Breastfeeding is the ideal food for the newborn and infants do not need any other food for the first six months. Despite the fact that the WHO and other health organizations have recommended exclusive breastfeeding for up to six months and accompanied by other foods for up to two years or more, breastfeeding rates in our country are low.
This is due, in part, to the fact that breastfeeding is not always easy and we may encounter numerous difficulties and little support, in addition to having a short maternity leave that does not allow us to be with the baby for the first six months of life. Here are some of the most common breastfeeding problems that we attend to in the office and how we can resolve them.
1. Pain when breastfeeding
Breastfeeding shouldn’t hurt . It can be bothersome in the first feedings due to the tenderness of the nipples and because it is a new sensation, but it should not be painful. If there is pain, it is up to the specialists to find out what it is.
One of the most frequent causes is a bad grip ; if the baby is not properly latched on, it will suck poorly and injure the nipple. You must reposition it as many times as necessary to get a good hook.
It is good to alternate the postures to find the one in which the shot is best and ask for help from professionals if necessary. Other common causes of pain are the frenulum in the baby, infection and / or inflammation of the breast, abnormalities in the palate, inverted nipples and vasospasm or Raynaud’s phenomenon.
As you can see, the causes of pain when breastfeeding are multiple; early diagnosis and treatment is essential to avoid unwanted weaning.
2. Acute mastitis
Mastitis is inflammation of the breast, which may or may not be accompanied by infection (usually bacterial). One or more quadrants of the chest become red, swollen, and very painful.
They are usually accompanied by systemic symptoms, such as when we have the flu: fever, general malaise … The first thing you should do is guarantee a correct emptying of the breast , frequently placing the baby to suckle in different positions (it is not necessary at all to stop breastfeeding ) and / or expressing milk with a breast pump or manually.
You can also apply cold and take medications to lower fever and reduce inflammation and pain (paracetamol or ibuprofen). If symptoms persist after 12-24 hours of effective voiding, you will likely need antibiotic treatment .
In this case, it is not necessary to stop breastfeeding as there are a multitude of compatible antibiotics and the baby can continue to drink the milk from the affected breast without problems (although sometimes they can reject it because the taste is different).
3. Cracks in the nipple
Unfortunately, it is so common to have cracks that many moms see it as something inevitable, that you have to go through. Well no, it is not necessary to “callus” “and it should not be normal to have cracks.
The cracks are produced by a poor latch on of the baby, which injures the nipple when sucking. Also here multiple remedies have been sought to solve it. According to the 2014 Cochrane systematic review, there was insufficient evidence that glycerin gel dressings, lanolin breast pads, lanolin alone, or multifunctional nipple ointment significantly improved maternal perceptions of pain of the nipple.
Applying the milk itself on the nipple, something common a few years ago, is already inadvisable due to the risk of infection. And what do we do then? The main thing is to improve the hitch ; It is good to vary positions and let us be advised by personnel trained in breastfeeding. In the event that the pain is such that it does not allow you to breastfeed the baby, you can carry out delayed breastfeeding (expressing the milk manually or with a breast pump and giving it to the baby) until the cracks have healed.
4. Breast engorgement
2-3 days after giving birth, the famous “rise in milk” takes place. It is a normal and transitory situation. However, sometimes there is an excessive accumulation of fluids (edema) and we speak of breast engorgement.
Breasts are so full that they are painful, swollen, and babies often find it difficult to latch on. To mitigate it, different solutions have been offered, without having clear scientific evidence according to the latest Cochrane review. Applying heat is not recommended, as it can worsen inflammation (if you do it, it should be limited to just before taking).
You can apply cold , in the form of thermal packs or cabbage leaves (yes, cabbage, oddly enough), it could be beneficial. In addition, performing the softening reverse pressure technique before feeding allows the breast to soften and favors the release of milk (as it triggers the ejection reflex). If necessary, the mother can take anti-inflammatories (to check the compatibility of the medication with breastfeeding, you can consult the website www.e-lactancia.org). In general, the situation improves in a few days.
5. Raynaud: the nipple that stays white
Raynaud’s phenomenon or syndrome occurs when the small vessels that carry blood to some areas of the body narrow and blood flow decreases ; the affected area remains white.
Within a few minutes it tends to turn purple and cold, and when the area warms up and circulation is restored, it turns red. It frequently occurs in the fingers and toes, but this phenomenon can also affect the nipple.
There are times when the cause is not identified and can be triggered by cold and / or stress . In others, it may be due to a mechanical problem : poor suction or a baby with a frenulum can trigger these phenomena. In addition to solving the cause if there is one, it is recommended to apply heat before and after feeding and to breastfeed in warm places. Drinking hot beverages (without caffeine) can also help. In specific cases, a drug may be necessary to dilate (widen) the blood vessels.
6. Flat nipples
Flat nipples are by no means a contraindication to breastfeeding and shouldn’t even be a problem. Only true inverted nipples (fortunately very rare) in which the muscle filaments that protrude the nipple are very short or absent, can make breastfeeding impossible.
In the case of having flat nipples, no preparation is necessary prior to delivery . After the baby is born, the ideal is to remain skin-to-skin and make a spontaneous latch on in the first hour of life; This first latch will create an imprint and the baby will probably have no problems sucking later.
If necessary, the mother can stimulate the nipples by applying cold or performing a brief extraction immediately before feeding. As lactation progresses, the nipples will protrude more and more (as in subsequent lactations). In specific cases it is necessary to resort to liners, at least temporarily.
7. Milk pearls
Milk pearls are whitish or yellowish spots that appear on the tip of the nipple and correspond to blocked ducts.
The cause may be traumatic (for example, baby pulling back without releasing the breast) or due to a deeper infection . Milk pearls are very painful. Depending on the reason that originates them, we will act differently.
In the case of trauma, we can wait a few days for them to resolve spontaneously (which I usually recommend initially); Another option is to apply heat (for example by immersing the breast in hot water) and try to undo the pearl by rubbing it gently with a towel. There are also midwives who prick the pearl with a sterile needle.
In the case of being due to an infection (they usually precede or coincide with mastitis and obstructions), it is preferable not to handle them; We will have to carefully review the technique, try to breastfeed in different positions and it is advisable that an expert in lactation assess us in case we need treatment.
8. Low milk production
The inability to produce enough milk to breastfeed our baby is called hypogalactia . Only in a minority of cases is it a true hypogalactia: the mother cannot produce enough milk; In most cases, however, it is due to secondary causes that can be corrected: poor latch on of the baby, shots with rigid schedules …
In addition to correcting this situation (improving hooking, taking frequent feedings and on demand …), there are several options to increase milk production. The extraction , both manual and with a breast pump, increases the stimulation of the breast and with it the amount of milk we produce; It can be more effective if we perform a breast massage beforehand as well as if we use a double pump (or we place the baby to suckle while we extract from the other breast).
For particular cases, powerful extraction can be useful. Galactogogues (substances that increase milk production) have their indication in particular cases and, in the case of pharmacological drugs, always under medical supervision . The natural galactogosos, although tremendously used in certain cultures, have not shown scientific evidence to date and some could even be dangerous for the baby.
9. Sleepy baby who does not want to breastfeed
Newborns are usually very alert within two hours of delivery and will suckle eagerly; later, however, they enter a sleep phase and some spend several hours like this without claiming the feedings. It is important to be on the lookout for possible signs of hunger. Many parents wonder whether or not they should wake the baby.
Although the pediatrician can give you certain guidelines depending on each baby, in general it is recommended to wake the baby if more than 3 or 5 hours have passed since the last feeding. Gentle stimulation, a diaper change, and / or undressing is usually effective for this. If the baby latches on to the breast but the suction is poor, we can compress the breast during the suction to help the milk come out.
Sometimes it is necessary to drop a few drops of breast milk into the mouth to stimulate sucking; We can do it with a syringe, with a finger-syringe (finger-feeding) or by placing a probe on the chest.
10. Ankyloglosia
The lingual frenulum is a band of tissue that connects the tongue to the floor of the mouth. When it is very short it can hinder the movement of the tongue and we speak then of ankyloglossia, which literally means “anchored tongue” .
Some babies with a short frenulum do not have difficulty breastfeeding; In others, however, this does pose a problem: they take very long feedings (because they cannot effectively express milk) and injure the mother’s nipple.
Babies with braces need to be assessed by a lactation expert; many benefit from correcting the latch on the chest and using certain positions (eg rocking horse). If, despite this, there are still difficulties, the frenulum should be cut to free the tongue ( frenotomy ); many times it can be done in consultation by cutting with scissors.
11. Lactation crisis
Lactation crises are periods in which babies need to increase the amount of milk and, for this, they demand more frequent feedings. They usually occur at 2-3 weeks, 6 weeks, 3 months and 6 months, but the dates will vary depending on each baby.
The three-month crisis is especially important since in many cases it leads to weaning. At this point, the mother’s breast is no longer as full, because much of the milk is produced during feeding; Furthermore, babies have become adept at suckling and only stay at the breast for a few minutes; Finally, from this age they do not gain as much weight, which can lead mothers to think that their milk production is decreasing.
The solution is none other than to continue doing what has been done: breastfeeding on demand . It is important to know that they exist and that they will be resolved in a few days (usually within a week). And, in case of having doubts about the correct growth of the baby or about our milk production, consult a lactation expert before making any decision .
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