Inverted Nipples

Before your baby is born, check your breasts for flat or inverted nipples. Place your thumb and forefinger around your areola in a “C” shape, about an inch from the base of your nipple, and gently press thumb and forefinger together. Your nipple should project outward. If your nipple pulls back into the breast or stays flat, seek advice from your doctor, or a certified lactation consultant.

Wearing plastic breast shells (see Breastfeeding Basics) during the last months of pregnancy may help your nipples project outward. However, some authorities suggest that a baby who is attached to the breast correctly (see When and How to Start Breastfeeding, Positioning) will breastfeed effectively regardless of the size or shape of mother’s nipples. Either way, it will be helpful for you to understand proper positioning and talk to a breastfeeding counselor or healthcare provider about this issue before your baby is born.

Engorgement

An uncomfortable fullness in the breasts that may cause your breasts to feel hard, hot, and painful may occur because baby is not removing enough milk. To eliminate this engorgement, breastfeed your baby more frequently or use a breast pump. Pumping to comfort or pumping only a few minutes, just long enough to make your breasts comfortable, will not produce an oversupply of milk. Applying cold compresses between feedings and/or warm compresses and circular massaging just before and during feedings may also be helpful.

Sore Nipples

Sore nipples are a common complaint at first. This may be a new experience for you, and it may indicate that your baby is not positioned properly at the breast (see When and How to Start Breastfeeding, Positioning). If the pain subsides in a minute and you are comfortable for the rest of the breastfeeding session, there’s nothing to worry about. If not, call a health professional for suggestions.

Causes of sore nipples include:

•	Baby’s latching on too close to the nipple, not taking enough areolar tissue.
•	Baby’s lower lip is tucked in instead of flanged out.
•	Baby slurps the nipple into his mouth instead of opening wide to accept the breast.
•	Baby’s gums rub against the nipple when coming off the breast.
•	Baby puts stress on the tissues and causes soreness by trying to draw out inverted or flat nipples during the early days/weeks of breastfeeding.
•	Moisture remains on an inverted nipple for a prolonged period.

Suggestions:

•	Improve baby’s latch on.
•	Ask for help from a lactation professional.
•	Allow baby to finish the first breast before offering the second.
•	If nipples are sore, express a little breast milk and apply it gently to the nipples after breastfeeding, or apply Lansinoh® lanolin to aid in the healing process and protect against chafing.
•	Try a different breastfeeding hold position.

Plugged Ducts

Too much milk remaining in the breast may cause a plugged duct. This can happen for a variety of reasons and may result in a sore spot on your breast that is red and slightly warm to the touch.

Treatment measures for a plugged duct include:

•	Wearing loose clothing and a bra that doesn’t bind.
•	Getting plenty of rest.
•	Nursing as often as baby will cooperate and/or pumping between feedings.
•	Nursing baby 8-12 times every 24 hours.
•	Applying moist or dry heat to the sore spot before nursing.
•	Starting every nursing session on the breast with the sore spot.
•	Positioning baby so his chin lines up with the sore spot.
•	Massaging the sore spot during breastfeeding.

Breast Infection

If you develop other symptoms, such as a fever, chills, achiness, or soreness in the breast that is generalized instead of in one spot, you may have a breast infection, also known as mastitis. Contact a certified lactation consultant, or healthcare provider for advice. Some breast infections will go away with the same treatment as you would use for a plugged duct.

If your symptoms persist, or if you have a high fever, you may need an antibiotic prescribed by your healthcare provider. Most antibiotics are safe to take while breastfeeding, but discuss this issue with your healthcare provider to be certain.

Is Baby Getting Enough Milk?

Weight gain is the most accurate way to tell if your baby is getting enough milk, so weigh your baby. A normal weight gain is approximately four to eight ounces per week. As your baby becomes a little older, the increase in weight will become more obvious. If you’re concerned about your baby, talk to your healthcare provider or a breastfeeding counselor.

Also, keep track of your baby’s diaper changes since what goes in must come out. At first your baby will have only one or two wet diapers per day. After your milk supply increases, baby should have five to seven wet diapers (six to eight if using cloth diapers) and three to five bowel movements every day. Some babies may have a small bowel movement with every diaper change.

The first bowel movements will be dark black, with a tarry consistency. Both color and consistency will change within a day or two of your milk supply increasing. The color of a breast milk stool is most often a mustard-yellow, but it can vary from tan to yellow to yellow-green. The consistency is loose and seedy and will remain this way as long as your baby is receiving only human milk. In addition, while nursing, your baby should swallow after every couple of sucks, so listen for swallowing. Other indicators include your breasts becoming softer after feedings, your baby’s skin feeling smooth and firm, and baby seeming satisfied after feedings.

However, if your baby shows any of the following signs, contact your healthcare provider immediately:

•	Weak cry.
•	Skin with no resiliency (when pinched it stays pinched looking).
•	Dry mouth and dry eyes.
•	Less than the usual amount of tears.
•	Minimal urine output (less than two wet diapers in 24 hours).
•	Fever.
•	Fontanel (soft spot) on the baby’s head is sunken or depressed.

If you previously had breast surgery, be sure to tell your healthcare provider. Many mothers have been able to fully breastfeed their babies after breast surgery. However, it is important that your healthcare provider be aware of your history and past breast surgery(ies) so that you and your baby can be monitored closely to make sure your milk production is good and baby is gaining weight.

Increasing Your Milk Supply

The amount of milk you produce is dependent on how much and how frequently milk is removed from your breasts. As baby’s demand increases, your body will increase its supply, but you might find the following suggestions helpful if you are concerned about your milk supply:

•	Nurse baby at both breasts at every nursing session.
•	Nurse baby twice at each breast at each nursing session.
•	Use the lying down hold occasionally so you rest while baby nurses.
•	Nurse at baby’s earliest cues.
•	Drink plenty of fluids (based on your individual needs).
•	Use a breast pump between feedings.
•	Refer to a certified lactation consultant for a complete breastfeeding evaluation.

Baby Constantly Awakens at Night

There are many reasons a baby wakes at night. You may have a newborn who is a light sleeper and is easily awakened. Plus, human milk digests twice as fast as formula, so breastfed babies get hungry more often than bottle-fed babies.

Baby Is Always Sleepy

Some medications used during labor and delivery may cause baby to become extremely sleepy. If baby sleeps constantly in the first week, it’s important to wake him to nurse so your milk supply will become established and baby grows and gains weight normally. Try nursing frequently at night when it is quieter. Contact another mother or breastfeeding counselor for tips on waking a sleeping baby.

Breastfeeding and Mother’s Medications

Most antibiotics and pain medications are compatible with breastfeeding. However, you should always discuss any medications with your healthcare provider or pharmacist.

The possible risks of a medication, whether a doctor’s prescription or bought over the counter, should be weighed against the risks of weaning and providing artificial milk.

Baby Seems Full of Gas

You may have heard that babies react to foods in their mothers’ diets but this is fairly rare. Infant formula is far more likely to cause some type of problem rather than a reaction to mother’s diet.

Infant massage often helps soothe a baby who appears to have gas, so you might read books on infant massage to find a technique that your baby likes. You also might try the colic hold to see if it helps baby become more comfortable. Drape your baby face down over your forearm with his head at the crook of your elbow, your hand supporting his midsection, and his legs dangling down.

When to Ask for Breastfeeding Help

Seek help when:

•	Your newborn has fewer than five to seven really wet diapers, or three to five bowel movements each day, even after your milk supply increases in the first week.
•	Baby’s urine is a dark color or has a strong odor.
•	Nipple or breast soreness becomes worse and persists between feedings.
•	Breastfeeding becomes painful. (A little pain at the beginning is normal, but it should fade as your baby learns to breastfeed.)

Alcohol and Tobacco

Avoid moderate to heavy alcohol consumption and tobacco products while breastfeeding. Both can interfere with let-down, decrease milk supply, and quickly transfer to the breast milk.

Supplements and Artificial Nipples

Supplements of water or artificial milk (formula) in the early weeks of breastfeeding can contribute to a poor milk supply, prolonged engorgement, jaundice, or cow’s milk allergy or intolerance—problems for both you and your baby.

Avoid artificial nipples and pacifiers because they can confuse your baby when he’s learning how to breastfeed. A baby uses mouth and tongue differently when taking a bottle or pacifier versus a human breast. Among other things, artificial nipples are firmer than your breast, and a baby holds them in the front of his mouth. If baby does the same thing while breastfeeding, he may not use enough suction and he won’t get as much milk. Your nipples may become sore in the process. Some very sensitive babies even refuse to breastfeed after using artificial nipples.

Since there is no way to tell ahead of time whether your baby will be able to switch back and forth easily, it’s best to avoid artificial nipples until your baby has been nursing well for at least three or four weeks and the likelihood of confusion is reduced. If you need to feed your baby other than at the breast, use an alternative to bottles, such as a spoon, eyedropper, or small feeding cup. Consult a knowledgeable breastfeeding counselor about these options.

Newborns with Special Challenges

Ask your doctor for advice with special circumstances such as babies born prematurely, multiple births, cleft lip or palate, or lactose intolerance.

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