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Breastfeeding ChallengesFeeding Your Baby

Introduction

If you have breastfeeding challenges, you’re not alone. Challenges are common in the first few weeks. Be gentle with yourself as you learn and build confidence.

Breastfeeding is a personal experience and there’s no ‘one size fits all’ approach to handling challenges. On this page, you’ll find information to help you identify challenges as well as how to prevent and manage them. You’ll also find ways to feel more comfortable while experiencing breastfeeding challenges. If you have any questions, call Health Link at 811 or talk with your health care provider.

Sore nipples

When you first begin to breastfeed, your nipples may feel tender, but breastfeeding should not hurt. While some tenderness is common during the first two weeks, pain that does not go away is not normal. Cracked, bleeding or blistered nipples are not normal either. The most common reason for sore nipples is that your baby is not positioned or latched well.

Sore nipples?

Check your baby’s position and latch.

To help prevent sore nipples:

  • Check your baby’s position and latch. If your baby is not getting a deep latch, take them off your breast by sliding a clean finger between their gums until the suction is released. Latch your baby again.
  • Do not use creams or ointments on your nipples unless your health care provider tells you to.
  • Do not use soap on your nipples. This can make them too dry.
  • Use clean cotton breast pads, not plastic-lined ones.

If you have cracked or blistered nipples:

  • Breastfeed your baby as soon as they wake up and before they start to cry—it’s okay to wait to change their diaper until after they feed.
  • Check your baby’s latch and try different feeding positions.
  • Start breastfeeding on the side that’s less sore.
  • Use a warm, clean face cloth or towel on your nipples.
  • Always wash your hands before touching your nipples.
  • Put some of your expressed breastmilk on your nipples to help them heal.

Talk with your health care provider before taking pain medicine, using a breast pump, or using a nipple shield (breastfeeding equipment that fits over the nipple and areola).

Call Health Link at 811 or your health care provider if you have any of the following:

  • nipples that are red, itchy, burning, cracked, bruised or blistered
  • nipple cracks that are slow to heal or have yellow pus
  • sharp, shooting or burning pain in your breast during and after feeds
  • nipples that are not feeling better within 1 or 2 days

“I had different problems breastfeeding each of my two kids. With one, I was really engorged once my milk came in. With the other, I had thrush. Both times, my midwife helped problem-solve with me. I felt like I had amazing support from her. She had so much experience and had seen it all. She helped me to feel confident. I ended up breastfeeding until their first birthdays.”

~Alisha, mother of two children

Engorgement

Postpartum engorgement

It’s normal for your breasts to feel full and heavy in the first few weeks as your body makes more breastmilk. This is called postpartum engorgement.

 Signs that you have postpartum engorgement:

  • your breasts are full, firm, swollen, warm or tender
  • your milk still flows and is easy to express
  • your breasts feel softer, less heavy, and less tender after feeding

If your breasts feel very full, here are some ways to help you feel more comfortable:

Before breastfeeding

  • Take a warm shower or bath just before you breastfeed.
  • Put a warm cloth or towel on your breasts for a few minutes.
  • Hand express a small amount of milk.

While breastfeeding

After breastfeeding

  • If your breasts are tender, put a cool compress such as a gel pack, frozen peas or ice that’s wrapped in a dry cloth on your breasts for up to 20 minutes at a time.  You can do this every hour.
  • If you’re feeling uncomfortable between feeds, hand express a little milk until you feel better—expressing too much milk will make engorgement worse as your body will make more milk.

Moderate & severe engorgement

Sometimes postpartum engorgement can get worse, and your breasts may become very painful and hard. When this happens, milk may not flow easily from your breasts.

Signs that you have moderate engorgement:

  • your breasts are hard, swollen, shiny, painful and red
  • your areola (darker area around your nipple) is swollen and your nipples become flat
  • your milk does not flow easily

Signs that you have severe engorgement:

  • your breasts are hard, swollen, shiny, painful and red
  • your areola (darker area around your nipple) is swollen and your nipples become flat
  • you feel numbness and tingling in your arms and hands
  • your milk does not flow

Hot or cold compress

If your breasts feel heavy and full but your milk is still flowing, it may help to put a warm cloth or towel on your breasts for comfort. Apply a warm compress before breastfeeding. Only apply warmth for 3 to 5 minutes – using heat for too long can cause swelling and tissue damage.

If your breasts are painful or milk is no longer flowing, use a cool compress instead, as this can help to reduce swelling.

How to manage moderate and severe engorgement

Here are some tips to reduce the pain and swelling in your breasts and help your milk flow:

Before breastfeeding

  • Put a cool compress such as a gel pack, frozen peas or ice that’s wrapped in a dry cloth on your breasts for up to 20 minutes at a time. Do this as often as you can.
  • Use reverse pressure softening (see below) to help your areola (darker area around your nipple) soften. This will make it easier for your baby to latch onto your nipple.
  • Use gentle lymphatic drainage (see below) to help your breasts soften and your milk flow.
  • If your milk still does not flow, repeat the steps above until you can express some milk. Your milk needs to be flowing before you try to breastfeed or express your milk.
  • Talk with your health care provider about taking anti-inflammatory and pain medicine.

While breastfeeding

  • Follow your baby’s cues to feed and feed at least 8 times in 24 hours. Your breast should soften as your baby feeds, and you should hear your baby swallowing.
  • Make sure your baby has good positioning and latch.
  • Feed on one breast and offer your other breast if your baby is still hungry.
  • If your baby does not breastfeed, express your milk. It is best to express your milk by hand, as this is better for the swelling in your breast. If you do need to pump, try to pump only the amount of milk your baby needs.

After breastfeeding

  • If your baby does not feed on your second breast, hand express just enough milk to feel comfortable. Start the next feed on this breast.
  • Put a cool compress such as a gel pack, frozen peas or ice that’s wrapped in a dry cloth on your breasts for up to 20 minutes at a time.
  • If you’re feeling uncomfortable between feeds, hand express a little milk until you feel better—expressing too much milk will make it worse as your body will make more milk.

Call Health Link at 811 or your health care provider NOW if these tips do not help and your breasts are still engorged.

Reverse pressure softening

Reverse pressure softening can help reduce the swelling around your nipple caused by engorgement. This will make it easier for you to breastfeed or pump.

Two-step method:

Step 1: Place 2–3 fingers of both hands on each side of nipple. Your top knuckles should touch your nipple. Apply constant pressure with your fingers. Hold for a count of 50. If the area is very swollen, count very slowly.

Reverse pressure softening, two-hand method: Step 1
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Step 2: Rotate your fingers above and below the nipple and repeat these steps until milk starts to flow.

Reverse pressure softening, two-hand method: Step 2
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One-hand method:

Place your fingertips around your areola (darker area around your nipple), away from your nipple. Curve your fingertips and press into areola. Hold for a slow count of 50. Make sure your fingernails are short and clean before you try this method.

Reverse pressure softening, one-hand method: Step 1
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Gentle lymphatic drainage

Gentle lymphatic drainage will help reduce pain and swelling in your breasts from engorgement. It is very important (like petting a cat), as a firm touch can cause damage and make engorgement worse.

Step 1: Locate the spot above your collarbone at the base of your neck. Gently make 10 small circles with your fingers.

Gentle lymphatic massage: Step 1
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Step 2: Locate the spot between your armpit and your upper breast. Gently make 10 small circles with your fingers.

Gentle lymphatic massage: Step 2
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Step 3: Using a light touch, stroke upwards from the nipple to the top and sides of your breast.

Repeat these steps on your other breast.

Gentle lymphatic massage: Step 3
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Mastitis & blocked milk ducts

Mastitis & 'blocked milk ducts'

Mastitis means there is pain, swelling and heat (inflammation) in your breast. Some parents who breastfeed may never get mastitis, while others may get it once or several times.

Mastitis usually starts when there is inflammation in your milk ducts, causing them to narrow and slow the milk flow. Narrowed milk ducts can cause areas of your breast to become tender, lumpy and red. These painful lumps are often called ‘blocked’ or ‘plugged’ milk ducts, although they are not plugged with anything.

This inflammation in your milk ducts can spread to larger areas of your breast, making those areas red and painful. Sometimes mastitis can become an infection but it is not contagious (cannot be spread from person to person).

Mastitis is more likely to happen if:

  • Your breasts make more milk than your baby needs
  • Your breasts are engorged
  • You are unable to breastfeed your baby regularly
  • You use a breast pump
  • You use a nipple shield

Follow your baby’s feeding cues and only feed as much as they want. Skipping feeds or removing too much milk can make mastitis worse.

Signs that you may have mastitis:

  • Areas of your breast become inflamed and are red, painful, hard and swollen
  • Usually only one breast is affected
  • You can feel a lump close to the skin
  • Your breast is tender or hurts around the lump
  • Flu-like symptoms that include a fever, chills and body aches

Here are some things you can do to help if you have mastitis:

  • Follow your baby’s feeding cues and feed at least 8 times in 24 hours.
  • Avoid using a breast pump if possible. Feeding at the breast or hand expression is better for inflammation than pumping. If you do need to pump, try to only pump the amount of milk your baby needs.
  • Avoid breastfeeding or expressing more often on the affected breast, as this will cause your breast to make more milk and make the inflammation worse.
  • Put a cool compress such as a gel pack, frozen peas or ice that’s wrapped in a dry cloth on your breasts for up to 20 minutes at a time
  • Avoid massaging or using heat on the affected breast as this can make the inflammation worse
  • Try to rest—ask your partner, family and friends to help you at home.
  • Drink enough fluids and eat well.
  • Wear a supportive bra.
  • Talk with your health care provider about taking anti-inflammatory and pain medicine.

Mastitis can be serious and may need to be treated with antibiotics if there is an infection. It usually clears up quickly once treated. It is usually safe to breastfeed with mastitis, even if you have an infection and are taking antibiotics.

Your baby may refuse your breast because your milk may have a different taste when you have an infection. If this happens, your baby will need to be supplemented. You’ll need to express your breastmilk to maintain your milk supply during this time. Learn more about supplementing.

Call Health Link at 811 or your health care provider if you have any of the following when breastfeeding:

  • trouble with, or unable to breastfeed or express your milk
  • flu-like symptoms such as headaches, aching muscles, chills or feeling tired
  • hard, red and painful breasts
  • a fever of 38.5 °C (101.3 °F) or higher
  • red, warm spots or streaks on your breasts
  • hard, swollen breast that your baby has trouble latching to

Not enough milk

Milk production

Parents usually make enough milk for their baby. There are some things that can affect milk production. Learn if your baby is getting enough breastmilk.

Your body may make less milk if your baby:

  • is not positioned and latched properly
  • is not breastfeeding often enough during the day or night
  • is not breastfeeding long enough at each feeding
  • is only offered one breast at each feeding
  • is being supplemented and you’re not pumping or expressing your milk
  • is feeding with a nipple shield, but you’re not using it correctly

Your body may make less milk if you:

  • are in pain or stressed
  • lost a lot of blood during or after birth
  • have had breast surgery such as a breast reduction
  • have certain health issues such as thyroid problems, diabetes or high blood pressure
  • take certain medicines such as birth control pills, antihistamines or some herbal teas
  • drink alcohol
  • use tobacco
  • are pregnant

Talk with your health care provider if you think any of the above or something else may be affecting your milk supply.

Herbal product claims

Some herbal products such as teas claim to increase breastmilk supply. There is not enough research around their safety or to know if they work. To find out more about herbal products, talk with your health care provider or call Health Link at 811.

Call Health Link at 811 or your health care provider if your breasts don’t feel full and heavy by the time your baby is 72 hours old.

Here are some tips to help increase your milk supply:

  • Spend more time skin-to-skin cuddling with your baby.
  • Rest when your baby is sleeping. Ask for help with household chores.
  • Watch for feeding cues and feed your baby whenever they want and for as long as they want. Feed at least 8 times in 24 hours, including at night.
  • Put a warm face cloth or small towel on your breasts and gently massage them before and during pumping, hand expressing or while your baby is feeding.
  • Use breast compression when your baby’s sucking slows down.
  • Offer both breasts at every feeding. Let your baby finish the first breast before offering the other one.
  • Use an electric breast pump if your baby is not breastfeeding well or you’re not able to breastfeed. Set it at a comfortable setting and use it at least 6–8 times in 24 hours. Express at least once at night.
  • Talk with your health care provider about expressing milk by hand or by using a breast pump after feedings. Using an electric pump together with expressing by hand will increase your supply more than pumping on its own.

Call Health Link at 811 or talk with your health care provider if you have any concerns with not having enough breastmilk.

Breast compression

Breast compression is a way to gently squeeze your breast during feeding to increase milk flow. Increasing milk flow can encourage your baby to suck if they fall asleep after only a few minutes at your breast.

To do breast compression, gently massage and place your thumb on top of your breast and the fingers of the same hand below it. Apply gentle pressure behind your areola for a few seconds. Do not squeeze so hard that it hurts. You can do this throughout the feed or at the end, when your baby gets sleepy.

Breastfeeding parent gently compresses left breast with right hand while baby (in football/clutch position) breastfeeds. Parent’s thumb is on top of the breast and fingers are below.

Too much milk

Oversupply

Your milk supply is usually affected by your baby’s appetite. Sometimes you may have a larger milk supply than your baby needs (oversupply). If you use a breast pump and pump more breastmilk than your baby needs, this can also lead to oversupply.

Signs that you may have an oversupply include:

  • Leaking a lot of milk during and between feedings
  • Feeling your breasts are really full
  • Having tender and lumpy areas in your breasts

There may be other reasons for having too much milk. If you have any questions, talk with your health care provider.

If you have too much milk, your baby may:

  • Cough, choke or leak milk from their mouth during feeds
  • Have a poor latch, suck, and swallow
  • Push off the breast when your breastmilk sprays
  • Be fussy and cough, sputter or pull away during feeds
  • Come on and off the breast often
  • Bite or pinch your nipple
  • Only feed from one breast
  • Refuse to breastfeed
  • Be fussy after or between feeds
  • Spit up a lot and have more gas
  • Have explosive, watery, green stools
  • Have short feeds and want to feed often
  • Be gaining weight well, but is fussy and always seems hungry

Here are some tips that may help if you have too much milk:

  • Feed your baby as many times and for as long as they want, following their feeding cues
  • Burp your baby often
  • If your breasts are very full and uncomfortable between feeds, express by hand just enough milk to feel comfortable
  • If you use a breast pump, try to pump only what your baby needs

If the above tips don’t help, talk with your health care provider about other options to lower your milk production.

Breasts leaking milk

After the first few days, when your milk supply increases, milk may leak from one breast while your baby is feeding from the other. You can either gently press a clean cloth or towel on your nipple to stop the flow or collect your breastmilk in a clean container.

Milk may also leak from your breasts between feedings. You may want to use cotton breast pads to protect your clothes. To help prevent infection, change your breast pads often.

Milk flows too fast

An overactive let-down is when your breastmilk flows too fast. Overactive let-down and oversupply are often seen together.

Signs that you may have milk that flows too fast include:

  • Pain with let-down at the start of the feed
  • Breastmilk spraying from one breast, while your baby feeds on the other breast
  • Painful nipples from your baby biting down to slow milk flow

Here are some tips to help with a fast milk flow:

  • Feed your baby when they are showing early feeding cues, like when they’re just waking up.
  • Use positions that help slow down your milk flow, such as laid-back or side lying.
  • Position your baby more upright while feeding, with their head higher than their body. This will help your baby cope with the faster milk flow.
  • Express or pump a little milk before latching your baby.
  • Burp your baby often and take breaks so your baby can pace themselves during the feed.
  • Release your baby’s latch if they choke or sputter. Let your milk spray into a cloth before your baby latches again.
  • Avoid using warm cloths or towels or taking long, warm showers or baths before breastfeeding.

Call Health Link at 811 or your health care provider if you have any of the following:

  • concerns about your milk supply
  • your baby pulls off your breast often and looks like they’re having trouble breathing
  • your baby chokes, coughs or sputters while feeding
  • your baby has explosive, green, watery stools
  • your baby spits up more than usual

Sleepy newborn

It’s normal for a newborn to be a little sleepy, and some newborns are sleepier than others. A baby may be sleepy for many reasons. If your baby is not able to wake up enough to feed, this creates a problem. Learn more about sleepy newborns.

Here are some ways to wake up your baby to feed while breastfeeding:

  • Let your baby sleep un-swaddled in their crib so they can wake more easily.
  • Unwrap or undress your baby or change their diaper.
  • Do skin-to-skin cuddling.
  • Hold your baby upright while supporting their neck and head, make eye contact, and talk to them.
  • Gently stroke or massage your baby’s body. Move their arms and legs, stroke their cheek, rub their back or circle their lips with your clean finger.
  • Put a few drops of expressed breastmilk onto their lips.
  • Try different breastfeeding positions. Using a laid-back position or more upright positions may help your baby be more awake during feeds.
  • Latch while your baby is in a light sleep as this may help them to feed more.
  • Make sure your baby is latched deeply as this may help them to be more awake while feeding.
  • Burp and put them on the same breast to feed until your breast feels empty or you hear less swallows.
  • If your baby falls asleep at the breast after only a few minutes, use breast compression while breastfeeding to encourage sucking. You can do this throughout the feed or at the end when your baby gets sleepy.
Newborn breastfeeding in a Koala hold position while being held by parent, who is sitting in a chair.

Call Health Link at 811 or your health care provider NOW if you’re having trouble waking up your baby or your baby is too sleepy to feed.

When breastfeeding is not advised

In rare cases, it may not be safe to breastfeed, but you might still be able to feed your baby your breastmilk. This may happen if you have some types of infection such as tuberculosis (TB), chickenpox or herpes lesions on your breasts.

There may be times when your health care provider advises you not to breastfeed or give breastmilk to your baby. This may happen if:

  • your baby has a rare metabolic condition such as galactosemia
  • you are a person living with HIV
  • you have Human T-cell Lymphotropic Virus Type I or Type II
  • you have cracked or bleeding nipples and also have hepatitis B or hepatitis C
  • you have an infection like ebola or brucellosis
  • you are on chemotherapy or taking other medicine that is not safe while breastfeeding
  • you are being given certain radioactive compounds for a medical procedure or treatment
  • you are unable to stop drinking alcohol, using cannabis or taking drugs such as ecstasy, methamphetamines, cocaine, heroin and fentanyl

If you’re advised not to breastfeed your baby, feed your baby infant formula. Learn more about formula feeding.

If you have questions, call Health Link at 811 or talk with your health care provider.

If you’re advised not to breastfeed or give breastmilk to your baby

This may be an emotional time. Whatever you’re feeling, be gentle with yourself and ask for help if you need it.

Breastfeeding while you are unwell

Breastfeeding or expressing breastmilk is considered safe when you have an infection like influenza (flu), as long as you feel well enough to continue. You can lower the risk of spreading infectious diseases by washing your hands carefully and often.

If you are too unwell to breastfeed and need support to express breastmilk for your baby, talk with your healthcare provider.