Common breastfeeding concerns

Breastmilk is a complete source of nutrition for babies that changes to meet their needs as they grow. It provides all the nutrients a growing baby needs during their first six months and beyond.

Colostrum

In the first two to five days after birth, the breasts will make a thick, sticky liquid called colostrum.

Colostrum contains nutrients, good bacteria, and antibodies that support newborn babies in their first few days of life. 

Colostrum will slowly change to milk over three to five days after birth. This slow change can help give babies, giving babies time to learn how to latch and suck at the breast.

Breastmilk

Breastmilk is generally made of two parts:

Foremilk is cloudy and can look slightly blue. It is the milk that comes at the beginning of each feed. Foremilk is lower in fat and higher in water, which helps to keep your baby hydrated.

Hindmilk is a creamy, white milk that comes after the foremilk. It is higher in fat and calories and helps satisfy hunger and meet your baby's nutritional needs. 

Babies will generally set the pace for their feeds and regulate how much they need each time. If you are unsure, speak to your health professional for support.

Breastfeeding can look different for everyone depending on things like:

• the size and position of the breasts
• the size and flatness of the nipples
• limitations with body movement
• physical or health issues that can affect a baby’s latch.

Generally, the basic steps for breastfeeding are:

1. get into a comfortable position where your back, arms and feet are supported – for example, a lounge chair or on the bed with pillows behind you
2. remove or open any clothing that is covering the breasts, including your bra
3. hold your baby in a comfortable position at breast level for feeding, for example:

• baby’s head and shoulders on your forearm
• baby’s hips, stomach and chest against your chest
• tucking your baby’s closest arm around your side
• using a pillow to lift and support baby while taking the pressure off your arms.

4. gently touch baby’s cheek to your nipple to trigger the rooting reflex
5. as baby roots and opens their mouth, gently guide them towards the nipple
6. check that baby is latched correctly:
   • mouth covering the dark area around the nipple, called the areola
   • chin touching the bottom of the breast 
   • head is straight
   • lips are turned out, not curled in.
7. when baby is latched to the breast, they should breathe and feed comfortably and unlatch when finished.

Latching your baby to the breast can cause pain and discomfort if it is too shallow or not in the correct position. If you feel like the latch is incorrect, you can break the suction by placing a clean finger in the corner of your baby’s mouth, between the top and bottom gums. 

How often a baby feeds will depend on their individual needs. 

During the first few days of life, newborn babies' stomachs are small, and they will need smaller feeds more often. Newborn babies may feed frequently, every one to three hours or so.

Newborn babies need to be fed on demand to: 

• help them grow
• help regulate your milk supply.

Feeding on demand means feeding your baby whenever they show hunger cues, like crying or rooting, during the day and night. 

As your baby grows, their stomach will get bigger, they will consume more milk at each feed, and they may become more predictable or regular when they want to be fed.

Parents cannot see how much milk their baby drinks at each feed, so they may feel anxious about whether their milk supply is enough.

Babies can also experience periods of rapid growth during which they want to feed more. This is called cluster feeding.

Cluster feeding is normal and is not a sign that your milk supply is low.

Milk production is supply and demand, meaning it will continue to be produced as long as it is regularly removed from the breast through feeding or expressing.

Signs that your baby is getting a good supply of milk include:

• having six to eight wet cloth or five to six wet disposable nappies per day
• having soft bowel movements that seem to pass easily
• healthy looking skin
• good muscle tone, and are not “floppy” 
• being alert and not wanting to feed constantly, outside periods of cluster feeding.

If your supply is low, you can try the following strategies:

• breastfeeding more frequently
• expressing using your hand or a pump between feeds
• letting your baby finish feeding from the first breast before offering the second breast
• look after yourself with rest, nutritious food and plenty of fluids.

There are some medications and nutritional supplements that can help with milk production. Speak to your health professional for more information and support.

Engorgement is when the breast tissue is overfilled with milk and other fluids.

When breasts are engorged, they can become:

• painful
• hard
• difficult for your baby to latch onto.

Engorgement can happen:

• in the first two to five days after birth, when your milk comes in
• when there is too much time between feeds or expressing
• when there are changing to feeding schedules, like weaning.

engorgement is usually temporary. It can be managed by:

• wearing a well-fitting, supportive nursing bra or crop top
• using cool packs or nipple pads between feeds
• using over-the-counter pain relief, like paracetamol
• hand expressing or using massage for comfort before or in between feeds
• feeding your baby on demand and expressing regularly if your baby cannot feed at the breast.

Signs of blocked ducts include an engorged or lumpy area on the breast, soreness and redness. If you have blocked ducts:

• rest as much as you can and keep feeding your baby. Hand express between feeds if necessary
• apply warmth to the affected area before feeding. Feed from the affected breast first while gently but firmly massaging the lump towards the nipple (also do so after feeding).
• changing your baby’s feeding positions may help drain the ducts
• if not cleared within 12 hours, you have a fever or are unwell, ask for advice from a lactation consultant, child and family health nurse or your local doctor.

Nipple pain can be common and can be caused by:

• a shallow or incorrect latch
• sensitive nipples
• nipples that are too flat or inverted
• infection.

Nipple tissue can also tear and crack during feeding, especially in the first few months as you adjust.

To help sore nipples:

• use a nipple balm, coconut oil or expressed breastmilk to soften and lubricate the nipple before feeding
• apply a warm cloth to the breasts
• rest the sore nipple and offer the breast that isn’t in pain
• use hindmilk, coconut oil or a nipple balm after feeding 
• let nipples air dry in between feeds
• use soft, cloth breast pads or gel nipple patches in between feeds
• on the nipple after breastfeeding and let it air dry
• take a break when the pain becomes too much and feed baby with expressed breast milk in an open cup, bottle, or spoon.

If the pain continues or you need help with latching your baby, speak to your health professional.

Milk ducts are tiny tubes that carry milk from the breast and out through the nipple. When the tissue in and around the milk ducts becomes swollen and inflamed, the milk cannot travel through properly and builds up. This causes pain and swelling and can lead to infection.

Blocked ducts are common and can be caused by:

• skipping breastfeeds without expressing 
• going too long between feeds
• periods of change to feeding schedules, like weaning 
• issues with baby’s latch
• pumping or expressing breastmilk     
• feeding too much from one breast and not enough from the other.

Symptoms of a blocked duct include:

• a hard, painful lump in the breast
• pain and swelling in one particular part of the breast
• pain or discomfort that gets better after feeding or expressing milk
• pain during a let-down when the milk starts to flow.

You can manage blocked ducts at home by:

• resting
• expressing milk with your hands for comfort in between feeds 
• using a warm washcloth or breast pad on the affected area before feeding
• using gentle massage on the lump during and after feeding
• changing your baby’s feeding position

Speak to your health professional if you:

• cannot clear the blocked duct after 12 hours
• develop a fever
• feel unwell.

Mastitis is the inflammation of breast tissue, which can be caused by an infection or a blocked duct. 

Mastitis causes symptoms similar to a blocked duct, including pain and inflammation.

It can also cause:

• flu-like symptoms, including fever and chills
• redness in the breast with a shiny or streaky appearance
• a hot feeling.

Mastitis can happen quickly and, if not treated, develop into a severe infection or abscess. An abscess is a painful pocket of pus and bacteria that builds up under the skin and causes infection to spread.

See your local doctor as soon as possible if you think you have mastitis, as you may need antibiotics to treat or prevent infection.

You can manage the pain and swelling like a clogged duct. Remember to feed on demand to help empty the breast and reduce swelling.

Engorgement happens  when your breast stretches and swells, as milk production increases. To treat engorgement:

• young infants may feed 8 to 12 times in 24 hours, including several times overnight
• massage breasts and express milk before feeding to soften the areola and help attachment. If having trouble, express under a warm shower or with a warm compress.
• use cold packs between feeds for relief
• use pain medicine if you are sore
• ask for advice on pain relievers from a lactation consultant, child and family health nurse, your doctor or the Australian Breastfeeding Association.

Breast refusal is when your baby does not want to feed from the breast. This is usually temporary and can depend on things like:

• how old they are – babies may get fussy through different developmental stages, like becoming more distracted by their environment as they get older
• how they have been feeding – babies can find it easier to feed from a bottle and may not want to work for their milk at the breast
• their general health – ear infections, thrush and other health conditions can affect the way a baby feeds
• your milk flow – things like a forceful let-down or oversupply of milk can make it difficult for babies to latch and feed.

Breast refusal can be frustrating and distressing for babies and parents, but it is usually temporary. Try to avoid forcing the nipple into your baby's mouth, and make sure you keep expressing or pumping milk at times when your baby would normally feed.

Strategies for breast refusal

If your baby is refusing the breast, you can try:

• feeding in a quiet, calm environment like a bedroom
• singing, rocking or massaging your baby before feeds
• timing feeds with when your baby is sleepy, just after they wake up or right before they go for a nap
• changing your baby’s feeding position
• having lots of skin-to-skin time outside of feeding
• using an SNS line or an open cup to feed expressed milk.

Pace feeding

If you feed your baby from the breast and a bottle, make sure you pace feed.

Pace feeding slows down the milk flow from the bottle to help your baby feed more slowly like they would at the breast.

Pace feeding involves:

• using a bottle with a slow-flow nipple
• encouraging your baby to latch onto the bottle nipple like they would a breast
• holding the bottle horizontally to the floor
• tipping the bottle back down after every 3-5 swallows for a few seconds to give your baby a break.

Speak to your health professional if you are struggling with breast refusal.

See your local doctor as soon as possible if you are worried that your baby is unwell.