Common breastfeeding problems and how to solve them

Breastfeeding has many benefits for both mother and baby, but it can also be a challenge — especially for new mums. While breastfeeding is natural, it is still a learned skill and many mums will need time and practice to get it right. For a baby to successfully breastfeed they need to be positioned correctly and be successfully latched.

Most mums have similar questions when they first bring a new baby home. How do I know when my baby’s hungry? Are they getting enough milk? What do I do if I have an issue breastfeeding? Understanding that these questions are normal and something all mothers experience can help you relax and allow yourself the time it takes to learn your baby’s hunger cues. It’s important to be patient and kind to yourself and allow your body time to adapt to breastfeeding.

How can I tell when my baby’s hungry?

Learning your baby’s feeding cues

It can be hard, especially for new mums, to understand all your baby’s cues. Does a cry mean their hungry? Does their nappy need changing? Is it time for a nap? The earlier you can read your baby’s feeding cues, the calmer your baby will be, and the easier breastfeeding will be.

Crying is a late feeding cue and it makes it harder to feed well, earlier cues can include:

• Your baby turning their head from side to side.

• Sticking their tongue out.

• Wriggling.

• Putting their hands to their mouth.

• Lifting their head and bobbing it around.

How do I know if my baby is attached properly?

Encouraging proper attachment

Getting attachment right takes practice and there are several positions mums can experiment with. Before you get started make sure you’re sitting comfortably with your back and feet supported. Ensure your body is in good alignment with your baby and that you’re supported in a way that the weight of your baby does not tire you. Some mothers use a pillow under their arms for extra support.

When you’re ready to start breastfeeding, follow these tips to help with proper attachment:

• Place your hand at the base of your baby’s head to avoid pressure against the back of their head. Pressure on the back of your baby’s head will make them arch away from the breast.

• Support the baby’s head so that their neck is not extended or flexed.

• Make sure the baby’s chest is to your chest and chin is to the breast.

• Align the baby’s nose and mouth with your nipple and areola.

• Tuck your baby’s limbs in toward their body to prevent flailing.

• Ensure enough room for nostrils of the baby to be open at all times.

Remember this attachment checklist:

• Baby’s mouth is wide open and lips turned outwards
• Baby’s lower lip is curled right back
• Baby’s chin is touching mum’s breast
• The nipple is deep in the baby’s mouth, with the tip touching the baby’s palate
• When the baby suckles, the lower jaw goes up and down while a muscular wave moves from the tip to back of the tongue
• The baby suckles with short quick movements, slowing to a more continuous sucking rhythm

• Baby’s cheeks are rounded and not drawn
• Ears may be moving

Signs your baby is not attached properly to the breast

With poor attachment:

• The baby sucks or chews on the nipple only
• The baby’s mouth is not wide open and the lips are sucked in.
• The baby’s lips and gums press against the nipple instead of the areolar.
• The tongue may be misplaced, blocking the protrusion of the nipple into the baby’s mouth.

• The baby’s cheeks are pulled in.

What if I can’t make enough milk?

Most new mums are concerned about making enough milk to support their baby. You and your baby work as a team to build your milk supply. Taking the time to look after yourself and feed your baby when they need it will help ensure you make enough milk. Before getting discharged from the hospital, speak to the doctor or midwife about do’s and don’ts, latching and attachment, frequency of feeds and any other questions you may have.

Looking after yourself

When you first bring your baby home, you will be busy adapting to your new routine, learning about your baby as well as trying to keep up with housework. It’s still important that you take care of yourself, so you can breastfeed successfully.

• Eat a healthy diet — Eat plenty of vegetables, fruit, whole grains and some dairy foods and protein each day.

• Drink plenty of fluids — Keep up your fluid intake through the day. Every time your baby feeds have a drink of water.

• Enjoy some gentle exercise each day — Keep up light activity if you can. This might be some gentle housework or taking your baby for a walk.

• Plan time to relax — Trying to fit in time for yourself is hard with a new baby, try and rest and relax when your baby is asleep.

• Accept help — Accept offers of help with meals and housework from your partner, family and friends. If you don’t have family close by, hiring a cleaner to help with the housework may be an affordable short-term option.

• Set limits — It’s okay to take the phone off the hook or limit visitors and phone calls. This gives you time to rest.

Building your milk supply

Building your supply will take time and understanding. There are simple things you can do to help build your milk supply:

• Supply equals demand — With breastfeeding supply tends to equal demand. The more you feed your baby, the more milk you will produce.

• Night feeds — Night feeds are important for making breast milk.

• Avoid offering dummies or bottles while establishing your supply — Your baby will feed from you less if he or she is often using a bottle or dummy.

• Try Fenugreek — Fenugreek has been used traditionally in Western herbal medicine to support a mother’s production of breast milk.

How do I know my baby’s getting enough milk?

• Wet nappies — Your baby should have at least 6 very wet cloth nappies or at least 5 very wet disposable nappies in 24 hours. The urine should be odourless and pale in colour. Strong, dark urine suggests the baby needs more breastmilk.

• Bowel movements — A new baby will usually have 3 or more soft or runny bowel movements each day for several weeks. An older baby is likely to have fewer bowel movements than this. Formed bowel motions suggest that the baby needs more breastmilk. Speak to your midwife or child health nurse if you’re concerned about numbers of wet nappies or bowel movements.

• Growth — Some weight gain and growth in length and head circumference.

• Skin colour — Good skin colour. If you gently pinch your baby’s skin, it should spring back into place.

• Alert and contented baby — Your baby will be alert and contented and not wanting to feed constantly. It is however normal for babies to have times when they feed more frequently.

• Changes to baby’s feeding routine — It is normal for your baby’s feeding routine to change. Feeds may increase during a growth spurt. Some babies cluster feed or want more feeds when they are ill. It’s normal for babies to wake for night feeds. Some babies sleep through the night early while others wake during the night for longer.

Common breast health concerns

Sore nipples

Some nipple pain is normal in the first few weeks. If it continues longer, it could be a sign that your baby is not attached to the breast properly, refer to our attachment tips above.

Here are some tips that may help to prevent pain:

• Look after the delicate skin around your nipples — Wash your hands well before feeding, avoid using soaps, lotions and shampoos that can dry out your skin on your nipples.

• Change breast pads — If you are using breast pads, change them often to prevent damp breast pads irritating your skin.

• Gently detach — When detaching your baby from your breast, carefully break the suction with your little finger in the corner of your baby’s mouth.

• Keep nipples dry — Let your nipples air dry after each feed.

• Gently hand express — Gently hand express if your nipples are too sore to breastfeed. This helps to prevent your breasts from becoming engorged. A hot warm washer on the breast can help start the flow of milk.

Cracked nipples

Cracked nipples can be painful but they often heal quickly. Cracked nipples are usually a result of poor attachment. If you have cracked nipples, here are some self-care tips:

• Self-care — Follow the care tips for sore nipples above.

• Express — Stop feeding out of the sore breast for the short term (for 12 to 24 hours) if it is too painful. You can express milk by hand during this time to feed your baby in a bottle or cup. Seek help if they are still sore after this time.

• Breast pads — Remove breast pads gently. If the pad sticks, express a little breastmilk to moisten it before trying again.

• Get Help — If you are having attachment or positioning issues, don’t hesitate to get help. See our resources below

Swollen breasts

In the first week when your milk comes in or if you are separated from your baby for a time, your breasts can feel hard or swollen. Watch out for discharge from nipples when not feeding. Pay attention to the colour and consult your doctor immediately if there is a discharge with hard, swollen breasts. Here are some tips to help reduce the fullness:

• Demand feed — Demand feed your baby (8 to 10 times or more in 24 hours).

• Express — If you are separated from your baby, try expressing milk as often as your baby would breastfeed. You may need to hand express a small amount of milk for your comfort before or after a feed. This will help to make the breast soft enough for your baby to attach.

• Massage — Gently massage your breasts during feeds.

• Empty each breast — Allow your baby to completely empty the first breast before offering the other. Next time start on the other breast.

• Apply warmth —Try applying warmth (e.g. heat packs or a warm shower) to your breasts before you feed.

Blocked milk ducts

A blocked milk duct can cause a painful, swollen mass in the breast. Seek help from a breastfeeding-trained professional if a blocked duct continues for more than 24 hours (see our resources below).

Here are some tips to help you manage a blocked duct early:

• Feed your baby as often as possible — Start with the breast with the blocked duct. Continue to start on this breast for the next few feeds to help drain the breast.

• Massage — Gently massage the lump towards the nipple while your baby is feeding. This can help clear the blockage. If your baby’s feeding has not reduced the lump, try to gently massage toward the nipple while hand expressing.

• Apply warmth — Apply warmth before and during a feed (e.g. a warm shower). Then apply something cold to the area after a feed.

• Comfortable bra — Make sure you have a comfortable bra that is not too tight. Remove the bra during feeds and sleeping without a bra can help.

• Position and attachment — Check the position and attachment of your baby during feeds. See our resources section below for more help.

Mastitis

Mastitis occurs when blocked milk ducts in your breast become inflamed or infected. Signs of mastitis can include swollen, hot, and red breasts. You may also have flu-like symptoms.

See your doctor straight away if you suspect mastitis. Self-care for mild mastitis can include:

• Continuing breastfeeding — You need to keep removing milk from the breast during this time. It’s safe to continue breastfeeding when you have mastitis.

• Expressing — If it’s too painful, gently hand express until the pain decreases

• Blocked ducts — Follow the recommendations under ‘blocked milk ducts’ above.

Help with breastfeeding

Most mums need help with breastfeeding at some stage. There are many resources available to mums and their families and you should always speak to your midwife, child health nurse or GP if you have any concerns.

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