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Breastfeeding Challenges

Breastfeeding Challenges

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Most women find breastfeeding to be very rewarding, enjoyable and convenient, after mother and baby have learned how to breastfeed together.

However some mothers may face challenges along their feeding journey.

If you need support with feeding your baby, ask your midwife or health visitor for help, and read the information below.

If baby won’t latch

After birth, some babies take a while to recover before they are ready to breastfeed. 

Your midwife will support you to have skin to skin with your baby during this time, to keep baby warm and comfortable and encourage them to feed.

Your midwife will also show you how to hand express your breastmilk, and feed it to your baby using a clean finger, a syringe or by cup feeding, to maintain your breastmilk supply and give your baby all the protection that breastmilk provides.

You will also be shown how to comfortably position and latch your baby, especially in a laid back feeding position, which will encourage and enable baby to breastfeed when they are ready.

Painful feeds

Breastfeeding should be pain free, so if you’re finding breastfeeding painful or your nipples sore or misshapen after breastfeeds, it’s important to seek breastfeeding support as soon as possible, as it could mean that baby is not latching onto the breast effectively.

The Breastfeeding Network’s If Breastfeeding Hurts web page will help you to explore possible causes and solutions to painful breastfeeding.

For more information see the NHS Breast pain and breastfeeding web page.

Overfull or 'engorged' breasts

If your breasts become overly full, and feel hard, tight and painful, they are often described as being “engorged”.

Some women experience this in the early days when their breastmilk gradually transitions from the first milk “colostrum” to the more plentiful ‘mature’ breastmilk.

Overfull or engorged breasts can also be caused if a baby does not feed as often as the mother and baby needs, or if a baby is not latched well. To avoid this, it is helpful for a mother and baby to breastfeed responsively and to seek breastfeeding support to learn how to latch baby effectively.

If your breasts feel overfull or engorged, it can make it difficult for baby to attach effectively to the breast, which makes it hard for them to feed well and can cause sore breasts and nipples. 

To relieve an engorged or overfull breast, some warmth, gentle massage and hand expression, until the breast feeds softer and more comfortable, can be really helpful and can prevent other problems developing, such as blocked ducts and mastitis.

'Cluster' feeding

When a baby seems to feed more frequently than usual, it is often described as ‘cluster feeding’.

This can be normal breastfeeding behaviour, usually during the first 3 to 4 months, and can be due to a ‘growth spurt’ or another reason that your baby needs to feed more frequently, for example during hot weather or to protect themselves from any illnesses around them.

When a baby feeds more frequently, it encourages your breasts to make more breastmilk, meaning that you’ll always have enough milk if you feed baby responsively and latch baby effectively.

However, very frequent and long feeds may be because baby is not latching well to the breast, meaning that they are not breastfeeding effectively, so it is helpful for a mother to seek breastfeeding support to improve how baby latches onto the breast.

Not enough breastmilk?

Although many women worry that they don’t have enough breastmilk, thankfully this is very rarely the case.

Because breastmilk is produced on a supply-and-demand basis, if baby starts to breastfeed soon after birth, and baby is fed responsively, latching onto the breast effectively for each feed, then a woman should generally be able to make enough breastmilk for her baby with no problems.

Your midwife will go through how to know that baby is having enough breastmilk, by explaining about baby’s tummy size and how to tell breastfeeding is going well, including what to look out for with baby’s wet and dirty nappies – see our “Breastfeeding - the early days“ webpage for details. 

Over time, the amount of breastmilk a mother makes will reduce if:

If you are concerned about not having enough breastmilk, visit our breastfeeding support webpage for sources of support and information.

Infant colic

Infant colic is a term used to describe an otherwise healthy baby who is gaining weight well, but who has long periods of crying, usually in the afternoon and evening, with no obvious cause.

Typically, babies tend to have ‘colic’ crying periods from about two to three weeks after birth, until around 3 months of age. 

Many babies seem to experience colic at some point, but it’s important to speak to your health visitor, call NHS 111 or see a GP if you're ever worried about your baby’s health or are finding it difficult to cope.

A baby with colic tends to:

  • be difficult to soothe or settle 
  • clench their fists
  • go red in the face
  • bring their knees up to their tummy or arch their back
  • have a rumbly tummy or lots of wind

Many medications and behaviour strategies have been tried to ‘treat’ colic, without any proved benefit, including:

  • anti-colic drops, ‘griping’ relief products, herbal and probiotic supplements
  • changes to your diet if you're breastfeeding
  • applying gentle pressure to your baby's spine (spinal manipulation) or skull (cranial osteopathy)

There is very little evidence that any of these things work. Instead, speak to your health visitor about methods of soothing and comforting your baby, including:

  • if you’re breastfeeding, ask for support to position and latch your baby effectively, so that they’re feeding well
  • holding and cuddling your baby, especially skin to skin
  • hold your baby in a more upright position during feeding, for example by feeding in a more ‘laid back’ position
  • wind your baby after feeds
  • gently rock your baby over your shoulder, in their Moses basket or crib, or push them around in their pram
  • carry your baby in a sling or baby carrier
  • bathe your baby in a warm bath
  • have some gentle white noise like the radio or TV in the background
  • keep feeding your baby as usual

For more information, see the NHS Colic webpage.

The “Crying is communicating” video from Best Beginnings tells the story of how one mother learned to feel less stressed when her baby cries, by understanding that crying is a baby’s way of communicating.

For more information about infant crying and how to cope , see our Looking After You And Your Baby webpage.

Too much breastmilk or a 'fast let down'

Some women worry that they have too much breastmilk, or that baby struggles to cope with their flow of breastmilk while they are feeding.

On some occasions this may follow a period where the mother has been expressing, to boost her supply or feed baby her expressed breastmilk.

Because breastmilk is made on a supply-and-demand basis, for most women, if they feed baby responsively and latch baby onto the breast effectively for each feed, this will allow her breastmilk supply to match her baby’s needs.

Some women may need to gently hand express a little of their breastmilk before feeds, if they’re feeling overfull and uncomfortable.

Other women may find that trying different feeding positions helps baby to cope with their flow of breastmilk more easily.

If you are concerned about having too much breastmilk or a fast let down, visit our breastfeeding support webpage for sources of support and information.

If a baby is not latched onto the breast effectively, or if mother and baby do not feed frequently enough, a mother may develop blocked ducts and/or mastitis.

Symptoms of blocked ducts tend to include a small, tender lump in your breast, which may then develop into the breast feeling hot, painful and inflamed, possibly making you feel unwell with flu-like symptoms.

The Breastfeeding Network’s Mastitis and Breastfeeding leaflet gives information on causes, prevention and self-help measures. 

If you think you have blocked ducts and/or mastitis it is very important to:

  • Seek support to latch your baby effectively
  • Continue breastfeeding, which is the best way to ease an effected breast and speed up your recovery - stopping breastfeeding suddenly can make the problem much worse
  • Gently hand express the affected area in between feeds to stay comfortable
  • Seek medical advice if you feel unwell with flu-like symptoms, as you may need to be prescribed with antibiotics

Thrush and breastfeeding

Other causes of breast and nipple pain are often misdiagnosed as Thrush (Candida albicans) for breastfeeding women.

Although a thrush infection can affect a mother’s breast at any time while she is breastfeeding, it is not common.

Breast and nipple pain is usually caused by baby not being latched effectively to the breast, so seeking support for positioning and attaching your baby should always be the first step towards pain free breastfeeding.

According to The Breastfeeding Network’s Thrush and Breastfeeding webpage, “Symptoms of thrush are a sudden start of breast and/or nipple pain in BOTH breasts after some weeks of pain free breastfeeding – pain is severe and can last for an hour after EVERY breastfeed.” 

Thrush can only be confirmed by a swab of your nipples - ask your GP for help.

Tongue tie

If a baby is diagnosed with a ‘tongue tie’, it does not always mean they have difficulties with feeding.

With support to position and latch baby effectively, many women find that they can continue to breastfeed their baby without problems.

For more information visit our Tongue Tie and Infant Feeding webpage.

If baby seems reluctant to feed

Some women find that at some point in their feeding journey, their baby seems reluctant or unwilling to breastfeed

This may be because baby is unwell - it’s important to call NHS 111 or see a GP if you're ever worried about your baby’s health.

Babies can also appear to be ‘fighting at the breast’ after being ‘helped’ onto the breast too forcefully, or by someone being too ‘hands on’ with baby.

This may mean a baby seems distressed by breastfeeding – arching their back and pulling away from the breast, becoming upset and unsettled – because of this earlier negative experience with breastfeeding.

Mothers can become very upset by this, sometimes feeling that “baby doesn’t like me” or that “baby is battling at the breast”.

Skin to skin and a laid back feeding position is very helpful for helping both mother and baby to be calm and comfortable.

If a baby becomes reluctant to breastfeed in this way, your midwife or health visitor will develop a plan with you, to help you and your baby gradually get back on the path to breastfeeding.

You will be shown how to effectively attach baby to the breast so you are both comfortable for feeds, how to express your breastmilk to enable you to maintain your breastmilk supply, and how to continue to feed your baby with your breastmilk.

Carrying, holding and cuddling your baby in between feeds also helps to break this challenging pattern, gradually and gently encouraging baby back onto the breast.

More information

For more information about feeding your baby, see the rest of the Infant Feeding webpages or the NHS Start for Life “Your questions answered” webpage.

A Teaching Trust of the University of Birmingham