Infant feeding: Common issues

Afterpains

Breastfeeding releases the hormone oxytocin. This hormone makes your milk let down as well as makes your uterus contract. As a result, each time you nurse, your uterus will start contracting. This will help your uterus return to its nonpregnant size.

These contractions feel like uncomfortable cramps or they may feel more painful. Taking ibuprofen (MotrinŽ or AdvilŽ) will keep you more comfortable. These afterpains usually only last a day or two.

Engorgement

For the first few days after giving birth your breasts remain soft and produce colostrum. During this time your baby only needs small amounts of this early milk that boosts her immune system. Colostrum also helps clear the intestines of meconium, your baby's first stool.

Sometime between the second and sixth day, your breasts begin to produce milk that is thinner and whiter. As your body gears up to make mature milk, the extra fluid in your breasts' lymph glands and increased blood circulation swell your breasts, causing engorgement.

As your breasts begin to fill with milk, they may feel hard and warm. They can become so full that is is hard for your baby to latch on and nurse comfortably. Engorgement can also happen as your baby grows and changes her feeding pattern, or if weaning occurs too abruptly.

Your body will naturally adjust your milk supply. The best thing to do is to make sure you feed your baby often. That means eight to 12 times or more every 24 hours.

Have your baby breastfeed as long as you hear swallowing. That way your breasts will be well drained. In addition, you can also do the following to lessen engorgement:

• Make sure your baby is positioned and latched on well. This will help prevent sore nipples that can shorten nursing times.
• If your baby is sleepy, wake her for feedings. Feed her every two to three hours during the day and three to four hours at night. Encourage her to keep feeding until there has been 10 to 15 minutes of active swallowing.
• Avoid feeding formula or water unless it is medically necessary. These can cause your baby to nurse less often. Breast milk has all the nutrients and fluid your baby needs.
• If you miss a feeding, hand express or pump your milk until your breasts feel less full.

If you become engorged, in addition to the previous suggestions:

• Feed at least every 1 ˝ to two hours. Time from the start of one feeding to the start of the next feeding.
• Have each feeding last until your breast softens. Let the milk leak out of the other breast when your baby is nursing
• Try using different nursing positions to help your baby completely empty your breasts.
• Help yourself relax by sitting with your feet up, listening to soothing music, or doing relaxation breathing such as taking slow, deep breaths.
• Before feeding your baby, take a warm shower or apply warm, moist towels to your breasts for a few minutes. Then, gently massage your breasts from the chest wall toward the nipple. Use a circular motion until milk begins to drip.
• To make it easier for your baby to latch on, hand express or pump until the areola tissue is soft enough to gently squeeze between your fingers.
• If your baby can't latch on, express or pump your breasts every two hours for 10 to 15 minutes. You can offer this milk in a cup or a bottle.
• If you notice hard areas in your breast after nursing, try taking your bra off when you breastfeed to be sure you are not restricting milk flow.
• If you have breast discomfort after nursing, apply a cold pack for 20 minutes. A large bag of frozen vegetables, such as peas, works well. Protect your skin with a light towel before using any type of cold pack.
• Take ibuprofen (such as MotrinŽ or AdvilŽ), following the package directions. The American Academy of Pediatrics has approved using ibuprofen while breastfeeding.

Sore nipples

It is not normal to have blisters, cracking, bleeding, or pain during or between feedings. Review the Breastfeeding worksheet to see if your baby is having a problem latching on.

If you can't determine what is making your nipples sore, contact a lactation consultant. In addition, try the following techniques to help your nipples heal:

• Massage your breasts both before and during the feeding to help stimulate milk flow.
• Express a little milk before nursing to get the milk to let down before your baby starts nursing. That way your baby won't have to nurse as vigorously.
• Nurse on the less sore side first. Your baby will nurse more vigorously on the first breast offered.
• Use bras and bra pads that do not have a plastic lining. The plastic traps moisture and can make your nipples sore.
• Change bra pads often to keep nipples dry.
• If your nipples become dry or cracked, apply a little USP-modified lanolin to form a moisture barrier, or apply a small amount of breast milk and let them air dry.
• Wear multiple-holed breast shields between feedings. These let air circulate around your nipples and protect them from rubbing on fabric.

Breast pain

There are two types of breast pain. Both need to be treated. However, you do not need to stop nursing.

Plugged ducts

A plugged duct is one that does not drain properly. This results in pressure building around the plug. The area becomes tender, and there may be a painful lump. That area of the breast may look red. If the blockage is in the nipple, the clogged pore may look like a small white pimple. A plugged duct does not make you feel sick or cause a fever.

To treat a plugged duct:

• Remove any clothing, including your bra, that may be too tight.
• Apply moist heat for five to 10 minutes and massage the area well before starting to breastfeed.
• Breastfeed at least every two hours, starting on the affected side.
• Be sure the affected breast is well drained before offering the other breast.
• For better drainage, try positioning your baby so his nose or chin is close to the plugged duct.
• Drink more fluids. You are drinking enough when you are urinating more.
• Watch for signs of a breast infection, including:

—fever

—chills

—aching

—increased breast pain.

Mastitis

Mastitis is an infection of the breast. The infection is in the tissue and not in your milk. You can and should continue breastfeeding. Bacteria entering your breast through a crack in the nipple or skin can cause mastitis. A plugged duct or incomplete emptying of your breast can also lead to mastitis.

Signs of mastitis include:

• fatigue, chills, and flu-like body aches
• fever higher than 101 degrees Fahrenheit
• red, hot, and swollen breast tissue
• pain that is intense in one spot.

If you have or think you have mastitis:

• Follow the tips to treat a plugged duct above.
• Call your health care provider. You will probably need antibiotics to treat the infection.
• Call a lactation consultant to talk about possible causes of the mastitis and ways to prevent it happening again.
• Accept help from others so that you can go to bed and rest.

First published: 10/04/2002
Last updated: 11/24/2009

Reviewed by: Allina Patient Education experts