Potential Breastfeeding Problems:

Sore Nipples

• Sore nipples in the first few days are due to poor latching.
• The only way to prevent and heal sore nipples is by correcting the latch, as described under ”A Good Latch”.
• Holding your baby in the underarm or cross-hold positions can go a long way in assisting with a good latch.
• A lactation consultant will be able to help you correct the latch.
• Nipple creams used with discretion may be helpful, but only correcting the latch will resolve painful nipples.
• Laser treatment with an experienced physiotherapist, who helps correct the latch, can be helpful.
• Painful, burning nipples when the baby is older is usually due to athrush infection. Please see your doctor immediately should you experience this.

Full Breasts/Engorgement

Full Breasts:

• Around day 3 and 4 after the birth, your breasts may feel full and heavy but much relieved after your baby has fed, this is perfectly normal.
• You may need to express a little milk, to soften the areola, if your baby cannot get a good grip or latch.
• This fullness diminishes with time, and by 6 weeks your breasts may remain soft between regular feeds. This is not an indication that you are producing less milk, but that the milk is being made as needed.

Engorgement:

• This happens when the breasts are hard, painful and unyielding i.e. no milk flowseven when your baby is able to latch.
• This condition is painful and distressing to both you and your baby.
• Standing under the shower or using hot and / or cold compresses, then massaging the breasts gently is a good way to stimulate milk-flow.
• Once you are able to establish a milk flow, your baby is likely to manage a good feed.
• A good latch, demand feeding and waking your baby for a feed if he sleeps for too long will prevent engorgement.

“Not Enough Milk”

One of the most common reasons for stopping breastfeeding is when mothers feel that they do not have enough milk. Mostly, the situation is in fact perfectly normal.

Important things to know:

• It is vital to understand that there is only a little milk (colostrum) in the first few days and that the milk only ‘comes in’ between days 2 and 5. Colostrum is extremely concentrated and perfect for a newborn baby.
• Many woman also think that their supply is inadequate around 4 to 6 weeks when the breasts settle down and no longer fill up and feel ‘full’ as they used to. This too is perfectly normal and not an indication of a decreased milk supply.
• Some mothers may never, others only sometimes, experience the tingling ofthe let-down reflex.
• It is normal for the breasts to stop leaking after a few weeks.
• Your baby’s weight gain may initially be less than a formula fed baby’s.
• Many babies are more “demanding” at some time during the day, most often in the evenings. This may be interpreted as having “too little or weak milk”, however allowing your baby tocluster feed (breastfeed often) at this time, allows your baby to sleep really well when she does eventually settle down.
• Many babies have obvious growth spurts round 2-3 weeks, 6 weeks and 12 – 14 weeks and may require more frequent feeds for a while. Once your supply has increased due to the extra stimulation, feeding times will settle down again.

Over-Supply “Overfeeding”

Once your baby is over 6 or 8 weeks of age, and you have an abundant supply of milk but your baby is restless, fretful and difficult to settle, in spite of frequent feeds, it is possible that you have an over-supply of breastmilk. Although breastfed babies do not really overfeed, it is possible that your baby drinks a lot without being satisfied because he is not getting the fatty milk at the end of a feed.

Fortunately it is not difficult to reverse such a situation:

• Make very sure that your baby is well positioned and latched.
• Remember especially to take the baby to the breast and not the breast to the baby.
• Feed your baby on one breast only per feed. Even when he wants more after his ‘winding’ time put him back onto the same breast.
• Offer the other breast at the next feed.
• If your baby coughs and splutters, because the milk-flow is too fast, lie back when feeding – feeding against gravity helps to slow the milk-flow down.
• Encourage him to stretch the time between his feeds by a half-hour or an hour.
• He should settle into a reasonable pattern.

Weight Gain

Comparing with others

• Breastfed babies gain weight at different rates compared to formula fed babies.
• In fact girls and boys even gain weight at different rates.
• It is also more likely that the baby whose parents are both, let’s say, over 6 ft tall is going to gain more weight when compared to a baby with small parents.

Gaining “too much”

• If your exclusively breastfed baby drinks well, is healthy and contented, do not listen to those who might tell you that your baby is gaining too much weight.
• Even the sturdiest breastfed babies loose the extra covering when they start crawling and walking.
• That is also provided your baby eats a balanced diet, when starting solid foods. Avoid giving cereal more than once a day.

Poor weight gain

• Should it be confirmed that your baby is not gaining sufficient weight or she feeds for hours at a time:
  • Have your baby’s position and latch checked – a good latch is essential.
  • Offer more frequent feeds.
  • Wake her for feeds if necessary.
  • Avoid giving formula feeds.
  • Giving one or two extra expressed breastmilk feeds, by cup, is an excellent way of increasing your milk supply and your baby’s weight gain.
  • Use breast compression when the suckling slows down, to allow her to have more of the fatty hind milk. (Read more on Articles Page)

Stopping night feeds

There is no denying, having a baby is tiring. Sleep deprivation is no fun. However, stopping night breastfeeds is not the easy answer some moms may think it is.

The potentially detrimental advice often given is: “give your baby formula milk for the evening feed”. Well meaning advice, but often not conducive to successful breastfeeding.

The fact is breastfeeding at night is far easier and less tiring than formula feeding – and is much better for your baby.

• It would be better to follow your babies hunger cues and ‘cluster feed’ him in the evenings if that is what he is asking for. He is then far more likely to have a longer sleep during the night.
• Trying to enforce fewer night feeds could lead to milk reduction, due to the long intervals between feeds, and ultimately more stress and less sleep.
• It could be helpful to have your young baby sleep in your room, even in your bed. Consider the pros and cons.
• Alternatively Dad could bring baby to you for feeds and or take him back and change his nappy after one or more of the night feeds.
• When your baby is around 6 weeks or older Dad could offer him a feed of expressed breastmilk once in a while so that you can get a little extra sleep. Done regularly though this can decrease your milk supply.
• Most babies will require fewer night feeds around 12 weeks, some much sooner. It passes all too quickly, don’t wish this precious time away.

The Crying Baby

Crying is normal and something that all babies do. In the beginning, it is the only way they can tell you that something is upsetting them, that they need something or need you.

There are many different reasons why a baby cries including that they are:

• hungry
• thirsty
• over-tired
• uncomfortable
• in pain
• too hot
• cold
• needing to be held and cuddled
• needing comforting after getting a fright
• not wanting to be alone

Responding to your baby when he cries, and holding and comforting him, is what your baby needs for his well-being and will not in any way ‘spoil’ him or be the start of ‘bad habits’. Your baby is not being ‘naughty’ or ‘manipulative’ – and ‘crying it out’ is not ‘good for his lungs’ or anything else!

Your baby is learning to trust that you will meet his needs, so although you may at times struggle to find out exactly what is wrong, it is important that you respond to your baby. Rule out what you can, but also hold and cuddle your baby. Babies need help to soothe themselves and calm down.

Some babies cry more than others or are more likely to cry at particular times of the day. There are strategies that might help, but some babies find it difficult to settle and will need a lot of holding and soothing until this period passes. After 4 – 6 weeks, crying usually starts to decrease or become less intense and by 4 – 5 months old most babies are much more settled and cry a lot less.

What to do?

Firstly, by consulting your clinic sister and doctor, rule out the possibilities of:

• hunger / insufficient weight gain
• illness (e.g. urinary tract infections or ear infections)
• reflux (a lactation consultant can help rule out feeding issues before a diagnosis of reflux is made)

Then consider the following:

• Communication:
  • Remember crying is a baby’s way of communicating and does not always mean that something is physically wrong – your baby may want company or to be held, or he may need to sleep.
  • As time goes on you will learn to ‘read’ your baby’s crying more easily and differentiate better between the different cries, e.g. hunger, tiredness, pain. It takes time to learn this ‘new language’ and your baby will get better and communicating his needs too.
• Feeding: 
  • In the early days the natural thing to do is to calm, then feed him.
  • Breastmilk is digested in 60 – 90 minutes and a baby’s tummy is small, so your baby may need to feed frequently.
  • A baby breastfed on demand is usually a more content baby as his needs are being met.
• Nappy change: may be all that is needed.
• Holding & movement: 
  • Sometimes it is only a little comfort that is needed.
  • Deeper pressure is more calming for babies than light, quick movements.
  • Kangaroo (skin-to skin care) him.
  • Rock him – slow, rhythmical movements are helpful.
  • Walk him in a carrier or pram
  • Go for a drive.
  • If your baby is pushing away from you when you hold him to comfort him, try holding him so he faces away from you.
  • Trying too many movements, sounds and holding positions at once or in very quick succession can aggravate rather than soothe the baby.
• Sleep: Your baby may be over-tired and need to sleep. Being over-tired or over-stimulated can make it difficult for a baby to fall asleep.
• Singing: sing to your baby
• ‘Winding or burping’ your baby: Only ‘wind’ your baby for five minutes or so after feeds, as too much handling after a feed can also make him irritable.
• Too hot / cold: Make sure he is not too hot or too cold.
• Distraction: Playing with your baby by offering him his favourite toy, showing him different things, making noises and funny faces or making movements with him that he enjoys make distract him and stop him crying. If however your baby is over-tired or very distressed then this may make the crying worse, in which case stop!
• Bathing: some babies find bathing very soothing.
• Mom’s stress/anxiety: 
  • Sometimes a baby senses his mother’s distress and anxiety and quietens if someone else takes him.
  • If you are feeling overwhelmed by your baby’s crying, or as if you may hurt your baby then put the baby in a safe place and walk out of the room for a few minutes to calm down. If you continue to feel this way then ask for help! Many parents feel this way – it is hard to deal with an inconsolable crying baby.
• Very wakeful, alert babies: 
  • Some babies are particularly wakeful, restless, and aware of their surroundings and therefore more demanding. These infants do not conform to the idealised picture of the perfect baby who simply eats and sleeps. In fact, few do.
  • They in particular need kangarooing, entertaining or carrying around in a carrier or sling until this phase passes. The mother needs help and support from Dad or other people.
• Baby massage: firm movements are more calming than a light touch. Always rub in a clockwise direction on the baby’s tummy.
• Mainstream/ alternative healthcare practitioners: Many parents choose to consult healthcare practitioners in a number of fields such as homoeopathy, a specially trained paediatric chiropractor or osteopath, a body stress release practitioner, e.t.c.