressions

Baby Will Not Latch

• A latch is when the baby attaches to the breast and suckles and drinks.
• 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.
• It is important to establish and maintain your milk supply by removing milk as many times as a baby would feed, at least 8 or more times in 24 hours including through the night.
• 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 (See information below on expressing and storing milk). 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 baby 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.

Expressing & Storing Milk

For information on expressing and storing milk, click here

Engorgement

• Breast fullness usually happens about 2-4 days after giving birth. You will notice that your breasts feel heavier and fuller and this will subside on its own if your baby is feeding often and removing enough milk. If your breasts become overly full and also feel tight, heavy and painful this is called engorgement. Engorgement can happen if not enough milk is regularly being removed from the breast by your baby or by hand expression and pumping.
• 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

Hand Expression is a painless, convenient way of removing milk from the breast. To learn more, please visit the Learn How to Hand Express section within Early Days.

• 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 feed on the breast and remove enough milk that your breast feels softer and more comfortable before switching breasts. If the baby does not remove enough milk for you to feel comfortable, hand express or pump to comfort. Milk in the breast at the end of the feed 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.
• Offer both breasts to your baby frequently or remove milk with hand expression or pumping. If your baby is breastfeeding and you have decided to use artificial nipples or pacifiers, avoid using them until the engorgement has resolved.
• 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, milk cannot flow through that duct until the blockage is released.
• 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 there has not been enough milk removed from the breasts or when a feeding is skipped.
• A plugged duct may 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. Pointing baby’s chin in the direction of the plugged duct or area of tenderness can sometimes help to dislodge the blockage.
• 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.

Please review the Blocked Ducts Fact Sheet provided by Best Start for more information.

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. Only take enough milk to help your breast feel comfortable. Taking too much milk will tell your body to make more milk.
• 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.

Please review the Breast Infection (Mastitis) Fact Sheet provided by Best Start for more information.

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).
• Most babies have some jaundice during the first week of life. As your baby’s liver function improves, bilirubin is removed from their system, and the yellow colour fades. Sometimes the bilirubin levels get higher than usual and the baby needs medical treatment. The baby will need to have blood tests to determine the bilirubin level. You can help your baby during the blood test by holding your baby skin-to-skin and breastfeeding.
• 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.

Please refer to the Best Resource Output Chart for what to expect as your baby continues to age.

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: MultipleBirthsCanada.ca

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: Tips for Breastfeeding Preterm Babies . Click here for information on Your Late Preterm Baby or Early Preterm Baby.

Caesarean Birth

Many mothers who breastfeed have given birth by caesarean birth.
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.

Nursing Strike

Nursing strike (also called breast refusal) is when a baby who has been breastfeeding well suddenly refuses the breast. This mostly happens before baby is 12 months old and can last a few days or longer. This is not the same as natural weaning when the baby moves from breast milk to other sources of food.

Baby Causes:

• ear infection, cold or other illness
• mouth pain from teething or thrush
• acid reflux
• recent immunization
• stress, upset, easily distracted or overstimulated
• allergy or sensitivity caused by new maternal medication, foods or vitamins
• reaction to new soap, lotion, deodorant or detergent mother may have used

Mom Causes:

• new pregnancy
• low milk supply or fast flow of milk
• negative reaction when baby bites
• long separation from baby

What to Try:

• breastfeed in a quiet place
• breastfeed when baby is sleepy
• change breastfeeding positions
• place baby skin to skin
• hand express before latching to start milk flow
• breastfeed based on feeding cues
• baby wearing (allows baby to see, smell, touch and taste at the breast)
• if breasts are full try pumping and giving expressed breast milk by cup
• avoid bottles or pacifiers
• if baby takes a bottle, start with the bottle and when actively sucking slowly take the bottle out and latch baby to the breast
• keep feeding times happy