Tips for common breastfeeding challenges

Engorgement is when your breasts get too full. They become swollen, hard and tender, and your baby has a hard time latching. Engorgement usually only lasts for a few days.

Tips to make your breasts more comfortable

• Breastfeed often, and let the baby stay on the breast until the breast is softer or the sucking slows, then offer the second breast.
• If your baby is not nursing well, express your milk 8 or more times in 24 hours.
• Express a small amount of milk to relieve the pressure before breastfeeding.
• Put cool cloths on your breasts for 20 minutes at a time.
• Massage your breasts while feeding or pumping.
• Take a warm shower.
• Try reverse pressure softening (reference from Dr Jack Newman ibconline.ca)
• Put clean green cabbage leaves inside your bra (we're serious!) 

If your engorgement lasts more than a few days or continues to be a problem, talk to your family physician, Midwife or Public Health Nurse.

When your milk comes out very fast at the beginning of a feeding, we call that a forceful letdown. It might seem like having a large amount of milk would be a good thing, but it can actually cause a lot of problems, including gas for the baby and pain for you as the baby bites down to slow down the flow of milk.

Tips for forceful letdown

If forceful letdown is a problem for you, you might find it helpful to:

• Try feeding from a different position, including holding baby upright or lying down on your back to feed.
• Let the milk spray out first and offer your breast to baby after the flow has stopped.
• Burp baby frequently.
• Avoid missing feedings; don't add formula to your routine.

Unfortunately, you'll need to be patient. Forceful letdown can take weeks to resolve. Talk to your Public Health Nurse, Midwife or Lactation Consultant for more support.

Mastitis is an infection in the breast. It happens to many new parents and can clear up quickly with treatment. Mastitis is not a reason to stop breastfeeding. If you think you might have mastitis, you should see your health-care provider for treatment within 24 hours.

Signs of mastitis include:

• Hot, red, painful area on the breast
• Muscle aches
• Headache
• Fever or chills
• Fatigue

How to prevent mastitis

You can try to prevent mastitis by:

• Washing your hands before feeding
• Ensuring your baby has a good latch
• Feeding one breast until soft before offering the other breast
• Gently massaging any plugged ducts or breast lumps (see Plugged Ducts handout)
• Trying not to miss feedings
• Getting help if you have sore or cracked nipples
• Taking care of yourself; rest, drink and eat well
• Wearing a comfortable, well-fitting nursing bra
• If weaning, doing it slowly

Increasing your milk supply

Sometimes babies don't get enough breast milk to gain weight. Babies who aren't getting enough milk are also still fussy after feedings and don't have a lot of soiled diapers. The good news is most women can make enough milk to feed their babies. Increasing milk supply might just take a little work.

Tips to Increase Milk Supply

• Breastfeed often (at least 8 times in 24 hours). More feedings create more milk.
• Offer both breasts at each feed.
• Take care of yourself. Rest when you can, eat well, drink lots of water and avoid alcohol and nicotine.
• Express your breastmilk
• Hand express or pump your milk after as many feedings as you can
• If your baby is not latching, express or pump your milk at least 7 times during the day and one time during the night
• Feed baby extra milk (expressed breast milk or formula) if your baby is not growing well with breastfeeding

If you still can't seem to make enough milk, talk to your health care provider. Domperidone (Motilium) is a safe prescription medication that increases milk supply that might be right for you.

Overabundant milk supply

Having more milk than your baby needs can be a problem. It can be hard to tell if your baby is hungry or not.

Signs of overabundant milk supply

• Your baby has short, frequent feeds, may be fussy during the feed and hard to settle
• The baby may have many explosive, runny, yellow or green stools in a day, be gassy and may spit up often
• During feeding, your baby may choke or cough, refuse or bite the breast, and cry or pull off with letdown
• Your breasts feel overfull, spray milk with letdown, have pain in the breast with letdown and may get plugged ducts or mastitis 

What to do about overabundant milk supply

• Try different positions when you feed – hold the baby upright, lean back after latching or side lying
• Feed the baby when they are drowsy or not too hungry
• Take baby off the breast if the baby chokes or coughs
• Let the milk spray (or catch it in a container) until it slows, then offer the breast again
• Burp baby frequently
• For each feeding use one breast only, feed until baby is content. Offer the same breast again if the baby is hungry soon after. You may need to hand express the other breast for comfort
• Avoid missing feedings or giving formula
• Watch for signs of plugged ducts or mastitis

Nipple pain is a common problem, especially during the first week of breastfeeding. Nipple pain usually means that there is a problem with the latch, but it can also be due to things like infection, thrush, Raynaud's Disease (poor circulation to the nipple) or problems with the baby's suck. The best way to prevent nipple pain is to make sure you have a good latch.

Nipple pain signs and how to prevent nipple pain (English)  (Chinese) (Farsi) (Punjabi) (Vietnamese)

Tips to ease nipple pain

• Feed your baby at the first signs of hunger.
• If you use them, change breast pads often.
• Express a little milk to soften your breast before feedings.
• Use lanolin cream on your nipples after every feeding.
• Hand express or pump your breast milk to give your nipples a break.

When milk builds up in a milk duct in the breast, the duct can get plugged. If you see any of the signs below, you might have a plugged duct.

Signs of a plugged milk duct

• A tender lump in your breast or near your armpit
• Red areas or red streaks on your breast
• Your affected breast feels warmer than the other
• There's a white spot at the end of your nipple
• Your milk flow is slow, causing baby to be fussy or tug at your breast

How to fix a plugged milk duct

Luckily, plugged ducts usually get better within a day or two, and you can (and should) continue breastfeeding. If your symptoms are more serious, or you continue to have problems, talk to your health care provider. You want to make sure that you don't have mastitis, which would need treatment.

Thrush is also known as a yeast infection. It’s a common condition that isn’t serious, but it can be painful and needs to be treated. It’s easy to pass thrush back and forth with your baby, so check both of you for symptoms:

Signs of thrush for parents

You might have thrush if:

• Your nipples feel sore, itchy or burning after you’ve finished breastfeeding.
• Your nipples are deep pink or bright red.
• Your nipples are shiny or flaky.
• You have a shooting pain in your breast during or after feeding.

Signs of thrush for babies

Your baby might have thrush if:

• You see white patches on the gums, tongue or inside of the mouth.
• They suddenly don’t want to latch or get fussy (but didn’t before).
• Their diaper rash is bright red with open areas and clear edges.
• The diaper rash doesn’t get better after three days.

If you and/or baby have thrush, follow the recommended treatment. Contact your health care provider if things don’t improve.