Breastfeeding problems

Cracked or sore nipples

Your nipples can get damaged and sore if your baby isn’t well attached when they breastfeed.

For breastfeeding to be painless, your baby must have:

• your breast and nipple in their mouth
• your nipple up over their tongue and resting at the soft spot on the roof of their mouth

If your nipple is not far enough back in your baby's mouth, it will get rubbed and become very sore. The skin becomes inflamed and the nipple can break. This is a cracked nipple.

Treating cracked or sore nipples

To find out what is causing pain, ask your midwife, health visitor or a breastfeeding counsellor to watch you breastfeeding. They can help you improve your baby’s attachment. Human milk has properties that fight infection and aid healing. Instead of using a nipple cream, apply a few drops of your breast milk to the grazed area after each feed.

Using nipple cream or nipple shields

Some nipple creams contain ingredients taht could cause an allergic reaction for you or your baby. If you have a scab or graze on your nipple, apply a small amount fo purified lanolin ointment to aid moist wound healing.

You should avoid using nipple shields, or use them for as short a time as possible, because;

• they can delay your baby learning to attach correctly to your breast
• they lower your milk supply as your breast is not stimulated properly
• babies become used to nipple shields and won't feed without them

Low supply of breast milk

To make sure your baby is getting enough milk:

• check they are well attached to your breast
• feed them as often as they seem hungry or want comforted
• offer more breastfeeds
• feed from both breasts at each breastfeed
• stop your baby using a dummy
• express breast milk after feeding if your baby is sleepy and not feeding well

Encouraging a sleepy baby to breastfeed

Some babies are reluctant to feed because they are sleepy. This can cause a problem with your milk supply. To encourage your baby to breastfeed:

• keep your baby close
• maintain skin-to-skin contact, with your baby wearing only a nappy when they breastfeed
• offer breastfeeds as soon as your baby wakes up and shows signs of wanting to feed, such as sucking hands and moving their head from side to side
• hand express a little breast milk and offer it to your baby
• if they stop feeding after a short time, switch to the other breast and back to the first breast

When a baby refuses to breastfeed

Sometimes your baby may refuse to breastfeed. Your baby pulls away from your breast, gets cross and tosses their head from side to side.

Reasons why a baby refuses to feed

Your baby may be in pain, which could be due to:

• a sore head from forceps or vacuum delivery
• an ear infection
• thrush in your baby’s mouth
• teething

Your baby can stop breastfeeding when they’re frightened. If your baby was put to your breast forcefully with their head held tight, this can put them off feeding. Your baby can also stop breastfeeding if your breast milk changes taste. This can happen when:

• you take medicine that can make your milk taste bitter, for example antibiotics
• you’re pregnant, are about to start your period or have your period
• you apply nipple cream, because this can change the taste of your breast for your baby
• your scent is different because you changed your perfume or toiletries (this can confuse your baby)

If your baby is used to a dummy, teat or nipple shield, they might find it difficult to feed from your breast as the sucking action is different.

Helping your baby breastfeed again

Identify what caused your baby to refuse your breast and remove or treat the cause. Be patient and gentle with your baby. Hold them next to you, skin-to-skin, so they can take the breast when they want. When breastfeeding is relaxed, your baby’s natural instinct is to find the breast.

When older babies refuse to breastfeed

Some older babies refuse to breastfeed because they are easily distracted by noise. Find a quieter place to feed or wait until your baby is sleepy. Older babies often want fewer and shorter breastfeeds. Don’t force your baby to feed for longer. Let your baby decide how often and how long each feed lasts.

When a baby gains weight slowly

Most newborn babies lose weight. They return to their birth weight when they are around two weeks old. Gaining weight slowly can mean your baby is unwell or isn’t getting enough milk to grow.

Weight gain for babies under one year old

A healthy baby should gain weight as follows:

• two weeks to four months old, 125 to 200g (five to eight ounces) a week
• four to six months old, 50 to 150g (two to six ounces) a week
• six to 12 months old, 25 to 75g (one to three ounces) a week

When a baby doesn’t get enough breast milk

If your baby isn’t getting enough breast milk, you’ll notice:

• they are gaining weight slowly
• they pass concentrated urine and have fewer than six wet nappies a day
• they have dark, dry stools instead of mustard-coloured, soft stools

Changing how you breastfeed your baby

If you’re concerned your baby isn’t getting enough milk:

• ask your midwife, health visitor or a breastfeeding counsellor to check your baby’s attachment
• offer your baby between eight and 10 breastfeeds a day and let them feed for as long as they want
• feed them in skin-to-skin contact and switch breasts during the feed to keep them awake and encourage your milk supply

Expressing breast milk

If your baby doesn’t feed well from the breast, you’ll need to express breast milk. Expressing stimulates your milk supply. Ask your midwife, health visitor or a breastfeeding counsellor about expressing.

• Expressing and storing breast milk

Mastitis

If the milk ducts in your breast are blocked, it can cause mastitis. This is a painful condition that can occur in breastfeeding women during the months after childbirth.

• Mastitis

Thrush

A damaged nipple can cause thrush, an infection that thrives on broken skin. A breastfeeding mother can pass thrush on to her baby.

• Breastfeeding and thrush