Breastfeeding – Overcoming some common challenges

For some lucky women, nursing clicks right away. The baby latches and it is smooth sailing. For many women, however, learning to nurse can be a long and arduous journey. Nursing was challenging for me from day one.  I was hopeful when we left the hospital that everything would come together soon.  Unfortunately, nursing remained painful for a long time.  I visited with hospital based-lactation consultants, lactation specialists in the community, attended a breast feeding support group, talked with my pediatrician and obstetrician and still found myself failing (in my eyes) at breastfeeding my son. My husband and mom told me I was doing a great job and that it would be ok to be done nursing.  But I wasn’t ready to quit…and suddenly around 8 weeks after my son was born things started to click. I am not sure what the “magic fix” was, only that slowly the pain subsided and I found myself enjoying nursing more and more.  In the end I was able to successfully breastfeed for more than a year. I could not have even imagined that possibility in the early weeks.  For women who are struggling with nursing it can be difficult to pinpoint exactly what is causing the problem.    Here are some of the common challenges facing nursing moms.

The latch- Breastfeeding experts often make it sound so easy.  But, for many moms and babies Kathleen-nursinglearning how to identify and create a “good” latch can be a challenge.  When a baby’s latch is too narrow or their lips are not turned out it can lead to painful nursing and damage to moms’ nipples.  Often there will be some pain when baby first latches on in the early weeks; however, this should subside once the let-down occurs.  If nursing continues to be painful or the pain increases throughout the nursing session a poor latch may be the culprit.   If you are having problems with latching it is a good idea to make an appointment with a lactation consultant or investigate community lactation resources.  An experienced lactation specialist should be able to help you both identify problems and correct the latch if needed.  A good review of latching can be found at.

Plugged duct – A plugged milk duct can be very painful and if untreated can lead to mastitis. It is very common in the early weeks when the milk is first coming in, but it can occur at any time while a mother is nursing.  Women usually note a hard painful lump or swelling in their breast tissue. Frequent nursing on the affected side is very important to help relieve the blocked duct. Applying a warm compress and massaging the area during feeds can also be helpful.  It can help to nurse in a variety of positions. Many women have luck relieving the pugged duct if they position the baby’s chin in the same direction of the plugged duct during the feeding.

Mastitis- Mastitis is a bacterial infection of the breast tissue. It occurs most frequently in the early weeks, but can occur months into nursing as well.  It often occurs after a change in milk supply or production- such as after mother’s milk comes in or during weaning. It may result from a plugged milk duct or a crack in mom’s skin. Symptoms often include fever, redness or streaking on the breast, and swelling and tenderness of the breast. If you think you might have mastitis you should call your physician immediately. Mastitis needs to be treated with antibiotics. You should continue to nurse through the infection. The infection will not be transferred to your baby and continued nursing will help relieve pressure and swelling and open any blocked ducts.

Yeast Infection: Yeast infections are common in the early weeks. Often the first signs of yeast infection will be seen in the baby. The baby will develop whitish plaques inside the mouth that do not easily wipe off. In some cases, babies will not have any symptoms but mom will notice painful nursing sessions and discoloration of the nipple. Both mom and baby need to be treated in the event of a yeast infection and all pumps, bottles, and other nursing equipment needs to well cleaned and sterilized. For mild yeast infections both baby and mother can be treated with topical type treatments; however, in more severe cases mom may need to be treated with an oral antifungal agent.  If you suspect you or your baby may have a yeast infection you should discuss treatment options with your physician.

Lanolin Allergy- Some unlikely women are sensitive or even allergic to lanolin. This can cause a rash and itchy skin. It can also lead to painful nursing. Women who have allergies to wool are at increased risk because lanolin cream is derived from wool. Most women who have mild to moderate sensitivities to wool will still tolerate lanolin cream.

Tongue Tie- Babies with a short frenulum or “tongue tie” often have problems with nursing.  Tongue tie occurs when the tongue is attached too tightly to the bottom of the mouth. Babies often are unable to extend their tongues beyond their gums or teeth. This can lead to a variety of problems with breastfeeding including poor weight gain in baby, fussiness, and painful nursing sessions. Most lactation consultants and pediatricians can diagnose tongue tie. Generally, it is only considered a problem in breastfed babies. Most bottle fed babies are able to feed without difficulty regardless of whether they have short frenulum. When necessary the frenulum can be clipped by a pediatrician. This usually takes place in the nursery or pediatrician’s office.

So if you’re struggling to nurse, don’t give up right away. Sometimes it takes time to identify the problem and work through it.

Sarah Lenhardt, MD About Sarah Lenhardt, MD

Sarah J. Lenhardt is an Instructor in Pediatrics at Washington University School of Medicine. She cares for children at St. Louis Children’s Hospital, Missouri Baptist Medical Center, and at Progress West Healthcare. She attended the College of Saint Benedict in St. Joseph, MN and Creighton University in Omaha, Nebraska. Dr. Lenhardt completed a residency in Pediatrics at the University of Minnesota and worked as a general pediatrician in Minnesota before joining the faculty at Washington University. She is a board Certified pediatrician and a member of the American Academy of Pediatrics. Her special interests include preventative care, integrative medicine, and breastfeeding. Dr. Lenhardt enjoys spending her free time with her husband and 1 year old son.

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