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December 13, 2016

It’s the most natural thing in the world, right? Well, breastfeeding can still throw some curve balls. Victoria Wells looks at some of the most common problems and what to do, with tips from midwife and lactation consultant Barbara Brinsdon. 

  • Problem: Baby gags or chokes once latched, or milk sprays from the breast when baby pulls away.

Likely cause: Overactive let-down/high supply. Some mums naturally have more milk than baby can handle, coupled with a strong milk flow. Oversupply can also be caused by pumping before feeding, as this can help to slow the flow but can also signal the body to produce more milk.

What to do: Try feeding baby only on one side each feed. If he’s hungry again soon after, offer the same side. Only change sides after a couple of hours has elapsed. Removing milk from your breast less often may help to slow the milk production rate. If your other breast becomes engorged or uncomfortable, express a little to ease the discomfort, but not too much that it kick-starts more milk production. Problem: Sore white blister on nipple Likely cause: Bleb (milk blister) A bleb is a white spot on the nipple that forms when skin covers the end of a milk duct opening in the nipple and milk builds up behind it. What to do: “Cover the bleb with a warm flannel for a few minutes,” advises Barbara, “then rub gently to break the skin and release the blister.”


  • Problem: Nipple pain when baby latches and/or during feeding

Likely causes: Incorrect latch/tongue tie. “This is often because of a latch problem that can be easily fixed or it might be a tongue tie on baby,” says Barbara.

What to do: Your nipples may be sore in the first week of breastfeeding, but should improve and may only feel tender for the first 10-20 seconds after baby latches each time. Avoid washing with soap. Let your nipples air dry with a little milk on them (the milk helps to heal them). Lanolin cream or gel pads can help too. If you have persistently sore nipples, talk to your midwife about help with adjusting baby’s latch. If baby is struggling then it may be a sign of a tongue or lip tie (see below for more detail). “Whenever nipple pain continues into the second week of breastfeeding then it’s worthwhile having a professional assessment of the tongue,” says Barbara.


  • Problem: Baby is unable to form a tight seal on the breast and milk may dribble out when feeding. Baby may make clicking noises when sucking, or slide off the nipple. They may gulp in air while feeding, which can leave them unsettled, or you may have nipple pain during each feed.

Likely cause: Tongue tie/lip tie In a tongue tie the frenulum (little membrane that joins the tongue to the floor of the mouth) is too tight. A lip tie is when the frenulum tethers the top lip tightly to the upper gum and restricts its movement. “Staff will often notice a tongue tie first and there are varying degrees so some are hard to diagnose,” says Barbara. “The baby can’t stretch the tongue out of the mouth to cup the breast properly. There are posterior tongue ties too, which aren’t quite so obvious.”

What to do: Talk to your midwife or GP for a professional diagnosis. Most tongue and lip ties are easily treated by a doctor in a straightforward procedure to ‘release’ the membrane.


  • Problem: Baby not settling after a feed/wakeful/wanting to feed constantly/pulls away and cries after latching

Likely cause: Wind

What to do: Burp baby regularly during the feed and avoid switching breasts too soon. “If the baby is gulping a lot on the breast and feeding from both breasts they can get more of that foremilk, which is higher in lactose and upsets the gut more,” says Barbara. “I try to get mums feeding on one side for as long as baby’s unsettled before they feed the other side. Then baby gets more hind milk which has more fat in it and is more satisfying.”


  • Problem:You’re worried you aren’t producing enough milk

Likely cause: Baby is unsettled or not sleeping regularly between feeds

What to do: Barbara says it’s common for new mums to worry. “Some think that baby should feed and sleep in a regular pattern, which they don’t always do when they’re breastfed. I talk to them about their expectations and encourage them to just keep feeding through those unsettled periods, sometimes switch sides to help bring more milk in – and I make sure the mums are eating and sleeping well themselves. It’s just trying to reassure them and suggesting that they express their milk to give baby extra, as the more they take off the more they’ll make.” She says a midwife’s regular weight checks of baby also give a good picture of overall growth and health and they can give you strategies to improve supply if there are any concerns.


  • Problem: You don’t know if baby is feeding for long enough/getting enough milk

Likely cause: Babies feed differently – some are hungry and quick, while others will take longer at the breast.

What to do: Barbara recommends tuning into your baby’s swallowing while he feeds. “If he’s sucking and swallowing regularly for 10 minutes then that’s an adequate feed,” she explains. “If it’s 20 minutes then that’s a good feed. They can be on longer, but towards the end of a feed they might not be doing much swallowing but just doing non-nutritional comfort sucking.” If baby pulls away and cries then try winding before switching breasts as it may just be discomfort, rather than being full. This ensures you are emptying your breast (which helps supply and prevent blockages) and that baby is getting the foremilk and hindmilk needed for good growth. If your baby is gaining weight, wakes regularly for feeds and is sucking and swallowing well at the breast, then they are getting enough milk. If you have any concerns about your baby’s growth or feeding then be sure to talk to your midwife or a lactation consultant.


  • Problem: Baby sleeps while feeding

Likely cause: Babies tire very quickly when new and feeding from mum is a very soothing place to be. 

What to do: “Undress them and place baby skin to skin with Mum, covered with a blanket,” recommends Barbara. “They’re more likely to wake up and keep feeding then. For a sleepy baby, at least take off the hat and outer cardigan, blow on the face gently and try to keep them awake so that they have a good feed.”

Problem: Inverted/flat nipples

Likely cause: Your nipples retract rather than protrude when you squeeze the areola.

What to do: “Once the milk is in, if baby is still unable to latch then introducing a nipple shield can help," says Barbara. “Some babies can feed through a nipple shield quite successfully and then after a few weeks when they’re a bit bigger and stronger they can transition to feed directly off the breast by a month old. Inverted nipples can be more difficult, but can be encouraged to come out with a lot of stimulation so that baby can eventually learn to latch, but sometimes a nipple shield is required or the mother might just express milk and feed by bottle.”


  • Problem: Sore lump in breast/flu-like symptoms of fever, headache, chills

Likely cause: Blocked ducts or engorgement leading to mastitis, and a bacterial infection introduced through cracked nipples.

What to do: “Keep feeding baby,” says Barbara. “You won’t pass on any infection and feeding helps drain the breast. Massage the lump while feeding. If you can do that within 24 hours of noticing the lump then antibiotics can often be avoided, but if your temperature goes up to 38°C or more then you’ll need a course of antibiotics, which your midwife can prescribe.”


  • Problem: Your breasts feel full and hard making it difficult for baby to latch.

Likely cause: Engorgement due to high milk supply or not draining the breast sufficiently when feeding.

What to do: Use your hand or a pump to express a little milk from the breast before you feed so that baby can latch more easily.


  • Problem: Baby has whitish patches on the tongue and around the mouth that don’t rub away easily (unlike milk residue) and he may cry when feeding and may have nappy rash.

Likely cause: Thrush. Infants naturally have yeast (a type of fungus called Candida) in their mouths, and sometimes the levels can increase, causing thrush. It could be because their immune system is lower when young or it can be passed to baby from the mum if she is taking antibiotics, has thrush while breastfeeding, or had a bout of thrush when she gave birth vaginally.

What to do: Mothers and babies are generally treated together. Your midwife can prescribe an oral thrush treatment for baby. Sterilise anything your baby puts in their mouth (i.e. bottles, dummies etc).

For more information on breastfeeding visit health.govt.nz


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