Hesperian Health Guides
Common Concerns and Problems
Fears
Being afraid you do not have enough milk is very common, but is almost never true. Even those who do not have enough to eat can generally make enough milk for their babies.
The amount of milk your breasts make (your milk supply) depends on how much the baby suckles. The more the baby suckles, the more milk you will make. If you skip a feeding and give a bottle instead of breast milk, your body will make less milk.
Some days it may seem like the baby is always wanting to breastfeed. If you feed your baby whenever it wants, your milk supply will increase. In a few days the baby will probably seem satisfied again. Night feeding helps to build up the milk supply. Try not to believe anyone—even a health worker—who says you do not have enough milk.
Breasts do not have to feel full to have milk. The more babies you have breastfed, the less full your breasts will feel. Small breasts can make as much milk as large breasts.
A baby is getting enough milk if:
- it is growing well and seems happy and healthy.
Babies more than 2 weeks old may not pass stool every day. If the baby is feeding well, wetting, and seems content, the stool will come.
- it wets 6 or more times, and dirties the diaper (nappy) about 1 to 3 times, in a day and night.
You can usually tell this after the baby is 5 days old, when the baby will start to pass urine and stool more regularly.
Because breast milk looks different from other milks, some women fear that it is not good milk. But breast milk gives babies everything they need
Nipple concerns and problems
Flat or pushed-in (inverted) nipples
If you have nipples that are flat or pushed-in, you can still usually breastfeed well. This is because the baby suckles on the breast, not just the nipple. You do not need to do anything to prepare your nipples during pregnancy.
If you have flat or inverted nipples or other concerns that make breastfeeding difficult, talk to a midwife, health worker, or someone with similar problems about what to do.
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| average nipple | flat nipple | long nipple | inverted nipple |
To help your baby suckle:
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| Offer the whole breast. This helps the baby get a good mouthful of the breast. |
- Start breastfeeding right after birth, before your breasts become full. Make sure your baby takes a good mouthful of breast.
- If your breasts become too full, remove a little milk by hand to make them softer. This will make it easier for the baby to get more breast in its mouth.
- Lightly touch or roll your nipple before you feed. Do not squeeze it.
- Try cupping your hand around the breast and pushing back to make your nipple stick out as much as possible.
Sore or cracked nipples
If you feel pain from breastfeeding, the baby probably does not have enough of your breast in its mouth. If the baby suckles only on the nipples, they will soon become painful or cracked. A cracked nipple makes it easier to get an infection. You can teach your baby to take more breast in its mouth. Here are some suggestions.
Prevention and treatment:
Watch for signs of breast infection.
- Be sure to hold the baby so it can get a good mouthful of the breast.
- Do not pull your breast out of the baby’s mouth. Let the baby feed as long as it wants. When it is done, it will let go of the breast itself. If you need to stop before the baby is ready, pull down on its chin or gently put the tip of a clean finger into its mouth.
- Soothe sore nipples with breast milk at the end of a feed. When the baby has stopped feeding, squeeze out a few drops of milk and rub them on the sore places. Do not use soap or cream on your breasts. Your body makes a natural oil that keeps the nipples clean and soft.
- Avoid rough or tight clothing.
- To help sore nipples heal, leave your breasts open to the air and sun for a while each day, if possible.
- Continue to feed from both breasts. If a nipple is very sore or cracked, start on the less painful breast and then switch to the other breast when the milk is flowing.
- If the pain is too great when the baby suckles, remove the milk by hand and feed the baby with a cup or spoon. A crack should heal in a few days.
Pain and swelling in the breasts
Your breasts are too full (engorgement)
When the milk first comes in, breasts often feel swollen and hard. This can make it difficult for the baby to suckle, and the nipples may get sore. If you breastfeed less because of the pain, your milk supply will be less.
Prevention and treatment:
- Start breastfeeding within the first hour after birth.
- Make sure you are holding the baby well.
- Feed the baby often, at least every 1 to 3 hours, and on both breasts. Sleep with the baby nearby so you can breastfeed easily during the night.
- If the baby cannot suckle well, remove some milk by hand—just enough to soften the breast—and then let the baby suckle.
- After feeding, put fresh cabbage leaves or cool wet cloths on your breasts.
After 2 or 3 days, the swelling should go down. If it does not improve, it can become mastitis.
Blocked duct, mastitis
If a painful lump forms in the breast, it may be a duct blocked by thick milk. The stopping of milk flow can also cause mastitis (a hot, painful swelling of the breast). If you have a fever (38°C or 100.4°F or higher) and part of your breast is hot, swollen, and painful, you probably have mastitis. Continue breastfeeding so the duct can empty and your breast does not get infected. Your milk is still safe for the baby.
Breast infection (mastitis with infection)
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| Warm, wet cloths can help with blocked ducts or mastitis. |
If you have had signs of mastitis with no improvement after 24 hours, including a fever of 38°C (100.4°F) or higher, a painful lump in your breast, and body aches, get treatment for breast infection right away
Treatment:
Follow the treatment for blocked duct and mastitis. It is most important to continue breastfeeding often. Your milk is still safe for the baby. Medicines and rest are necessary too. If you can, take time off from work and get help with your household work.
| Medicine for Breast Infection | ||
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| Medicine | How much to take | When and how to take |
| For infection take: | ||
| dicloxacillin | 500 mg | by mouth, 4 times a day for 7 days. |
| If you cannot find this or are allergic to penicillin, take: | ||
| erythromycin | 500 mg | by mouth, 4 times a day for 7 days. |
| For fever and pain, take: | ||
| paracetamol (acetaminophen) 500 to 1000 mg | 4 times a day as needed (do not take more than 4000 mg in a day). | |
| Before taking medicines, see the “Medicines Pages.” | ||
IMPORTANT! If there is no improvement after 2 days, go to a hospital for treatment. If you have a painful lump in your breast (abscess) that did not go away with antibiotics, see a health worker who has been trained to drain an abscess using sterile equipment. | ||
Thrush (yeast)
If the baby is in a good position while suckling and pain in your nipples lasts for more than a week, it may be from thrush on the nipple or in the baby’s mouth. Thrush can cause itchy, stabbing or burning pain in the nipple or breast. You may see white spots or redness on your nipple and in the baby’s mouth.
How to treat thrush:
Cover white spots in the baby’s mouth with nystatin drops. Use 2 full droppers (0.5 ml of nystatin per dropper) 4 times a day. Keep giving this medicine for 2 days after the patches are gone or they may return. If you have itching or pain on your nipples, treat them the same way you did the baby’s mouth, with nystatin drops. Keep breastfeeding. If thrush does not get better in 3 days, get medical advice.