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Overview

Your newborn is hard-wired to breastfeed and is born with instincts to help them latch right after birth. Despite these instincts, breastfeeding doesn’t always come naturally or go perfectly right from the start. In reality, breastfeeding can take practice and patience as you and your baby navigate your nursing relationship. Many issues can come up during breastfeeding in the first few days and even months down the road. The more you know about the small speed bumps you could run into, the more likely you are to be able to get over those and correct minor issues before they become significant problems. Issues can include symptoms in your breasts like leaking, sore nipples, nipple shields, pain during breastfeeding or pumping, vasospasms, blebs, plugged ducts, mastitis, and engorgement. Or issues that affect your baby like jaundice, tongue-tie, yeast infection, thrush, food allergies or sensitivities, nursing strikes, sleepy babies, cluster feeding, growth spurts, and spitting up. This article will help you identify common breastfeeding issues and have a basic understanding of how to correct them so you and your baby can enjoy the benefits of breastfeeding.

Article and Resources

In this episode, we are talking about troubleshooting issues that can come up in your breastfeeding journey. I wish breastfeeding were natural and perfect from the start for every mom, but the reality is that it may take some work. It is 100% worth it, but give yourself and your baby some patience and understanding that it may take some time and some practice to get this all figured out.

This article will help you learn about and tackle some breastfeeding issues, but this is not a substitute for the value you can get from seeing a lactation consultant or going to a breastfeeding support group. I cannot emphasize enough how helpful it can be to get help as soon as you need it before a minor issue becomes significant.

The thought of hiring a consultant may sound expensive, but many times you can find these resources for free. La Leche League is a great starting place for this. Also, check with the venue where you plan to give birth or check with your midwife if you plan a home birth.

For all of the breastfeeding resources, episodes, and articles in one place, see this page.

The Kelly Mom blog is an excellent resource for breastfeeding-related topics, and I reference and link to it throughout this article.

The Womanly Art of Breastfeeding is a fantastic book with everything you could need to know about breastfeeding all in one place. I have read this book multiple times and referred to it throughout both of my breastfeeding experiences.

The Breastfeeding Relationship

Breastfeeding is a relationship between you and your baby, and it has to work for both parties involved. Many issues can come up with breastfeeding. Some problems arise in your breasts, and others present in your baby. Having a baseline understanding of the issues that can arise will help prepare you. If you run into any issues, you know what it is, have some idea of how to treat it, and know where to go to get help.

Leaking

Leaking tends to be common in the beginning when you are getting everything calibrated with your supply and your Baby’s demand. If your breasts are full and you do not remove milk, they will leak. It is also possible that you will leak at random times, like when you hear a baby cry. If you are concerned at all about leaking, you will want to use some nursing pads.

Disposable pads are convenient to use and throw away, especially if you leak and need to swap them out when you are away from home. They also have a sticker on one side to stick to your bra and keep them in place. You may consider washable nursing pads, which are more environmentally friendly. You can simply throw them in the washer and dryer. One downside is that they will feel wet against your skin if you leak, where disposable pads tend to absorb more moisture and wick it away from your skin. If you are thinking about trying reusable pads, check out Bamboobies or the non-slip pads from Bodily.

Your Baby’s Latch is Painful

A painful latch is likely due to them not being latched on properly. There is a trick to get your baby off your nipple painlessly so you can help them latch properly. To do this, you want to put a finger in the corner of their mouth and twist it. This will break the suction and allow you to start again. If you are doing this numerous times, it could frustrate your baby, and possibly you too. In the long run, it will save your nipples.

The first tip to help your baby latch is to tilt your nipple before entering your Baby’s mouth. Aim the top of your nipple towards their upper lip and wait to put it in their mouth until it is open wide. You can also squeeze your breast to compress it and make it easier for your baby to fit in their mouth. With time and practice, you and your baby will find what works best for you.

Sore Nipples

You likely hear that breastfeeding is not supposed to hurt. It isn’t supposed to, but it is really common to have sore and sensitive nipples in those first few days. This is a part of your body that isn’t used to this much stimulation all the time. Sore nipples are often related to a poor latch. As with anything breastfeeding, you always want to fix or correct the underlying problem, not just treat symptoms. As you are correcting the underlying issue, you want to give yourself some relief if you have damage to your nipple.

The first thing you can do is start your baby off on the other side. Their sucking tends to be more intense at the start. After breastfeeding, you can use a saline solution on your nipple. This is easy to make with 8 ounces of warm water and ½ teaspoon of salt. Soak your nipples for about a minute. You don’t want to do it too long. Afterward, pat them dry and then put breast milk on your nipple. Your breast milk has anti-inflammatory and anti-bacterial properties that can help promote healing. Nipple cream can also provide some relief and may speed up recovery. This isn’t something you should be using every day for your entire breastfeeding life. Nipple cream should be short-term to help heal while you fix the problem causing the damage.

When you are not nursing, try giving your nipples exposure to air, and you can use mild soap once a day on your nipples if they are chapped or cracked. Damaged nipples are uncomfortable, but they will heal and get better. The more proactive you are in correcting latching issues as soon as possible, the more you can prevent problems like cracked nipples. You can visit the Kelly Mom blog for more info on Healing Tips for Nipple Cracks or Abrasions.

Nipple shields

Nipple shields are made from clear silicone you wear over your nipple during breastfeeding. You can use these for a baby with difficulty latching or for nipple pain from cracked or damaged nipples. There are some disadvantages to using a breast shield, and they are commonly misused. Before you use a nipple shield, you should see a lactation consultant. These are more of a short-term solution to some issues for which there may be better solutions. This is why it is best to refer you to a lactation consultant. If you want to read more on nipple shields, you can visit the Kelly Mom blog that explains some of the challenges of using a shield, including that it can be tough to get your baby off of it.

Pumping is Painful

If pumping is painful, you can try lowering the suction on your pump. If it is too high and you are uncomfortable, it isn’t going to work well. One, it will hurt, and two, it will not be effective in removing very much milk. You may want to try a different-sized flange. Most pumps come with just one size flange. The flange is the cone-shaped piece that goes on your nipple. If it is too small, this can be uncomfortable. A sign it is too small is if your nipple is swollen or darker after pumping. It is normal for your nipple to be slightly bigger after pumping, but it should not be swollen. Your nipple should move easily in and out of the flange. You can also try some olive oil to lubricate it and see if that helps.

While it may be easy to separate pumping and breastfeeding, they are so related, and a lactation consultant or a LLL member can help if you are having issues with pumping. Try a lactation consultant or a support group if you need help with pumping, bottle feeding, or supplementing. Please do not assume breastfeeding resources are only for breastfeeding where your baby is on your breast only.

Vasospasm or Nipple Blanching

Muscle spasms in your nipple can cause the blood to flow out of the nipple. You feel this as a stinging or burning sensation. This makes your nipple turn white during the spasm, then red afterward, when the blood flows back in. It usually happens after feeding but can occur in between feedings. To stop a spasm, you can squeeze the base of your nipple when it happens. Some women find keeping their nipples warm can help, and cold can sometimes trigger this. For more details on nipple blanching and vasospasms, visit the Kelly Mom blog.

Blebs

A bleb (aka milk blister) is a tiny white spot on your nipple. It looks like there is milk stuck in a pore. If it isn’t painful, you do not need to do anything about it. If it is bothering you, try soaking a cotton ball in vinegar and wear it over your nipple in your bra. Since milk has calcium in it, vinegar can help dissolve it. You can soak in the bathtub or shower and soak a cotton ball in water or olive oil, and put it over your nipple in your bra. Another tip is to soak your nipple in a cup of warm water with two teaspoons of Epsom salt before nursing. For more info about blebs and what you can do to treat them, visit the Kelly Mom blog.

You are Not Making Enough Milk (Undersupply)

Not making enough milk is one of the top reasons mothers start supplementing with formula and stop breastfeeding. Milk works on a supply and demand system, and the more milk you remove from your breasts, the more milk your body will make. The number one thing you can do to increase your milk supply is to increase how often you are feeding your baby. While pumping is a great way to provide milk for your baby, a pump will not remove milk as effectively as your baby can.

Before you jump to the conclusion that you are not making enough milk, make sure that is the case. Please seek the help of a lactation consultant if you have concerns and want to continue breastfeeding. If your supply has decreased due to an underlying issue, you want to fix that issue, not just pump more throughout the day. Kelly Mom has an excellent article with many resources on increasing low milk supply.

Lactogenic foods or galactagogues are substances that are thought to increase milk supply. Things like lactation cookies or smoothies usually incorporate several of these ingredients. Eating foods or herbs that theoretically increase supply is not going to make up for nursing frequently.

One study surveyed women who used some type of galactagogue, and overall, they found it to help increase their supply. This wasn’t scientifically measured; it was through questions answered by mothers. It is possible there was some placebo effect. Meaning they perceived an increase in milk supply just because they were consuming something that they thought would increase their supply. 

Common ingredients in lactation cookie recipes include oats, brewer’s yeast, flaxseed, coconut oil, almond butter, or dates. These ingredients may be beneficial overall by providing things like vitamins, minerals, iron, or healthy fats, but there isn’t much evidence to support their efficacy in increasing supply. The most common galactagogue is Fenugreek. If you are interested in reading more on Fenugreek and seeing the evidence available, check out this article from Kelly Mom. MOBI (Mother’s Overcoming Breastfeeding Issues) has a good article that breaks down lactogenic foods and herbs.

You are Making too Much Milk (Oversupply)

On the opposite end of the spectrum of undersupply is oversupply. This may seem like a good problem to have, but it can create many other issues and make breastfeeding difficult. Oversupply may mean that you have a forceful let-down. This is when your milk comes out too quickly, and your baby has a tough time nursing because of it. Oversupply can also contribute to more severe problems like engorgement, plugged ducts, and mastitis.

Many moms who experience oversupply will notice a decrease by around three months. It is tricky to reduce supply without overdoing it and creating a problem with not making enough milk. Kelly Mom has more information on oversupply and using herbs to reduce your milk supply. A lactation consultant can be invaluable for dealing with oversupply.

Engorgement

You will likely experience engorgement when your milk first comes in. It can also happen if you go longer than usual in between feedings. When your breasts are engorged, they can feel full, heavy, tender, hard, and even hot. It can also make it difficult for your baby to latch. The top tip to help with engorgement is to nurse your baby. If it is hard for your baby to latch, you can try putting pressure around your areola with your fingertips to try and press some fluid back, so the area around your nipple is softer and easier to latch. This technique is reverse pressure softening. To get a better idea of how to do this, check out the Kelly Mom article on reverse pressure softening that includes some pictures which may make this concept a little easier to understand.

You can also express a small amount of milk by hand or with a pump. Remember, your milk works on a demand and supply system. If you are engorged and empty your breast, you just told your body that you need that amount of milk at that time, and you are likely to get engorged again. A warm shower can also make it easier to hand express some milk. The heat doesn’t help engorgement, but it does seem to help you express milk. Cooler temperatures may be more helpful for dealing with the discomfort from engorgement. For more information on engorgement, see this Kelly Mom article.

Plugged Duct

Your breast has many ducts that send milk to your nipple. When one of those ducts gets plugged, it doesn’t get emptied, and it can get hard, swollen, red, and feel warm or hot to the touch.

This is usually due to ineffective milk removal if your baby isn’t eating well and getting engorged. You can also cause a plugged duct with a bra that is too tight or doesn’t fit well. You must be wearing comfortable bras and tops that are not digging into your skin or too tight.

The best method to treat a plugged duct is to empty the milk from your breast, make sure you drink plenty of fluids and eat well. Before you breastfeed, you can apply some heat to your breast with a warm compress or a warm shower and massage it. While you are nursing, you want to massage from the plugged duct towards your nipple to try and help get in unclogged.

Mastitis

If you do not resolve a plugged duct, it can turn into mastitis. The symptoms are similar but often more intense and can include a fever and flu-like symptoms like aches and chills.

Mastitis is a more severe plugged duct and may or may not be an infection. Bacteria entering through a point of damage on the nipple can cause infection. To treat mastitis, you want to follow the same treatment as for a plugged duct, but you also want to rest, preferably in bed, with your baby. Your care provider may prescribe antibiotics to treat an infection. If you are running a fever and have flu-like symptoms contact your doctor or midwife to talk to them about their suggested course of action and whether or not you should consider antibiotics.

Plugged ducts and mastitis are very similar, and there is an excellent article on Kelly Mom compares and explains the two.

Weakened immunity is one of the risk factors for mastitis. I got mastitis with my son, and it was not fun.

In my most recent breastfeeding journey with my daughter, even worse, I got mastitis, and it turned into a full-blown abscess. This was not a fun experience, and you can visit this episode if you want to hear more about my experience and the lessons learned breastfeeding the second time around. It is critical to take great care of your health anytime but definitely when breastfeeding, especially in the first few weeks when mastitis is most common. If you have anything you do to strengthen your immune system, now is the time to do it. My go-to is Athletic Greens and lots of rest.

Spitting up

Your baby will spit up. This is why new parents stock up on burp cloths. Usually, this doesn’t bother your baby much, and it looks like more than it is. Spitting up is expected, so don’t stress out about it. If you think your baby is spitting up more than they should be, you can always bring it up with a lactation consultant or your pediatrician.

Spitting up is different from vomiting. Spitting up looks more like milk free-flowing from your Baby’s mouth, where vomiting is a forceful ejection of the stomach’s contents.

Luckily, there are some really simple things you can do to reduce spitting up. Burping your baby after eating may help reduce the amount of spitting up they do. Also, keeping them upright for a bit rather than immediately laying them down may reduce the frequency of spitting up. If you would like more information on spitting up and reflux, check out this article from Kelly Mom.

Your Baby is Falling Asleep at Your Breast

With a newborn, getting breastfeeding established in those early newborn days is essential. This can be challenging with a baby who is falling asleep at your breast or who is just overly sleepy. It is recommended to wake them up to nurse every 2-3 hours during the day or 4 hours at night. This is usually just until they get back to their birth weight. You can check with your doctor, midwife, or pediatrician for their suggestion on how often you need to be feeding your baby in those early days.

The most common suggestion to gently wake a sleepy baby or keep them interested in nursing is to burp your baby or change their diaper. Any gentle activity, like undressing them or holding them in a different position, may wake them up a bit and get them more interested in breastfeeding. Kelly Mom has additional information that may be helpful if you are dealing with a sleepy baby.

Your baby Refuses to Nurse (Nursing strikes)

A nursing strike happens when your baby suddenly decides they do not want to breastfeed. The keyword here is suddenly. This isn’t your child weaning, which they would rarely do on their own before age two. A nursing strike can be for an infinite number of reasons. It could be something simple to detect, like your baby has a cold, or something more obscure, like a change in the taste of your milk.

Fortunately, there are some tips for dealing with a nursing strike. First, you still want to express milk to keep up your supply and avoid plugged ducts. If your baby is not breastfeeding, you can express milk by hand or with a breast pump. You cannot force breastfeeding; it just doesn’t work that way. Your baby may be more amenable to nursing at night or when they are sleepy. You may want to try breastfeeding in a different position or a different place. If you would like to read more, Kelly Mom has a great article aptly titled, Help My Baby Won’t Nurse.

Your Baby Will Not Stop Nursing (Cluster Feeding and Growth Spurts)

On the opposite end of a nursing strike is a baby who will not stop nursing. This can be frustrating at times, but this is normal. Your baby will not eat in the same patterns every day, which will vary all over the place, especially early on.

Cluster feeding is when your Baby spaces feedings closer together during a part of the day. For example, if your baby wants to be attached to your boob from 5-8 pm, yes, for three solid hours, they are cluster feeding. It is common for babies to be fussier in the evening, and they may prefer to be at your breast and nursing during this time. Your breast is their safe, comforting place, and remember, this is normal. If you find yourself dealing with a fussy baby in the evenings and cluster feeding, you can read more on Kelly Mom.

A significant contributor to cluster feeding is your baby going through growth spurts. You will know when they are because they will breastfeed more often and be more fussy than usual. When they increase their feedings, this will be temporary and usually just goes for 2-3 days, but it could be as long as a week. Typical timeframes for growth spurts are 2-3 weeks, 4- weeks, 3, 4, 6, and 9 months. Every baby is different, but these seem to be most typical. While growth spurts can be more challenging times with a baby, it is pretty awesome that your baby and your body will adjust the amount of milk needed during and after a growth spurt. Kelly Mom offers more information on growth spurts in this article.

Food Allergies and Sensitivities

You pass everything you eat to your baby in trace amounts in your milk. If your baby has an allergy or a food sensitivity, many symptoms may be present. Symptoms can be your baby being more fussy than usual, spitting up more often, more gas than usual, a rash that usually shows up on their cheeks or even on their bottom, you may even see some signs of eczema. The only real way to tell if something you are eating is bothering your baby is to cut it out of your diet and see if the symptoms improve. Some of the foods that are most often associated with allergies and intolerances are:

  • Cow’s milk (This isn’t just in milk, but is also in cheeses, butter, and many packaged foods.)
  • Soy
  • Eggs
  • Wheat
  • Corn

If you eliminate something from your diet, it could take a week or two to fully see symptoms improve, assuming that food was causing the problem. This can be a challenging process of trial and error. For more information on dairy and food sensitivities, check out this article on Kelly Mom.

Tongue Tie

Tongue-tie is when your baby’s frenum or frenulum (the membrane under their tongue) is too short and restricts the movement of their tongue. When your baby nurses, they are sticking their tongue out, and if they cannot do that, it is difficult for them to get a good latch and effectively remove milk.

Some symptoms of tongue-tie are your baby having difficulty maintaining a latch or not being able to suck or swallow effectively. While this can be visible to you, it is best for your pediatrician or a lactation consultant to diagnose it.

To treat a tongue-tie, a doctor snips the membrane. This procedure is done with a local anesthetic and is quick. If your baby has a tongue-tie, the sooner you get it fixed, the better. If you have any concerns about tongue-tie, please bring them up with a lactation consultant or your pediatrician.

For additional resources for breastfeeding a baby with tongue-tie or lip-tie, you can read this article on Kelly Mom.

Yeast Infection & Thrush

A yeast infection or thrush presents symptoms in both you and your baby. A yeast infection on your breast makes your nipples pink and shiny looking, your skin may be flaking, and you will have burning, itching, or pain. If your baby has a yeast infection in their mouth, it is known as thrush and can be passed back and forth between you and your baby. A sign you would see in your baby is creamy white patches in your Baby’s mouth and on their tongue that do not wipe off. It is common for babies to have somewhat of a white coating on their tongue from milk, which should wipe off easily.

If you think you and your baby may have thrush seek out a lactation consultant or your doctor or midwife. You can see additional thrush resources on the Kelly Mom blog.

There is quite a bit to do to treat thrush involving you, your baby, and anything coming into contact with your breasts or your baby’s mouth. Please talk to your pediatrician if you think you may have thrush.

Jaundice

A buildup of a chemical called bilirubin in your baby’s blood causes jaundice. Bilirubin is formed naturally from the body’s normal breakdown of red blood cells. The liver is responsible for removing bilirubin from the bloodstream. Often a newborn’s liver doesn’t work quite as efficiently as it needs to, and the result can be a slight yellow tinge to their skin.

It is common for babies to have a mild case of jaundice, which is entirely harmless. If bilirubin does reach high levels, it can become a severe condition and, if not treated effectively, and can lead to some pretty serious health problems. Jaundice does tend to be more common in newborns who are breastfeeding and most often in those who are not nursing well. If you are breastfeeding, you should be nursing your Baby eight to twelve times per day in the first few days, which will help produce enough milk and help keep bilirubin levels low.

If you suspect that your baby has jaundice, contact your pediatrician. Keep breastfeeding, and do it often. This is one of the best things you can do to prevent this issue. If your baby does get jaundice, it will first appear on their face, then on the chest and abdomen, and finally on their arms and legs. The whites of the eyes may also be yellow. When you have your first checkup with your pediatrician, they will examine your baby for jaundice. If they suspect it may be present, they may order a skin or blood test to diagnose the condition definitively.

Jaundice tends to peak at three to five days old since this is the time when the bilirubin level is highest. If your pediatrician determines that jaundice is present, there are several ways you can treat it. You can reduce bilirubin levels by placing the infant under special lights when they are undressed. Light therapy can take place in the hospital or at home.

For more reading on breastfeeding a baby with jaundice, see this article from Kelly Mom.

The Value of a Lactation Consultant

I cannot overstate the importance of getting help from a professional with any breastfeeding issues. An IBCLC (International Board Certified Lactation Consultant) can make a world of difference. It is great to listen to podcasts and read articles, but this will not be a substitution for a professional who can help to resolve any issue. I encourage you to reach out to a lactation consultant if you need assistance or if breastfeeding is not going smoothly.

If you are concerned about the cost or have limited resources, please reach out to your doctor, midwife, or pediatrician. La Leche League is also an international organization with many free resources and support groups.

Thank you to the amazing companies that have supported this episode.

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