Many new mothers experience breastfeeding challenges. There are steps you can take to overcome them.

Common breastfeeding challenges

Engorgement

Your milk will come in anytime within 24 to 72 hours after birth. A degree of fullness may be experienced at this time. After a feed at least one breast should feel soft and light (well drained).  

Engorgement occurs if the breasts aren’t drained well during a feed. Some tips to prevent and manage engorgement:

  • Ensure your baby is attached well when breastfeeding.  
  • Feed your baby frequently at least 8 to 12 times per 24 hours.  
  • Do not limit time at the breast.  
  • Express to soften areola to attach your baby to the breast. 
  • Use cool gel packs from refrigerator – NOT FREEZER – for comfort.  
  • Seek professional advice to ensure the condition resolves. 
Blocked ducts

A blocked duct presents as a lump that is tender or painful. It is a result of milk building up behind the block 

  • Ensure correct positioning and attachment, frequent drainage of the breast, alter position during feed to include underarm position, cradle position or lying on your side. Check for a white ‘bleb’ on the nipple as this may be blocking the milk duct.  
  • Avoid sudden long gaps between breastfeeds or expressing for your baby, tight or restrictive clothing (bra), and pressing or holding one area of the breast too tightly, especially close to the nipple. 

Some suggestion to manage blocked ducts:

  • Feed frequently from the affected side first.  
  • Gently stroke towards the nipple during the feed. This may assist the let-down reflex.  
  • For comfort and to reduce swelling from excess fluid apply a cold cloth or cool gel pack.  
  • Express after feeding.  
  • If a white ‘bleb’ is present – soak the nipple with a warm moist cloth and rub or scratch off the ‘bleb’ with a sterile needle to allow the milk to flow again.  
  • Use paracetamol or anti-inflammatory tablets according to directions until the lump clears. 
Mastitis

Mastitis occurs when there is a blockage in a milk duct causing the milk in the duct to enter the surrounding tissues. These tissues become inflamed.
The blockage of milk can lead to inflammation of the ducts and mastitis may occur.  

Signs of mastitis include a red, painful area on the breast and aching flu-like symptoms such as a fever, feeling shivery and generally unwell. 

Seek medical help if fever lasts more than six hours.  

Treatment of mastitis: 
  • Drain the breast frequently.  
  • Attach your baby to the affected side first.  
  • Keep the breast drained by expressing the affected breast after each feed.  
  • Cool gel packs from refrigerator – NOT FREEZER – or cool cloths can relieve discomfort and pain.  
  • Anti-inflammatory medication e.g. ibuprofen, will reduce the inflammation and pain. 
  • You may need antibiotics for 10 to 14 days.  
Breast refusal

There may be several reasons for this. The number of feeds your baby needs changes as they grows older. A very young baby commonly needs eight to twelve breastfeeds in 24 hours, but there is a wide variation in the number of feeds an older baby needs.  

There is a big difference between a four-month-old who refuses one or two feeds in eight, and a baby of the same age who refuses four out of five feeds. 

Even though your baby is refusing some feeds, if they contented and healthy and getting sufficient breastmilk for their needs, try not to worry. 

If your young baby is refusing to feed, consider these strategies. 

  • Be as patient and calm as you can, and try to distract yourself by doing something completely different – a walk outdoors, looking at toys, singing a nursery rhyme.  
  • When baby has settled down they may be eased on to the breast, or may be happier just being cuddled.  
  • Walk around with your baby in an upright position against your body with their head level with your nipple.  
  • Walk and feed at the same time.  
  • Feeding your baby while you are both in the bath may help.  
  • Try breastfeeding baby after the bath when baby is warm and relaxed. 
  • You could try playing with your baby on the floor while you are bare from the waist up. After some time gradually offer your breast.  
  • Anticipate your baby’s waking time and lift their head to feed while still sleepy – you may slip in extra night feeds this way.  
  • Feed in a rocking chair.  
  • Express some milk into your baby’s open mouth before the feed. 
  • Try massaging or singing to your baby – or soothing background music. 
Lactose overload in babies

Lactose overload is often seen in babies consuming large amounts of breastmilk, that is when their mothers have an oversupply.

This may result in an unsettled baby with adequate to large weight gains. The baby usually passes urine more than 10 times a day and has many (often explosive) bowel motions in 24 hours. 

Try to slow the rate at which milk goes through the baby by feeding one breast per feed, or by ‘block-feeding’. Block feeding involves restricting baby to one breast for 3-hour or longer blocks of time before giving the other breast. 

Reflux

Reflux happens when some stomach contents (e.g. breastmilk) pass from the stomach back up into a baby’s oesophagus (muscular tube that leads from the mouth to the stomach) and sometimes spills out if their mouth. 

If a baby with reflux is otherwise happy and putting on weight well, this is called ‘simple reflux’. It doesn’t hurt the baby and it usually stops by itself as the baby grows. 

The following symptoms may indicate reflux disease, which needs medical advice: 

  • bringing up a large amount of milk after most feeds 
  • seems to be in pain after breastfeeds
  • fussy and unhappy between feeds
  • arches their back after most feeds 
  • problems gaining weight
  • ongoing breathing (respiratory) problems

It often helps to feed a baby with reflux in a more upright position than is usual. You may need to experiment with different positions.

After a feed, keep baby upright and still. Many mums find putting baby on their shoulder keeps them happier. 

How frequently to feed

Some babies do better with smaller, more frequent feeds. This causes less pressure on the sphincter muscle between the oesophagus and the stomach. They may not want both breasts at each feed, or may do better if offered only one side, but more often. 

Often babies will want to feed frequently in the early evening and may not settle to sleep easily. Many a couple can recall having to eat tag-team style with one carrying an upset baby while the other gulps down their dinner. 

Want to know more?

Raising Children Network – Sore nipples and nipple infections 

Australian Breastfeeding Association – Breastfeeding information 

Pregnancy, Birth and Baby – Breastfeeding