There may be times when breastfeeding is challenging. Never ignore any issues you may have – talk to your health visitor, midwife, GP or breastfeeding specialist as soon as possible, they will be able to help you sort it out quickly. Here are some common breastfeeding issues, and tips on what to do.
Colic usually starts when a baby is a few weeks old – and stops when they're around 4 to 6 months of age.
If your otherwise healthy baby cries inconsolably for 3 or more hours a day, at least 3 days per week (and it's been happening for 3 weeks or more) – it could be caused by colic.
Colic is a very common condition affecting 1 in 5 babies, regardless of if they are breast or formula-fed. As a parent of a colicky baby, it can be exhausting and extremely upsetting – but it will stop. It's also important to remember that you need to be looked after too – if possible ask family and friends for their support so you can take regular rest breaks.
If you are finding it difficult to cope, there are support groups like Cry-sis (originally set up by a group of parents who had problems with their crying and sleepless babies) who offer support and advice. Call 0845 122 8669 (9am-10pm, 7 days a week).
Sadly there is no actual cure for baby colic, only methods to provide relief and soothe them. And you may find that what works one day, has no effect the next. These are some of the tried and tested techniques that other parents use:
Burp (or wind) your baby during and after every feed – have a look at burping your baby for techniques.
When breast or bottle feeding, sit your baby up as straight as possible. This will help minimise the amount of air they swallow. If you are bottle feeding, try to make sure the milk fills the teat and there are no air pockets – you could try using an anti-colic bottle to see if that helps.
During bouts of crying, hold your baby to your chest so they can feel and hear your heartbeat.
Sometimes the swaying motion of rocking your baby in your arms can help.
A warm bath can be soothing, followed by a gentle tummy massage (with gentle, circular strokes on the tummy).
Babies can become overstimulated with lots of noise and activity around them. Try to quieten your surroundings, switch the TV off, dim the lights, and try to take some deep breaths yourself.
Constipation makes it more difficult for your baby to have a poo. It's often caused by their diet and is easy to treat from home.
The symptoms of constipation in your baby can include:
Other signs of constipation can include your baby lacking energy and being a bit grizzly.
There's no 'normal' when it comes to how often babies poo – breast-fed babies will sometimes go several days, or even a week without having a poo (this is more common in babies aged 6 weeks or older). You'll quickly get used to your baby's bowel movements, so you'll be able to tell what's normal for them.
If your baby's constipation is caused by a lack of fibre or dehydration, then it should be fairly straightforward to relieve. Here are some tips on helping relieve constipation at home:
It may take a few days to get things moving again, but if things don't improve, speak to your health visitor or doctor. Your doctor may prescribe a laxative, or want to double check that it's not being caused by any underlying medical conditions.
If you are breastfeeding and experiencing horrible sharp, shooting pains in both breasts, this could be caused by thrush. It can make breastfeeding very painful, but don't worry – it’s easily treated.
Thrush is a fungal infection in the breasts. It's easily spread, and if you are breastfeeding, you and your baby can pass it back and forth to each other. The fungus (candida albicans) is a normal part of our bodies - we all carry it – but usually, good bacteria keeps it under control. The perfect environment for thrush to grow and spread is somewhere warm and moist – breastfeeding creates this perfect environment.
A thrush infection can happen if your nipples are sore or cracked (making it easier for the infection to get into your nipple or breast). And sore, cracked nipples can be caused if your baby isn't latching on properly.
It's worth remembering that a thrush infection may not be the cause of nipple pain, it could be that your baby simply isn't latching on properly. If you think this could be the case, ask your health visitor or lactation specialist for guidance.
If you are breastfeeding and have the following symptoms, it may be thrush. Make an appointment with your doctor as soon as possible.
If you think your baby has thrush, make an appointment with your GP as soon as possible. Signs of thrush in babies include:
Read more about oral thrush in babies.
Your doctor may want to take swabs from your nipple and your baby's mouth. If it is a thrush infection, you may be prescribed an antifungal cream or tablets. The cream needs to be applied to your nipples after every feed. If your baby has thrush, your doctor will prescribe a gel or cream to apply to the infected area.
Thrush spreads easily (and can spread to other members of the family) so you'll need to be extra careful with hygiene. Things you, and everyone else in your household should do:
Yes, carry on breastfeeding if you can. If you can't because it's too painful, try expressing your milk instead. You can give your baby freshly expressed milk, but throw away any leftovers – and don't freeze it, freezing does not kill off the thrush and you could re-infect your baby. If you are in the early days of breastfeeding, it's very important to continue breastfeeding, or expressing your milk. By pausing, or taking a break, you'll reduce the amount of breastmilk you produce.
Read more about thrush and breastfeeding.
When you first start breastfeeding, you may have sore or sensitive nipples. This is very common in the first week of breastfeeding, and is usually because your baby is not latching on (positioned or attached) properly. If you do have nipple pain, speak to your midwife, health visitor or breastfeeding specialist as soon as possible - breastfeeding should not be painful!
The most common cause of nipple pain is when your baby doesn't latch on properly. It's very important that you correct this as soon as possible – ask your midwife, health visitor or breastfeeding specialist for help, they will be able to show you how your baby needs to be positioned when feeding. You can also have a look at our step-by-step guide to latching on.
To get your baby into the right position:
Hold your baby's whole body close with their nose level with your nipple.
Let your baby's head tip back a little so that their top lip can brush against your nipple. This should help your baby to make a wide, open mouth.
When your baby's mouth opens wide, their chin should be able to touch your breast first, with their head tipped back so that their tongue can reach as much breast as possible.
With your baby's chin firmly touching your breast and their nose clear, their mouth should be wide open. You should see much more of the darker nipple skin above your baby's top lip than below their bottom lip. Your baby's cheeks will look full and rounded as they feed.
Whatever you do – don't stop breastfeeding! Breastmilk is created on a supply and demand system, so the less you feed, the less you make. If you are finding it really painful to breastfeed, you could try hand expressing to keep up the supply.
tongue-tie - If your baby has tongue tie – when the strip of tissue under your baby's tongue (attaching the tongue to the floor of the mouth) is shorter than normal – this can prevent them from latching on properly.
thrush- (or 'candida') infection can occur when your nipples become cracked or damaged. Symptoms are usually severe pain in your nipples after breastfeeding (it's described as burning or shooting pains) lasting up to an hour. Your doctor can prescribe treatment for you and your baby.
Mastitis makes your breast tissue inflamed and painful. You might notice a lump and some redness around the sore area. Sometimes the inflammation turns into an infection. Mastitis can make you feel achy and run down, with flu-like symptoms or a fever.
Mastitis mainly affects breastfeeding women, most commonly within the first three months of giving birth – but you can also get it if you are not breastfeeding (due to an infection in the breast).
Usually, mastitis affects one of your breasts, but can sometimes affect both. Signs and symptoms of mastitis often develop quickly and can include:
If you are breastfeeding, mastitis is usually caused when the milk in your breast builds up faster than it's being removed. This creates a blockage in your milk ducts (known as 'milk stasis') and can be brought on by:
If you aren't breastfeeding, mastitis can be caused by infection. The infection could happen if your nipples are sore or cracked, or through a nipple piercing.
The main thing to do is carry on breastfeeding (even though it may be extremely painful). By stopping breastfeeding, the blockage will only get worse. Even if you have an infection, breastfeeding won't harm your baby (although your milk may taste a little salty).
Make sure your baby is latched on properly and aim to feed 8 to 12 times a day (including at night). Try putting a warm flannel over your breast before feeding, this will help ease the pain and encourage the let-down reflex.
After feeds, make sure any leftover breast milk is drained by expressing by hand or with a pump.
Don't leave it too long. If you feel that you're not improving and continuing to feed regularly isn't making a difference, see your doctor. They'll be able to assess whether your mastitis is caused by an infection. If it is, you may need antibiotics.
There are various ways you can help ease the pain and inflammation:
Luckily, once it's diagnosed, mastitis is easy and quick to treat. But remember, prevention is better than cure - here are some of the ways you can reduce the risk of mastitis in the first place:
If you'd like some confidential breastfeeding advice, call the National Breastfeeding Helpline 0300 100 0212 (9.30am-9.30pm, seven days a week).
If you catch the early signs of mastitis, it's quick and easy to treat. If the pain continues for more than a few days, it may be a sign that you've got an infection, and it's time to make a GP appointment. Your GP may prescribe a course of antibiotics, which should clear up the infection in a few days.
When your baby brings milk back up during, or just after a feed, this is known as reflux (it's also referred to as possetting or spitting up). Reflux is different to vomiting. If your baby vomits, their muscles contract noticeably. But with reflux, the milk travels back up the food pipe (oesophagus) very easily.
Reflux is very common in the first 3 months, and usually stops by the time your baby is 1 years old.
The muscle at the bottom of the food pipe acts as a kind of door into the stomach - so when food or milk travels down, the muscle opens allowing the food into the stomach. However, while this muscle is still developing in the first year, it can open when it shouldn't (usually when your baby's tummy is full) allowing some food and stomach acid to travel back up again. Acid in the stomach is normal and a necessary part of the digestion process - it helps break down food.
In most babies, reflux is nothing to worry about (as long as they are healthy and gaining weight as expected). However, in some cases (though very few) reflux can cause a lot of pain when strong acid travels up into the food pipe. When reflux becomes painful and it happens frequently, this is known as 'gastro-oesophageal reflux disease' (GORD).
GORD stands for gastro-oesophageal reflux disease. It's more serious than mild, everyday reflux. The strong stomach acid can irritate and make the oesophagus (food pipe) sore and inflamed, which is painful for your baby and may result in them needing medication.
The main signs and symptoms of GORD in your baby are:
These symptoms can lead to your baby not gaining weight, or even losing weight.
Silent reflux can be confusing as there are no obvious signs or clues (such as spitting up). It's when the food travels back up the food pipe – but it's swallowed rather than spat out so is harder to identify. But your baby may display similar symptoms to those of regular reflux.
Baby reflux symptoms include:
If your baby has difficulty feeding or refuses to feed, regularly brings milk back up and seems uncomfortable after a feed, talk to your pharmacist, GP, or health visitor. They'll be able to give you practical advice on how to ease the symptoms and manage it - they may also need to rule out other causes (such as cow's milk allergy).
It might be helpful to keep a record of when your baby feeds, with details of how often and how much your baby brings the food back up, and how often your baby cries or seems distressed. This will help your health visitor or GP decide if your baby needs treatment.
If your baby is putting on weight normally and is otherwise healthy despite the reflux, no treatment is necessary. However, if your doctor feels the reflux is a problem, they may offer medication.
While there aren't really any remedies, there are some ways you can help with your baby's reflux:
Tongue tie can make it harder for babies to breastfeed (and sometimes bottle feed). It's when the strip of tissue, called 'the frenulum' (attaching the tongue to the floor of the mouth) is shorter than normal. Tongue tie can prevent your baby from latching on properly – which can then lead to sore or cracked nipples.
Cases of tongue tie can range from mild to severe. If severe, the tongue may be completely fused to the floor of the mouth. You may be able to see if your newborn or baby has tongue tie by looking into their mouth when they're yawning or crying, although it's not always easy to spot. Signs of tongue tie in your baby might include:
Sometimes, babies with tongue tie have no problems at all. They may still be able to latch on and feed well – so not every case of tongue tie needs treatment.
If your baby does have tongue tie, it will hopefully be picked up in the first routine check by your midwife. However, tongue tie is not always easy to spot and may be discovered at a later stage (usually after feeding issues become apparent).
This is when the tongue tie is at the back of the mouth, rather than the tip of the tongue. This is rare and harder to spot.
If treatment is necessary, your baby will have a straightforward procedure called a 'frenulotomy'. This is carried out by specially trained doctors, nurses or midwives – and is very quick (it takes a few seconds). Generally, no anaesthetic is used. The surgery simply involves snipping the short, tight piece of skin connecting the underside of the tongue to the floor of the mouth. As soon as it's done, you can feed your baby (which helps to heal any bleeding).
Read more about tongue tie.
The Association of Tongue-tie Practitioners (ATP) has a directory of NHS tongue-tie practitioners.