Problem Solving

Breast Problems

Engorgement
Some mothers' breasts get very hot, hard, and swollen when their milk comes in. This is called engorgement.

Nurse your baby every two hours and long enough to soften at least one breast each time. Make sure the baby is sucking right to get the milk out. If your nipple hurts as the baby sucks, or the breast is not getting soft, the baby's mouth is on the breast wrong. Once the baby is nursing right, the swelling will usually go down in about 24 hours.

Ice packs on your breasts between feedings will reduce the swelling and feel good. (Bags of frozen vegetables make easy ice packs.) Some mothers find that taking a warm shower will start their milk flowing. This may soften the breasts enough for the baby to latch on and nurse. Ice packs after the feeding will help keep the swelling down.

If the breasts are too hard for the baby to nurse, hand express or pump a little milk before feeding. Sometimes even as little as a teaspoonful of milk will be enough to soften the breast so the baby can latch on more easily.

Pumping a few times will not cause you to make more milk. You have to pump regularly for 1-2 days before your milk supply will increase.

You may need to use ice packs on your breasts for about 15-20 minutes to reduce swelling. After removing the ice, wait a few minutes and then pump. Massage your breast gently down toward the nipple as you pump. Use warm towels on your breasts if you need them to get the milk to flow. Once the nipple and areola begin to soften, start the baby nursing. Babies are usually better at getting milk out than pumps. Keep the baby nursing long enough to soften at least one breast well.

If your baby gets full on one breast, try burping and playing with the baby for a few minutes. If the baby is still too full to nurse on the second side, pump or express the second breast enough to be comfortable. Wake the baby in about an hour to nurse on that breast and soften it.

Engorgement only happens when the milk first comes in. Later, you may get over-full from time to time, but nursing your baby will quickly take care of this problem.

Sore Nipples
Many mothers' nipples get a little sore at first. If your nipples keep hurting during the feeding, there is something wrong.

If you cannot hear the baby swallowing after a few strong sucks, the baby is not sucking right. You can teach the baby to latch on the right way. Using the football hold often makes it easier to help the baby latch on for the first few days. You can see if the baby's mouth is open wide and if the tongue is down before bringing the baby to the breast.

The baby's sucking should not hurt. If it does, slide one finger of the hand supporting your breast forward to the baby's chin. Gently hold the baby's chin down. This gets the baby's tongue out over the lower gum so the tongue does not pinch the nipple and the baby will get more milk. Someone can sit on the other side of the baby and reach under your breast to hold the chin down for you.

Hold the chin down while the baby nurses for a few feedings. The baby will soon learn to do this without help.

Remember to:

• Hold the baby close enough to get the breast far back in the mouth.
• Hold the breast during the feeding, so it stays far back in the baby's mouth.
• Hold your baby so the lips are in line with your nipple, before the baby starts to nurse.
• Hold the baby's head and body in a straight line. Do not push the head forward.
• Use pillows or folded towels under the baby for support. (Babies bite if they feel like they are slipping.)

Healing Sore Nipples
While your nipples are getting better you may want to:

• Start each feeding on the side that hurts less. Babies suck harder at the start of each feeding.
• Let air get to the nipples to make them feel better. Wear a loose top and go with no bra. If you must wear a bra, leave the flaps down after feeding.
• Dry off the nipple and rub a little breast milk into the sore places to help them heal.

Helping your baby to latch on and nurse the right way will help your sore nipples heal quickly. Also, your baby will be getting more milk and be more relaxed nursing the right way.

If you have sharp, burning pain while the baby nurses, you may have a thrush (yeast) infection on your nipples. Usually with thrush, the nipples keep burning even after the baby is done nursing. If you think you have a thrush infection, check with your doctor to get medicine. Both your breasts and the baby's mouth need medicine. You should begin to feel better within a day or so of starting the medicine. Be sure to use the medicine for as long as the doctor or nurse suggested. All pacifiers, bottle nipples and toys that come in contact with the baby's mouth must be cleaned with hot soapy water.

Plugged Milk Ducts
Sometimes milk will build up in one part of your breast. It will feel hard and may be sore to touch. You can:

• Nurse the baby on the hard side first.
• Massage the hard part of the breast while the baby is nursing.
• Put warm wet washcloths on the hard part of the breast.
• If you wear a bra, take it off to nurse.
• Nurse until the hard part is softened. You should be nursing at least every 2-3 hours.
• Pump that breast if the baby does not get it softened.

If one of your milk ducts is plugged, you may see a little white blister on your nipple after breastfeeding. Soak your nipple in warm water before you nurse again. Gently rub a clean wash cloth across the tip of the nipple. As the baby is nursing, massage behind the hard area to help the milk come out. Do this several times until the white blister is gone and the nipple does not hurt.

Breast Infections

A hard area in your breast may get sore and red. You may also have a fever, headache, or ache all over. You need an antibiotic from your doctor or clinic to get rid of a breast infection. You will need to take all the medicine, even after you start to feel better.

It will help to:

• Nurse at least every 2 1/2 hours.
• Start each feeding on the side that hurts least.
• Nurse without a bra if you wear one.
• Gently massage the sore area during feedings or pumping.
• Pump or hand express any time the breast does not get soft during a feeding.
• Rest as you would with any serious illness.

The infection is usually caused by the normal germs that are in the baby's mouth and nose all the time. They will not make the baby sick.

Nursing at regular times usually protects you from breast infections. There may have been some change in the timing of the baby's feedings that left milk in your breast for a long time. Has your baby started sleeping longer? Had a cold and not nursed well? Did you go a long time between feedings? Anytime your breasts feel too full, you may want to pump or hand express a little milk to help prevent infections.

A baby with colic cries constantly, pulling his legs up on his stomach and passing large amounts of gas. Both breastfed and bottle-fed infants get colic. Switching a colicky breastfed baby to formula usually makes the colic worse.

No one really knows what causes colic. There are some things you can try to make your baby feel better.

• Wrap your baby snugly and hold your baby very quietly to help the baby relax.
• Do not feed the baby formula, juice or any solid food until the baby is at least four months old.
• If you recently started giving your baby vitamins or fluoride, check with your baby's doctor about stopping them for a few weeks.
• If you smoke, try cutting down the number of cigarettes each day.

Make sure your baby empties the first breast before switching to the other side. This way the baby gets the creamy part of your milk and will get full without overeating. Some babies that are taken from the first breast too soon do not grow well and show signs of colic.

Your Diet and Colic
There are no special foods all breastfeeding mothers need to give up. Some foods that may be a problem are cabbage, beans, turnips and broccoli. Most babies get fussy from one or two foods, but not all of these.

You can test whether something you have eaten is bothering your baby. For two days do not eat the food you think caused your baby to feel bad. If your baby is not happier, that food must not be the problem. If your baby seems to feel better, that food might be a problem for you. Try a little of it again to see if the baby gets fussy. It usually takes 4-24 hours for something you eat to affect your baby.

Some babies have a fussy time each day no matter what their mothers eat. Most babies outgrow this problem as they get older.

Slow Weight Gain

Most babies gain 7 ounces a week until they double their birth weight. If your baby is gaining more slowly, there are three main things to think about.

Make sure the nipple is back far enough in the mouth to allow the milk to flow freely.

Your nipple needs to be back far enough in the baby's mouth so it will not be pinched shut as the baby sucks. If your nipple hurts with each suck, change the way you are holding the baby. Use the football or across-the-lap hold. Your hand will be under the baby's shoulders. As the baby nurses, push in on the baby's shoulders with the palm of your hand. At the same time, the hand that is holding the breast can push more of the breast into the baby's mouth.

If your nipple still hurts as the baby nurses, hold the baby's chin down. This will help the baby get the tongue under the breast and get more milk with each suck.

Make sure you are nursing your baby often enough.

Fit in more feedings each day. You can do this by waking your baby to eat sooner. For example, if your baby has been nursing at 10am, 2pm and 6pm, nurse the baby at 9am, 12pm, 3pm and 6pm. If your baby has been sleeping 5 or 6 hours at night, you can get in another feeding by waking your baby once a night.

If your baby seems too sleepy to nurse, talk close to the baby's face and rub the baby's back, arms, legs and tummy. Put a clean finger in the baby's mouth to get the baby sucking. Change the diaper. It may take about five minutes to wake your baby. You may need to do this before every feeding for a few days.

Nurse your baby long enough to finish each breast.

Higher fat milk comes after about 5 - 10 minutes of nursing. This creamy milk has more calories. It is important for your baby to nurse long enough to get this high calorie milk.

Most babies nurse 10 - 20 minutes on each breast. If your baby stops sucking and seems to go to sleep before then, take the baby off the breast. Rub and pat the baby. Give the baby a chance to burp. Use your finger to get the baby started sucking again. Put the baby back on the SAME breast. Then the baby will nurse a little longer and get the higher calorie milk needed for weight gain.

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