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Common
Concerns
Concerns About Mom's Health
On this page we provide a short overview of some common concerns faced by breastfeeding mothers. We provide a small description of what the issue is, explain the common causes and give suggestions for how to help improve the situation. Where possible, we also include recommendations for when you should get outside help from a lactation professional or your health care provider.
If breastfeeding is new to you, it can be challenging, especially at the beginning. With patience and practice, you and your baby will gain a better understanding of how breastfeeding works and you will also enjoy one of the most natural and mutually beneficial bonds a mother and child can share.
Sore Nipples
Some mothers find that their nipples can feel tender or sore especially in the early days and often at the beginning of a feed. This initial pain or tenderness should improve daily and disappear as your baby sucks at your breast.
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Common Causes:
Nipple soreness often occurs when the baby latches on to and sucks the nipple only.
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How to Help:
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Try different positions when breastfeeding. This will stop the baby from putting too much pressure on the same spot each time. If initial discomfort does not disappear with sucking, try repositioning.
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Try to make sure the baby has a deep latch. When your baby opens their mouth to feed, direct your nipple to the back of their mouth and make sure they take a large amount of breast tissue surrounding the nipple, including the areola (the pink or dark area around the nipple) into their mouth. See video, below.​
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Sore nipples are not related to the length and/or frequency of breastfeeding. Sore nipples are also not related to skin colour and can not be prevented prenatally.
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To prevent sore nipples, break the suction before trying to remove baby from your breast by gently inserting your clean finger into the corner of your baby's mouth or pressing down on the breast near the baby's mouth.
What to Watch For:
Nipple pain can be common while learning to breastfeed. Getting help with establishing an effective latch and/or positioning from a lactation professional may be all that is needed.
If breast pain, nipple pain, nipple cracking or bleeding continue, consult a health care provider to determine the specific cause and create a personal treatment plan.
Plugged Ducts
A plugged or blocked duct means there is a blockage in one or more of the milk ducts in your breast. When a milk duct is blocked, milk cannot flow through that duct until the blockage is released.
Sometimes a plugged duct can feel like a lump or swelling in one area of your breast. It may appear as a tender spot with redness and little or no warmth. A plugged or blocked duct can be uncomfortable and usually affects only one area of one breast. ​
Common Causes:
While there is no specific cause of plugged ducts, it does occur more often in the following situations:
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When not enough milk has been removed from the breast due to baby not feeding long enough, too long between feeds or a feeding being skipped.
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Women with greater milk supply.
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Wearing tight fitting bras or clothing.
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How to Help:
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Breastfeed more frequently - breastfeed at least 8 or more times in 24 hours.
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Make sure the baby has a deep latch and is positioned with nose-to-nipple and tummy-to-tummy.
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Start all feedings with the breast that has the plugged duct until the blockage is removed.
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Remove any tight fitting clothing or bras. Wear bras without underwire and get plenty of rest.
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What to Watch For:
A lump in your breast that will not go away should be seen by your health care provider.
Breasts with blocked ducts can become infected, a condition called mastitis. Watch for signs of mastitis including fever, chills and generally feeling unwell. See your health care provider if you experience any of these symptoms.
Mastitis
Mastitis is an inflammation of the breast tissue causing it to become red, hot, swollen and sore. Red streaks and swelling may be visible in the breast. Mom may feel tired and achy and may develop a fever and/or flu-like symptoms.
Mastitis is more common in the first six (6) weeks and usually happens in one breast, but both breasts can be affected. It is important to know that mastitis affects the breast tissue and does not affect the quality of your breast milk.
Common Causes:
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Damaged or cracked nipples.
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A shallow latch.
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Milk being made faster than baby can remove it. When the breast milk is not removed from the breast it may cause a plugged duct or engorgement.
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Tight fitting clothing or bras with underwire.
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A change in your baby's feeding habits. Your baby may not be breastfeeding as often or suddenly refuses to take the breast.
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How to Help:​
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Continue to breastfeed frequently including from the affected breast. If it is too painful to breastfeed, you can remove the milk by hand expression or by pumping.
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Apply a cool, moist compress to the breast before breastfeeding.
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Ensure your baby has a deep latch.
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Try breastfeeding in different positions to improve comfort.
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Wear loose fitting clothing and avoid bras with underwire.
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Drink fluids and get plenty of rest.
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Ask for help from your partner, family, friends and neighbours.
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Call your health care provider. You may need treatment with antibiotics and a pain reliever.
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If the mastitis is related to a plugged duct, follow the suggestions for how to get milk flowing again.
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What to Watch For:
If your mastitis does not improve and you experience signs of an infection like fever, chills and generally feeling unwell, see your health care provider. In some cases mastitis can become an infection and, if untreated, could lead to an abscess in your breast. ​
Engorgement
Breast fullness usually happens about 2-4 days after giving birth. Mothers will notice their breasts feel heavier and fuller. Breast fullness subsides on its own if baby is feeding often and removing enough milk.
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Engorgement is when breasts become overly full of milk and feel tight, heavy and painful. Engorged breasts may look shiny and tight. The flow of breast milk may be impacted by the swelling. The areola and nipple may also appear swollen causing the baby to have trouble latching correctly. Mothers may experience pain throughout the feed.
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If left untreated, engorgement may lead to complications for the mother:
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a decreased supply of milk,
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sore nipples related to poor latch,
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risk of mastitis due to increased pressure in the breast, and/or
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damage to the milk-producing cells in the breast.
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Engorgement may also lead to complications for the baby:
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early weaning,
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slow weight gain.
Common Causes:
Engorgement can happen if not enough milk is regularly being removed from the breast by either your baby or by hand expression and pumping.
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How to Help:
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The best way to treat/prevent engorgement is to remove the milk from the breast through feeding or expressing/pumping milk.
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Watch for feeding cues from your baby and allow your baby to breastfeed when hungry. Your baby should feed 8 times in 24 hours and should feed until full. Be sure to offer both breasts at each feed.
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Avoid use of artificial nipples or soothers during periods of engorgement.
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Due to swelling, you may have to soften the areola and nipple before the baby can latch on. This can be done with reverse pressure softening. You can also hand express milk before starting to feed to soften the areola and nipple.
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Make sure your baby takes in/latches onto more breast tissue, not just the nipple.
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Do not limit the time your baby feeds at the breast. Let your baby feed on the breast and remove enough milk so that your breast feels softer and more comfortable before switching breasts. If your baby does not remove enough milk to make you feel comfortable, hand express more milk until you are comfortable.
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Milk in the breast at the end of the feed will let your body know it has made more milk than necessary and the breast will respond by making less milk.
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Use breast compressions to help move the milk.
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Apply a wrapped ice pack or cold compress (for 10 - 15 minutes at a time) to the breast between feedings.
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If using a bra, make sure it is not too tight and does not have underwire.
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What to Watch For:
If engorgement does not improve, continue to express milk and contact your primary health care provider.
Too Much Milk
When a mother's breast makes more milk than her baby needs, the baby might latch well at first and then start to gag, choke, gulp, gasp, cough and/or pull away from the breast. The baby may try to stop or slow the flow of breast milk by changing position at the breast or by clamping down on the nipple. The baby may come off the breast fully and milk may run out of the corners of the baby's mouth. Babies may also spit up, be gassy or have green watery stools.
Common Causes:
An oversupply of milk is normal and can be common in the early days of breastfeeding as mom's body tries to figure out how much milk the baby needs. Expressing breast milk while also feeding your baby regularly may cause mom's body to make too much milk.
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How to Help:
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It is common in the early days of breastfeeding to make more milk than your baby needs. This will slow down over the next few weeks and months.
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If you are expressing breast milk, try to reduce the amount you are expressing or pumping until you are no longer making more milk than your baby needs.
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If you are not expressing milk but have more than your baby needs, try breastfeeding from only one breast per feeding. If the second breast becomes too full and uncomfortable, try expressing just enough breast milk to soften the breast. Removing too much milk from the breast will encourage your body to make more which is not what you want if your breast are engorged or making more milk than your baby needs.
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Try different breastfeeding positions, such as your baby on your tummy while you are lying down or leaning back while feeding.
Not Enough Milk
Mothers often worry about how much milk their baby is getting and if it is enough. One of the amazing things about breastfeeding is that a mother's milk is always changing to best meet her baby's needs. In the early days, a mother produces colostrum in small amounts that match the size of her baby's tummy. On day 3 or 4, most mothers notice that their milk looks whiter and the amount increases. The milk changes into mature (white) milk through frequent stimulation and milk removal. The more milk the baby removes from the breast during breastfeeding, the more milk the breasts produce.
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Common Causes:
If a mother starts to supplement breastfeeding with formula it may impair the natural removal-production relationship between baby and mom and result in mom producing less milk than needed by her baby.
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As babies grow, some days they seem hungrier than usual and parents may worry there is not enough milk. These times are called growth spurts. If your baby is content, has a normal amount of output (pees and poos) and is growing and gaining weight, there is no need to worry. The more you feed your baby, the more milk you will produce.
How to Help:
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Watch for feeding cues from your baby and allow your baby to feed when hungry.
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Do not limit the time your baby feeds at the breast and remember to offer both breasts at each feed.
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Make sure the baby has a deep latch and is positioned with nose-to-nipple and tummy-to-tummy.
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Babies should breastfeed at least 8 or more times in 24 hours. Wake your baby to feed if necessary, especially in the first few months.
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Avoid using pacifiers or artificial nipples. Allow your baby to suck at the breast.
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Increase the amount of milk your breast produces by expressing or pumping after breastfeeding to increase the amount of milk removed.
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If your baby needs to be supplemented, it is best to give your baby expressed breast milk. In this case, work with a lactation professional to maintain and increase your supply of breast milk.
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What to Watch For:
Check your baby for signs of appropriate nutrition and hydration such as the amount of wet and dirty diapers. If your baby does not have enough wet and dirty diapers for their age, get help right away.
Concerns About Baby's Health
In this section we provide a short overview of some concerns about baby's health that can be common among breastfeeding mothers. We provide a small description of what the issue is, explain the common causes and give suggestions for how to help improve the situation. Where possible, we also include recommendations for when you should get outside help from a lactation professional or your health care provider.
Jaundice
Jaundice is a condition where a newborn baby' skin and the whites of their eyes turn a yellow colour. It usually can be found on the baby's face and chest. Babies with higher levels of bilirubin tend to be sleepy and hard to wake up. It is important that babies wake up to feed at least eight (8) times in 24 hours.
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Common Causes:
Jaundice occurs when the baby has high levels of bilirubin, a substance made when the liver breaks down red blood cells. Babies get rid of bilirubin in their stools (poo). If bilirubin builds up, parts of the skin and eyes can start to look yellow.
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Most babies have some jaundice during the first week of life. As your baby's liver function improves, bilirubin is removed from their system and the yellow colour fades.
How to Help:
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Feed your baby often, especially in the first hour and days after birth. Colostrum, the initial breast milk, is a natural laxative and will help your baby start to get rid of bilirubin.
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Regular feeds, at least eight (8) in 24 hours will help build your supply of breast milk and get nutrients to your baby.
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Baby's with persistent or severe jaundice may need blood tests to determine their bilirubin levels. You can help your baby during the blood test by holding your baby skin-to-skin and breastfeeding.
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Phototherapy light can help decrease the amount of bilirubin in the baby's blood. Sunlight is not an effective treatment.
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What to Watch For:
Over the first few days, your baby's bowel movements (poos) should turn from dark green to yellow and any jaundice (yellow) in the whites of their eyes or skin should lessen.
Contact your health care provider if your baby shows any of the following:
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Refuses to breastfeed or has decreased appetite
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Is sleepy all the time and is difficult to wake up
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Is making fewer wet diapers (peeing) than expected
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Yellowing of the whites of eyes and skin is getting worse (deeper yellow)
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Bowel movements (poos) have not changed from dark green to yellow by day 4.
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Check your baby for signs of appropriate nutrition and hydration such as the amount of wet and dirty diapers. If your baby does not have enough wet and dirty diapers for their age, get help right away.
Vitamin D
Babies need vitamin D for healthy growth and development. It helps them build strong bones and teeth. Babies without sufficient vitamin D may be at risk of developing rickets, a disease that affects the way bones grow and develop.
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Common Causes:
Vitamin D is formed naturally when skin is exposed to sunlight. Since Canada is located so far north, sunlight is not able to develop sufficient vitamin D at certain times of the year. Also, sun protection like sunscreen and clothing which protects babies from the harmful rays of the sun also prevents vitamin D formation.
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How to Help:
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A daily vitamin D supplement of 400 IU (10 µg) is recommended from birth for all infants who are breastfed or receiving breast milk.
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Partially breastfed infants should receive a daily vitamin D supplement of 400 IU regardless of their average formula intake.
Calming a Fussy Baby
Crying is a normal newborn behaviour and one of baby's only ways to attempt to speak to us. Almost all babies have at least one fussy period during the day or evening and most babies cry more at night, sometimes for an hour or more.
Parents find that crying begins to increase at 2 weeks of age and decrease at about 3 months of age. It is normal to worry about your baby crying in the first few months. You may feel angry, frustrated, tired and overwhelmed when your baby cries. ​
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Common Causes:
All babies cry and some cry more than others for different reasons. Babies might cry because they are hungry, tired, bored, uncomfortable, overstimulated or sick. They may be looking for the comfort of a hug or a diaper change. Trying to find out why your baby is crying can be challenging. Babies do not cry to try to make you angry or to control you. Responding to a baby's cry will not spoil a baby.
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How to Help:
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Responding to your baby's cry is very important. Mother-baby togetherness will help you learn about your baby's cues and allow you to respond in a timely way.
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Watch for early hunger cues and feed your baby at least eight (8) times in 24 hours. Remember that crying is the last hunger cue.
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Change your baby's diaper whenever it becomes wet or soiled.
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Spend time skin-to-skin with your baby. Most babies feel more relaxed and secure when held close.
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Comfort your baby with gentle massages, singing or speaking softly.
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Make sure your baby's clothing does not restrict movement or lead to discomfort.
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Try different techniques to help calm your baby. Each baby will respond differently to different techniques.
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There may be times when you cannot settle your baby. This is normal and can be frustrating. If you have tried different techniques and are still having trouble settling your baby:
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Ask for help from a support person - partner, family, friend or an adult you trust - while you take a break. ​
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Try self-calming strategies like counting to 10 or taking a few deep breaths. If possible, try taking your baby on a walk or moving to a dark, quiet room.
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If no one is immediately available to help, put your baby safely and calmly in their crib and call on someone to help.
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Never shake your baby, no matter how frustrated or upset you might feel. ​​​
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Using a Pacifier to Calm or Sooth Your Baby
Many breastfeed babies never use a pacifier. When a baby is fussy, offer the breast first. Offering a pacifier may result in your baby not getting enough milk and slow weight gain patterns. This can also lead to a reduction in your milk supply. There is limited research that suggests pacifier use can increase the risk of ear infections and future dental problems.
If you have made an informed decision to use a pacifier, try to only give it to your baby for a short time after your baby has fed. Be sure to wash it regularly to avoid infections. You can also let your baby suck on your clean finger. If a short time of sucking does not settle your baby, offer them your breast again.
Trouble Latching
A latch is when the baby attaches to the breast and suckles and drinks. Some babies may have difficulty establishing an effective latch. ​
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Common Causes:
If breastfeeding is new for mom and baby, it make take a little patience and practice to get into a comfortable routine. At the beginning, it can be common for babies to try and feed with only the nipple in their mouth which can be painful for mom and frustrating for baby. An effective latch requires the baby take a large portion of breast tissue, including the areola - the pink or dark area around the nipple - in their mouth.
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If artificial nipples and/or pacifiers have been introduced before breastfeeding is well established, it can interfere with breastfeeding since the way a baby suckles at the breast is different than how a baby suckles on an artificial nipple.
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How to Help:
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It is important to establish and maintain your milk supply by removing milk as many times as baby would feed - at least 8 times in 24 hours , including through the night.
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Pumping your breast and feeding your baby your expressed milk will help make sure your baby is receiving the nutrients from breast milk and that your milk supply is maintained. This may be necessary as you work to get your baby on your breast.
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Place your baby skin-to-skin and observe for early hunger cues prior to feeding.
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Get into a comfortable position and make sure your baby is supported.
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Support the breast, keeping fingers away from the areola. Tickle the baby's upper lip gently with the nipple or breast until the baby's mouth opens very wide.
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Bring your baby to your breast with the chin and lower jaw first.
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Try to avoid moving the breast once the baby has latched on. Keep your baby's body well supported and do not push the baby's head into the breast.
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If the feed continues to be painful, break the suction by pressing down on the breast near the baby's mouth, pulling down on the baby's chin, or inserting a finger into the corner of your baby's mouth.
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If you continue to experience challenges with latching, contact a lactation professional or your primary health care provider. ​​​
Waking a Sleepy Baby
Too much sleep, particularly with newborn babies, can prevent them from feeding often enough to get the nutrition they need to grow. For this reason, it is important to wake your baby up to feed until they are regularly waking up on their own and showing signs that they are getting enough to eat.​
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Common Causes:
Most newborn babies are sleepy. In the first few weeks, babies typically sleep 11 - 18 hours per day. As a newborn, most babies will feed for 20 - 45 minutes and may fall asleep while breastfeeding or shortly after breastfeeding.
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At the same time, babies should feed at least at least 8 times in 24 hours
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How to Help:
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Make sure your baby feeds at least 8 times in a 24 hour period. The longest stretch of sleep for your baby should be no more than 4 hours.
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Babies feed best when they first start to show signs of hunger. Keep your baby close to you so you notice the early hunger signs.
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Undress your baby before you start to breastfeed and hold them skin-to-skin. Remember to change a wet or soiled diaper.
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Express a little bit of milk when you bring your baby to the breast. This will let the baby know there is milk present and increase their interest in feeding.
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During a feed, if you notice your baby is sleepy and no longer swallowing, try switching to the other breast. Switching breasts can be done several times during the same feeding.
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Change your baby's position by lifting the baby up to your shoulder or rubbing your baby's back. Keep your baby awake by talking to your baby or singing songs. Try upright breastfeeding positions to encourage your baby to feed longer and not fall asleep.
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Ensure baby is latched deeply and positioned comfortably. If the baby's sucking and swallowing starts to slow down while breastfeeding, compress the breast to remind the baby that there is milk and encourage feeding until full. Once the baby starts sucking again, you can stop compressions.
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What to Watch For:
Be sure your baby is waking to feed and staying awake at the breast 8-12 times in 24 hrs. Watch for signs you baby is getting enough, with adequate energy and output (pees/poos) for their age.​​