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Common concerns while breast feeding

                                                                     
                               

Breast feeding can be challenging at times, especially in the early days. It can be hard to ask for help, but tackling any problem as soon as they start will give you more time to enjoy these early days.

In lots of cases, the solution is as simple as changing your baby’s position slightly or feeding them a bit more often. Start breastfeeding your baby in the hospital, right after birth. Request the help of a nurse to get you started. Read about breastfeeding before your baby is born.
 
Here is a list of some common problems new mums may encounter during breast feeding. Remember, you must consult your doctor before starting any medications: 
 
Sore or cracked nipples
Low milk supply
Over supply of milk
Breast engorgement
Blocked ducts
Breast infection
Thrush
Tongue tie                                

                                  Sore or cracked nipples

It is common to have some pain or discomfort when your baby first latches on and begins feeding in the first few days or weeks. If your nipples hurt, take your baby off the breast and start again. Breast feeding should be comfortable once you have found some positions that work for you and a good latch is established.

Nipple soreness may be caused by many things, including:
  • Poor feeding techniques

  • Wrong position of the baby when feeding

  • Not taking care of your nipples

It can sometimes take a little while to sort out how to prevent the soreness, but it is important to get support as soon as possible. The following suggestions may also help:
  • A good latch is the key. If your baby is only sucking in the nipple, gently break your baby’s suction to your breast by placing a clean finger in the corner of your baby’s mouth and try again.

  • Try changing positions each time you breast feed. This puts the pressure on a different part of the breast.

  • After breast feeding, express a few drops of milk and gently rub it on your nipples with clean hands. Human milk has natural healing properties and emollients that soothe. Also, try letting your nipples air-dry after feeding, or wear a soft cotton shirt.

  • If you are thinking about using creams, hydrogel pads, or a nipple shield, consult your doctor first.

  • If you are using breast pads, they need to be changed at each feed to avoid trapping in moisture. (if possible, use pads without a plastic backing)

  • Avoid soap as it dries your skin out

  • Wear a cotton bra, so air can circulate.

  • Some mothers treat any cracks or bleeding with a thin smear of white soft paraffin or purified lanolin. Put the ointment on the crack (rather than the whole nipple) to help it heal and prevent a scab from forming.

  • Avoid using soap or ointments that contain astringents or other chemicals on your nipples. Washing with clean water is all that is needed to keep your nipples and breasts clean.

  • If you have very sore nipples, you can ask your doctor about using non-aspirin pain relievers.
                                           Low milk supply

Most mothers can make plenty of milk for their babies. But many others are concerned about  having enough. The baby’s milk demand determines the mother’s supply. Frequent feedings, adequate rest, good nutrition, and adequate fluid intake can help maintain a good milk supply. Checking your baby’s weight and growth is the best way to make sure he is getting enough milk. There may be times when you think your supply is low, but it is actually just fine:
  • When your baby is around six weeks or two months old, your breasts may no longer feel full. This is normal. At the same time, your baby may nurse for only five minutes at a time. This can mean that you and baby are just adjusting to the breast feeding process-and getting good at it!

  • Growth spurts can cause your baby to want to feed longer and more often. These spurts can happen around two to three weeks, six weeks, and three months of age. They can also happen anytime. Don’t be alarmed that your supply is too low to satisfy your baby. Follow your baby’s lead-nursing more and more often will help build up your milk supply. Once your supply increases, you will likely be back to your usual routine.

What you can do
  • Make sure your baby is latched on and positioned well.

  • Breast feed often and let your baby decide when to end the feeding

  • Offer both breasts at each feeding. Have your baby stay at the first breast as long as he wants. Offer the second breast when the baby slows down or stops.

  • Try to avoid giving your baby formula milk as it may lead to less interest in breast milk.

  • Limit or stop pacifier use while trying the above tips at the same time.

  • Let your doctor know if you still think the baby is not getting enough milk.

                                          Oversupply of milk

Some mothers are concerned about having an over-supply of milk. Having an overfull breast can make feedings stressful and uncomfortable for both mother and baby.

What you can do
  • Breastfeed on one side for each feeding. Continue to offer that same side for at least two hours until the next full feeding, gradually increasing the length of time per feeding.

  • If the other breast feels unbearably full before you are ready to breast feed on it, hand express for a few moments to relieve some of the pressure. You can also use a cold compress or washcloth to reduce discomfort and swelling.

  • Feed your baby before he or she becomes overly hungry to prevent aggressive sucking

  • Try positions that don’t allow the force of gravity to help as much with milk ejection, such as the side-lying position or the football hold.

Some women have a strong milk ejection reflex or let down. This can happen along with the oversupply. If you have a rush of milk, try the following:
  • Hold your nipple between your forefinger and middle finger or with the side of your hand to lightly compress milk ducts to reduce the force of milk ejection.

  • If baby chokes or sputters, unlatch him and let the excess milk spray into a towel or cloth.

  • Allow your baby to come on and off the breast at will.
 
                                           Breast engorgement

It is normal for your breast to become larger, heavier and a little tender when they begin making more milk. It is a sign that your milk is coming in. Sometimes this fullness may turn into engorgement, when your breast feels very hard and painful. This is caused by congestion of the blood vessels in the breast. You also may have breast swelling, tenderness, warmth, redness, throbbing, and flattening of the nipple. Engorgement sometimes also causes a low grade fever and can be confused with a breast infection. Engorgement is the result of the milk building up. It usually happens during the third to fifth day after birth, but it can happen at any time.

Engorgement can lead to plugged ducts or a breast infection, so it is important to try and prevent it before it happens. If treated properly, engorgement should resolve.

What you can do
  • Breast feed often after birth, allowing the baby to feed as long as he likes, as long as he is latched on well and sucking effectively. In the early weeks after birth, you should wake your baby to feed if four hours have passed since the beginning of the last feed.

  • Breast feed often on the affected side to remove the milk, keep it moving freely, and prevent the breast from becoming overly full.

  • Breast feed often (8 times or more in 24 hours) and for at least 15 minutes at each feeding can also prevent engorgement.

  • Avoid overusing pacifiers and using bottles to supplement feedings.

  • Hand express or pump a little milk to first soften the breast, areola and nipple before breast feeding.

  • Massage the breast

  • Alternate between taking warm showers and using cold compresses to help relieve the discomfort.

  • If you are returning to work, try to pump your milk on the same schedule that the baby breastfed at home. Or, you can pump at least every four hours.

  • Get enough rest, proper nutrition, and fluids.

  • Wear a well-fitting, supportive bra that is not too tight.

  • See your doctor if the engorgement lasts for two days or more.

                                              Block ducts

It is common for many women to have a plugged duct at some point when breast feeding. A plugged milk duct feels like a tender and sore lump in the breast. It is not accompanied by a fever or other symptoms. It happens when a milk duct does not properly drain and become inflamed. Then, pressure builds up behind the plug, and surrounding tissue becomes inflamed. A plugged duct usually only occurs in one breast at a time. A milk duct can become plugged if the baby does not feed well, if the mother skips feedings, or if she wears a tight bra. It is important that you deal with a blocked duct as soon as possible so that it doesn’t lead to mastitis (inflammation of the breast).

What you can do
  • Breastfeed often on the affected side, as often as every two hours. This helps loosen the plug, and keeps the milk moving freely.

  • Massage the area, starting behind the sore spot. Use your fingers in a circular motion and massage towards the nipple.

  • Use a warm compress on the sore area.

  • Get extra sleep or relax with your feet up to help speed healing. Often a plugged duct is the first sign that a mother is doing too much.

  • Wear a well-fitting supportive bra that is not too tight, because this can constrict milk ducts. Consider trying a bra without underwire.

  • If the plugged duct doesn’t loosen up, talk to your doctor as it can lead to a breast infection.

                                             Breast infection

Mastitis is soreness or a lump in the breast that can be accompanied by a fever and/or flu-like symptoms. If you have a breast infection (mastitis), your breast will feel hot and tender. You may see a red patch of skin which is painful to touch. You may also have yellowish discharge from the nipple that looks like colostrum. It usually only occurs in one breast. It is very important to carry on breast feeding as this will help you get better more quickly.

It is not always easy to tell the difference between a breast infection and a plugged duct because both have similar symptoms and improve within 24 to 48 hours. Most breast infections that do not improve on their own within this time period need to be treated with antibiotics. Consult your doctor if this happens.

Breast infections often occur in mothers who:
  •      Are stressed and exhausted
  •     Have cracked nipples, plugged milk ducts, or breast engorgement
  •     Have been skipping feedings
  •     Wear a tight bra
  •     Insufficient drainage of the breast.
  •     Attachment which is not quite right

What you can do
  • Breast feed often on the affected side, as often as every two hours. This keeps the milk moving freely and keeps the breast from becoming full.

  • Massage the area, starting behind the sore spot. Use your fingers in a circular motion and massage toward the nipple. This should help the milk to flow.

  • Apply heat to the sore area with a warm compress before a feed. This can help milk flow and make you feel more comfortable.

  • Get extra sleep or relax with your feet up to help speed healing. Breast infection is the first sign that a mother is doing too much and becoming overly tired.

  • Take extra care to make sure your baby is attached well to your breast. Ask for help on how you can get your baby latched on properly. You can also refer to our section on positioning and attachment.

  • Wear a well-fitting supportive bra that is not too tight, because this can constrict milk ducts.

  • It is important to continue breast feeding from both the breasts. This will prevent further breast engorgement.

  • If nursing is too uncomfortable, express your milk; pumping or manual expression is recommended. You can try offering the unaffected breast first until let-down occurs, to prevent discomfort.

  • Consult your doctor if you do not feel better within 24 hours of trying these tips, if you have fever, or if the symptoms worsen. You might need medicines.
See your doctor right away if: both your breasts look affected, there is pus or blood in the milk, or symptoms came on severely and suddenly.

                                                               Thrush

Thrush is a common yeast infection that can be passed between the mother and the baby during breastfeeding. The yeast (called Candida albicans) thrives in warm, moist areas. If you suddenly get sore, bright pink nipples after you have been feeding without problems for a while, you might have thrush. Some other signs of a thrush include pink, flaky, shiny, itchy, or cracked nipples or deep pink and blistered nipples.

Your baby might have thrush if he has little white spots on the inside of the cheeks, gums or tongue. Many babies with thrush refuse to nurse or are cranky. A baby’s fungal infection can also appear as a diaper rash that looks like small red dots around a main rash. This rash will not go away with regular diaper rash cream.

Fungal infections may take several weeks to cure, so it is important to follow these tips to avoid spreading the infection:
  • Change disposable nursing pads often
     
  • Wash any towels or clothing that comes in contact with the yeast in very hot water.

  • Wear a clean bra every day.

  • Wash your hands often, and wash your baby’s hands often-especially if he or she sucks on his fingers

  • Put pacifiers, bottle nipples, or toys your baby puts in his mouth in a pot of water and bring it to a roaring boil daily (first make sure they don't get damaged by boiling). After one week of treatment, discard pacifiers and nipples and buy new ones.

  • Boil or sterilise daily all breast pump parts that touch the milk.

  • Make sure other family members are free of thrush or other fungal infections. If they have symptoms, make sure they get treated.
Consult your doctor to get a prescription for an antifungal medication for both you and your baby. You can easily give thrush to each other, so if your baby has it in his mouth, you will still need cream for your nipples to stop it spreading to you.


                                                Tongue-tie

Some babies are born with a tight piece of skin between the underside of their tongue and the floor of their mouth. This is known as tongue-tie, and it can be hard feeding by making it hard for your baby to attach to your breast. Tongue-tie can be treated easily, so if you have any concerns talk to your doctor.

 

 



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