Signs of breastfeeding problems

Don’t let fears of baby not getting enough milk, or painful breasts or nipples, discourage you from nursing as long as you can.

01 August 2019
By Glynis Horning

Breastfeeding is natural, but it’s not always as easy as new moms expect – and when difficulties arise they can worsen rapidly, interrupting milk production and preventing baby getting the nutrition baby needs.

Get help early if you experience any of the following – speak to your healthcare provider, a clinic sister, an International Board-Certified Lactation Consultant (IBCLC), or a La Leche League Leader who’s been trained to support breastfeeding moms and babies. “With guidance and support, most women can manage at least the recommended minimum of exclusive breastfeeding for six months,” says Esmé Hough, professional liaison for the La Leche League SA. “And hopefully they’ll keep breastfeeding long after that!”

Baby appears to still be hungry after nursing

Have baby weighed in case they're not getting enough milk. Also check that baby is latching on properly and transferring milk effectively – ask a breastfeeding-friendly healthcare provider, IBCLC or La Leche volunteer Leader (counselor) to watch you breastfeed. They can also examine baby for problems such as a tongue-tie or lip-tie that makes it hard to suckle properly, or an uncoordinated suck (when the tongue doesn’t move with the right rhythm to extract milk).

Your newborn often sleeps through the night and misses feeds

This may sound like a new parent’s dream, but can mean baby isn’t getting enough nutrition. Listen for sounds of swallowing when baby feeds, to indicate that they are, in fact, ingesting milk. In baby's first week, baby should be nursing eight to 12 times in 24 hours. Keep count of wet and soiled nappies, says Hough.

Your baby is two weeks old and under her birth weight

It’s common for term babies to lose around 7-10% of their birth weight in their first five to seven days of life, but they generally regain it within one to two weeks. If this doesn’t happen, there may be a problem – get professional advice.

Your baby is more than a week old, and has fewer than four to six wet nappies a day

And, has fewer than four bowel movements a day (with the nappy soiled) – especially if the urine is dark yellow or has red specks, or their stools are still dark and haven’t become yellow and seedy (which happens when your milk comes in, usually on the third or fourth day).

Your milk hasn’t come in after five days, and it doesn’t feel as though your breasts are filling

Have baby’s weight checked, your breasts examined, and your health checked for possible illnesses that may cause a delay in the onset of lactation, such as diabetes, says Hough.

Your breasts are engorged and hard

This can make it hard for baby to latch properly and nurse, and painful for you, discouraging you from breastfeeding. You may need to express a little milk by hand or with a manual or electric pump to soften your breasts before each feed, but don’t express too much, as you can encourage even more milk production and worsen the engorgement. Try reverse pressure softening, suggests Hough (applying gentle pressure to soften a 2.5-5cm area of the areola surrounding the base of the nipple, temporarily moving some of the swelling slightly backward into the breast). ‘Feeding as soon as possible after birth, and every one to two hours, usually prevents engorgement,’ she says.

Your breasts remain engorged even after a feed

Baby may not be suckling properly or transferring milk effectively.

Your breast or nipple hurts when you nurse

“Mild soreness when starting breastfeeding is normal and shouldn’t last more than 30 seconds,” says Hough. “To prevent nipples cracking, make sure baby is latched correctly. Try a different position (the laid-back position, especially, works well) and apply a thin layer of ultra-pure modified lanolin or a hydrogel pad.’

If your breast looks red and feels hot and firm, and you have a temperature, you could have mastitis

Get help. You may need to feed from the other side for a while, or use a pump and express milk for a few days. Try applying warm or cool compresses for relief, and ask your health professional to recommend a mild pain reliever.

To find your nearest La Leche League volunteer counsellor, go to https://www.lllsa.org/contact

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