Breastfeeding Problems and Solutions

We all know that breastfeeding is wonderful! But it can also come with its own set of challenges. However, most breastfeeding issues can be resolved rather quickly and get you back on track to bonding with your baby, providing the best nutrition and on the road to meeting your breastfeeding goals!

Breastfeeding Problems: Engorgement, Infections, Thrush, and More

Jaundice
: Infant jaundice is a yellow discoloration in a newborn baby’s skin and eyes. Infant jaundice occurs because the baby’s blood contains an excess of bilirubin, a yellow-colored pigment of red blood cells

Engorgement: Breast engorgement means your breasts are painfully overfull with milk. This usually occurs when a mother makes more milk than her baby is drinking. Your breasts may become firm and swollen, which can make it hard for your baby to breastfeed.

Mastitis: Mastitis is an infection of the breast tissue that results in breast pain, swelling, warmth and redness. You may also experience fever and chills.

Nipple Yeast: (also known as infant thrush and candida)  An overgrowth of yeast in the mouth with distinctive white mouth lesions, infants may have trouble feeding or be fussy and irritable.

Jaundice

Some babies are born with jaundice or can become jaundiced. A baby with jaundice can be sleepier and therefore harder to breastfeed! Visually jaundice is a yellow color in the skin. It happens when a yellow pigment called bilirubin builds up in the blood and seeps into the skin. Bilirubin is made when the extra red blood cells babies are born with are broken down. When jaundice is mild, no treatment is needed.

Your baby’s healthcare provider will check your baby’s skin color under good light. The yellow color is first seen in the face. Then it moves to the chest and belly. As the levels get higher, it may spread to the arms and legs. You may also see it in the whites of your baby’s eyes. Jaundice can be harder to see if your baby has dark skin.

BREASTFEEDING MAY BE ALL YOU NEED!

Most cases of jaundice don’t need to be treated. Simply breastfeeding often may be all that’s needed. But if that is not enough, the first step is to help the baby take more milk at each feeding.

  • Help your baby take the breast deeper in his mouth.
  • Compress or massage the breast during feedings to speed milk flow.
  • Breastfeed at least 10 to 12 times per day.
  • To spur your baby to feed more, lean back and lay him tummy down on your body with his torso skin to skin with yours.
  • Guide your baby to the breast when he is drowsy or in a light sleep.
  • Avoid giving water, which may make jaundice worse.
  • Avoid pacifier use. If all sucking is at the breast, your baby gets more milk.

If your baby is not breastfeeding well, pump your milk and feed it to him. Talk to a board-certified lactation consultant for advice on how to give your baby extra milk.

Your milk is usually the first choice, but if you can’t express enough milk, talk to your healthcare provider about feeding donor milk or formula. You may need to supplement for a short time until your milk catches up to your baby’s need. Until your baby is getting the milk needed at the breast, use a multi-user breast pump at least 8 times a day and double-pump for at least 10 minutes each time to boost your milk production.

To find more information on what causes jaundice and what to expect you can read “Everything you’ve always wanted to know about jaundice in a full term baby!” By Linda Zager, RN, IBCLC

Engorgement

A few days after your baby’s birth, your milk production increases or comes in. It is normal to feel some breast fullness, but engorgement, which can happen during the first week after birth, goes beyond normal fullness. When a mother is engorged, her breasts become full, firm, hard, hot, and sometimes painful.

Some think breast engorgement is caused by too much milk. But it is really caused by fluid build-up in the breast. If the milk is not drained often and well, extra blood, lymph, and other fluids build-up in the breast, too. Lots of IV fluids during labor can also be a factor.

TO PREVENT ENGORGEMENT:

  • From birth, breastfeed at least 8-12 times a day. If the baby is not feeding well, use a multi-user pump to drain the breasts this often.
  • Be sure when breastfeeding that your baby latches on deeply. This feels better for you and helps your baby drain the breast more fully.
  • Avoid bottles and pacifiers. Keep your baby at the breast for all sucking.

TO TREAT BREAST ENGORGEMENT: 

  • Discuss with your healthcare provider taking ibuprofen to relieve swelling.
  • If needed, express some milk before feeding to make it easier for your baby to latch deeply.
  • Apply warmth right before feeding to aid milk flow.
  • Breastfeed at least every 1.5-2 hours during the day and at least every 2-3 hours at night until engorgement is gone.
  • Use breast massage or compression during feedings to more fully drain your breasts.
  • Let warm water run over your breasts in the shower. Leaking relieves pressure.
  • If your breasts still feel full after feedings, pump to drain your breasts fully.
  • Express milk to comfort between feedings.
  • Apply cold—gel ice packs or bags of frozen peas, wrapped in cloth—after feedings for 10-15 minutes to reduce swelling.

Be sure to treat breast engorgement before it gets painful. Severe pressure and swelling can cause breast damage. If these methods do not provide relief, seek help right away from a board-certified lactation consultant or other knowledgeable healthcare provider.

Mastitis

Mastitis is an inflamed or swollen area in the breast. This swelling prevents the milk from flowing freely. With a mild case of mastitis, a mother may feel a small lump. With a more severe case, a large area of the breast may feel swollen or hard. The swollen area may feel tender or painful and it may look red. It may hurt to breastfeed. Most often only one breast is affected. But in rare cases may occur in both breasts. A mother with mastitis may or may not run a fever.

 THE THREE MOST COMMON CAUSES OF MASTITIS ARE:

  • Broken skin on the nipple that allows organisms to enter the breast.
  • Inside pressure from a very full breast.
  • Outside pressure on the breast over time from a too-tight bra, swimsuit, or strap that presses into the breast.

RISK FACTORS FOR MASTITIS INCLUDE:

  • Overabundant milk production, which may often leave the breasts feeling full.
  • Diabetes, which puts mothers at higher risk for infections of all kinds.
  • Feeling very run down.

WHAT SHOULD YOU DO IF YOU HAVE MASTITIS?

First, contact your healthcare provider. Ask about taking ibuprofen to reduce the swelling. If you are fever free or have a low-grade fever, your healthcare provider may suggest treatments for mastitis.

  • Breastfeed often—every 1.5 to 2 hours during the day and at least every 3 hours at night.
  • Use breast massage while feeding to help the baby more fully drain the breast.
  • If that breast still feels full after breastfeeding, express more milk from it.
  • Apply warm compresses to the swollen area 3-4 times a day for 10-15 minutes. It can take up to a week for the swelling to go away. If you are improving, you should feel less swelling every day.

If you notice any of the following at any time before or during treatment for mastitis, contact your doctor right away. He or she may prescribe an antibiotic if:

  • You do not feel any better within a day or two.
  • You have a fever of 101°F (38.4°C) or higher.
  • You see red streaks on your breast, it is feeling hotter, or the swelling is getting worse.
  • You feel achy and have chills.

Nipple Yeast

Nipple yeast, also known as thrush or candida, can be painful and interfere with breastfeeding.  Only your healthcare provider can diagnose nipple yeast. If you have one or more of the following signs you may want to consult your doctor.

Signs of Nipple Yeast

  • Itchy, burning nipples.
  • Flaky nipple skin.
  • Bright pink skin on the breast where baby’s mouth touches during feedings.
  • Shooting pains in the breast during or after breastfeeding.
  • Symptoms of a vaginal yeast infection.
  • Your baby may have one or more of the following signs:
  • Creamy looking white areas inside the mouth.
  • A film in the mouth on gums or tongue.
  • Diaper rash with raised patches or shiny skin in the diaper area.
  • Sudden feeding problems, pulling off or crying.
  • Gassiness or colic.

Treatment of Nipple Yeast

Nipple yeast and thrush is only one of many common skin problems caused by an overgrowth of yeast. You may be more likely to develop nipple yeast if you or your baby have recently taken antibiotics, you have a history of vaginal yeast infections, you have diabetes, or if you have broken skin on your nipple. Your healthcare provider may need to treat both you and your baby with an antifungal medication, such as:

  • A prescribed or over-the-counter product to apply to your nipples.
  • A solution to swab inside your baby’s mouth after every feeding.
  • An ointment or cream for his diaper area.
  • A drug you swallow.

Keep breastfeeding while you and your baby are being treated. To reduce pain, start on the least sore breast first and switch breasts after your milk begins flowing. With the right treatment, the pain should be almost gone within three to seven days. If not, tell your doctor and ask about another treatment.

What You Can Do to Prevent Nipple Yeast From Returning:

Yeast is hardy and can grow in many places. While you and your baby are being treated:

  • You may find advice suggesting you boil daily for 20 minutes anything that goes in baby’s mouth (such as bottle nipples, pacifiers, teething toys), anything your baby sucks on or chews, and any breast pump parts that touch the milk.  Please contact your healthcare professional for more guidance.
  • Wash hands often—both yours and your baby’s.
  • If you use nursing pads, use the disposable kind and replace often.
  • Be sure to follow the treatment for the recommended time.

This is general information and does not replace the advice of your healthcare provider. If you have a problem you cannot solve quickly, seek help right away. Every baby is different. If in doubt, contact your physician or healthcare provider.