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Indian Health Service The Federal Health Program for American Indians and Alaska Natives

Mother and child.
BREASTFEEDING PROMOTION AND SUPPORT

Common Problems

It’s not unusual for mothers to have problems breastfeeding. The following are common problems they may encounter.

Engorgement

Breasts that are normally full can become engorged between days three and six. Engorged breasts are very swollen, hard, warm, and painful. It’s important to treat engorgement, because, if a mother leaves milk in her breasts for a long period of time, her milk production may decrease. There are enzymes and fats in the milk that signal her breasts to slow down milk production. Also, the pressure of milk, blood, and lymph fluid on the milk-producing cells may damage them and cause them to decrease her milk supply. Removing the milk by breastfeeding or pumping signals the breasts to make more milk.

Sore nipples

The most frequent cause of sore nipples is poor positioning or poor latch-on. When the baby comes off the mother’s breast, the nipple should look round, like the end of a finger. A nipple that looks flat (like a NUK pacifier or a new tube of lipstick) often becomes damaged and sore. The mother may need help with positioning and latch. Other causes of sore nipples are: inverted nipples; prolonged non-nutritive sucking; delayed letdown; not breaking the suction prior to removing baby from the breast; improper pump use; a pump kit that does not fit properly; and prolonged exposure to wet nursing pads or bras.

Sleepy baby

Babies need to breastfeed eight to 12 times in 24 hours to gain weight and establish your milk supply. A newborn usually breastfeeds every two to three hours. Sometimes, the baby will take a four- to five-hour break during the night. If the baby seems to sleep longer, the mother will need to wake the baby up and encourage the baby to feed more frequently. Her baby may wake up to feed, but the baby may fall asleep before breastfeeding long enough.

Newborn jaundice

Most babies get a slight amount of jaundice (a yellowing of the skin). The mother can lessen the amount of bilirubin (the reddish yellow pigment in bile) in her baby's system by breastfeeding soon after birth and often—every two to three hours around the clock. Allowing her baby to finish on the first breast (10 to 30 minutes) will help her baby have more bowel movements, which will help get rid of bilirubin.

Mastitis

Mastitis is an inflammation in the breast that may be from a plugged duct or an infection. If the mother has mastitis, it’s important that she continues emptying her breasts by breastfeeding. Stopping may cause her to develop an infection or abscess. If it’s too painful to breastfeed, have her pump her breasts with an effective electric breast pump.

Flat or inverted nipples

Flat or inverted nipples can make it harder for a baby to breastfeed. In order to stimulate the baby to suck, the baby needs to feel the mother’s nipple and breast tissue far back in the baby’s mouth, between the baby’s hard and soft palates. Nipples that are flat or inverted can be a challenge. A flat nipple may not stand out even when stimulated. An inverted nipple pulls inward instead of protruding when the areola is pinched.

Breast surgery or injury

If the mother has had breast surgery or a breast injury, she may be wondering if she will be able to breastfeed. The only way to know is to try. She may be able to produce a full milk supply or only a partial supply, depending on the number of milk ducts and nerves that were affected by the surgery or injury. It’s important to work closely with the mother and a lactation consultant in the first few weeks after the baby is born to make sure that breastfeeding is working well.

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