Common breastfeeding problems can often be resolved by providing parents and carers with the right information and assistance. By asking appropriate questions, healthcare professionals can identify if parents are experiencing breastfeeding difficulties and can provide appropriate support. If a mother requires assistance with breastfeeding issues not discussed here, seek further help.
Approximately one third of mothers think that they don’t have enough milk, and will introduce infant formula. There are a number of reasons mothers may believe they have insufficient milk:
- The baby is unsettled
- The baby is constantly feeding
- The baby is not sleeping through the night
- The breastmilk looks watery
- Between 6-12 weeks after birth, breasts may become softer, smaller and stop leaking.
Each mother and baby is different and the above signs can differ between individuals, while still being normal. Parents need to be informed about what to expect and how to check their babies for signs they are getting enough milk.
What causes low milk supply?
There are different reasons why a mother may experience low milk supply. If signs of low milk supply have been identified, explore the following with the parents:
- Perception of the mother that she doesn’t have enough breastmilk for her baby (“my milk dried up” –occurs frequently)
- Baby not attaching well to the breast
- Breast refusal
- Baby not feeding often enough at the breast
- Frequent use of dummies or introduction of complementary feeds (e.g. infant formula, solids)
- Missing night feeds
- Health conditions of mother.
Management of low milk supply
Once the cause of low milk supply is identified, health professionals can provide assistance and advice or refer to an appropriate healthcare provider for assistance. Encourage mothers to:
- Ensure the baby is well attached to the breast and feeding at least 8 times per day
- Hold baby in skin-to-skin contact
- Encourage the baby to feed well on the first breast before offering the second breast
- Express milk after feeds to maintain or increase supply
- Give the baby dummies infrequently
- Eat a healthy well balanced diet based on a range of healthy foods and plenty of water
- Find time to rest
- Avoid herbal preparations to increase milk supply (e.g. fenugreek) as their effectiveness and safety have not been established.
Breastfeeding can be a little sensitive for the first few days; this is partly to do with hormones. However, breastfeeding should not be painful through a whole feed, or continue to be painful over time.
Cracked or bleeding nipples can be painful but often heal quickly. This is often a sign that the baby is not attached to the breast correctly.
To prevent or treat pain when breastfeeding, discuss the following with the breastfeeding mother:
- Ensure the baby is well attached to the breast and not just attached to the nipple.
- Apply warm water compresses or small amounts of expressed breastmilk on the nipple after feeding and air dry.
- Replace damp breast pads frequently, if used.
- Avoid using shampoos, soaps, ointments and powders on the nipples.
- If there is a need to rest breasts, the mother may consider expressing breastmilk to keep up supply.
If breastfeeding continues to be painful, or there is nipple damage, mothers should be advised to seek expert help to identify and treat the cause of pain.
About three days after having a baby, many mothers will experience breast ‘fullness' as their milk 'comes in'. This ‘fullness’ usually only lasts for 24 hours, however may develop into engorgement, where the breasts become swollen and tender. Engorgement is common, particularly when establishing breastfeeding, but needs to be managed. Early initiation of breastfeeding, with frequent and unrestricted feeds can assist in preventing full breasts and engorgement.
Signs of engorgement
- Breasts full and painful
- Swelling down to areola (brown part) of breast
- Baby unable to attach to breast because of fullness.
What causes engorgement?
- Limiting the time or frequency babies feed at the breast
- Using dummies to extend time between breastfeeds
- The baby not being attached well to the breast.
How to treat engorgement
Health professionals can provide assistance by discussing the following with mothers or parents:
- Offer frequent and unrestricted feeds
- Apply warmth before a feed
- Express a small amount of milk before feeds or apply reverse pressure softening to make breast softer
- Allow the baby to completely empty the first breast before offering the second, alternating between what breast is offered first at each feed
- If the mother is separated from the baby, complete expression is necessary
- If engorgement persists, completely drain both breasts with an electric pump after a feed
- Over-the-counter pain medications may be required in some circumstances.
Mastitis is an inflammation and/or infection of the breast tissue. Mastitis can be caused by:
- A blocked milk duct
- Ongoing nipple damage
- Milk oversupply that is ongoing
- The baby not being attached well to the breast
- Poor overall health (stress, fatigue, poor nutrition).
Signs of mastitis
- An area on the breast that is red and swollen
- Breast feels hot
- Skin on breast may look tight, shiny and red
- The mother may feel unwell with flu type symptoms, including shivers and aches.
Management of mastitis
Refer the mother to a doctor for treatment immediately. This will likely involve commencement on antibiotics. In addition, it is recommended that the mother:
- Continue breastfeeding (or expressing) to avoid complications
- Feed frequently, starting with offering the affected breast. Unless instructed otherwise, the milk from the affected breast is safe for the baby, even when the mother is taking antibiotics
- Begin expressing the affected breast, if unable to attach the baby to that breast. (If the milk is not removed, a breast abscess may form, requiring hospitalisation and possibly surgical drainage.)
- Get plenty of rest and drink plenty of fluids.
If a mother decides she no longer wants to breastfeed to reduce the risk of complications from the mastitis, it is recommended that she continue to express until the mastitis is gone, and then wean gradually.
- Child and Youth Health Practice Manual, Queensland Government (PDF, 3.6MB)
- Infant Feeding Guidelines: Summary (PDF, 825kB)
- Infant Feeding Guidelines: Information for health workers
- Australian Dietary Guidelines (Refer to section 4: Encourage, support and promote breastfeeding)