Breastfeeding issues

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

Colic usually starts when a baby is a few weeks old – and stops when they're around 4 to 6 months of age.

babyCrying.jpg

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.

Symptoms include:

  • intense crying, lasting several hours
  • clenched fists, arched back, knees being pulled up to tummy
  • red or flushed face when crying
  • inconsolable – nothing you do seems to make it better

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).

How to soothe a colicky baby

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:

Burping

Burp (or wind) your baby during and after every feed – have a look at burping your baby for techniques.

Sit your baby up

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.

Hold your baby

During bouts of crying, hold your baby to your chest so they can feel and hear your heartbeat.

dadHoldBaby.jpg

Rock your baby

Sometimes the swaying motion of rocking your baby in your arms can help.

Warm bath and a massage

A warm bath can be soothing, followed by a gentle tummy massage (with gentle, circular strokes on the tummy).

Create a calming atmosphere

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

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.

How can I tell if my baby is constipated?

The symptoms of constipation in your baby can include:

  • pooing fewer than 3 times in a week
  • finding it difficult to poo, and poos that are larger than usual
  • dry, hard, lumpy or pellet-like poos
  • unusually smelly wind and poo
  • your baby may be less hungry than usual
  • their tummy might feel firm

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.

What causes constipation?

  • change in diet - it's quite common for your baby to become constipated when they first start taking formula (which is harder to digest than breastmilk), or eating processed foods. That's just because their body is learning how to cope with digesting new things
  • dehydration - constipation can be caused by a lack of fluids. There are various reasons why your baby may not be getting enough fluids – they may be teething and finding it uncomfortable, it could be down to illness (a cold, a throat or ear infection, etc), or if they are older, not drinking enough fluids with their food. Lack of fluids can make your baby's poo harder and more difficult to push out
  • lack of fibre – in older babies, it can also be caused by not getting enough fibre, (such as fruit, vegetables and cereals) in their diet

How do I treat my baby's constipation?

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:

  • if your baby is bottle-fed try giving them extra water between some feeds
  • lie your baby down and gently move their legs like they're riding a bicycle – this can help get things moving. If your baby is happy lying down, give them a gentle tummy massage
  • if your baby is on solids, make sure they're getting enough fibre. Apples, pears and prunes are particularly good for constipation. Find out more about foods with plenty of fibre.

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.

Thrush

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.

What causes thrush?

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.

Signs of thrush in breastfeeding mums

If you are breastfeeding and have the following symptoms, it may be thrush. Make an appointment with your doctor as soon as possible.

  • pain in your nipples (burning, sharp, shooting pains) that can last up to an hour after feeds
  • sore, cracked nipples
  • shiny, red or pink nipples
  • itchy or flaky nipples

Signs of thrush in breastfed babies

If you think your baby has thrush, make an appointment with your GP as soon as possible. Signs of thrush in babies include:

  • creamy, white spots on the tongue, gums, on the inside of the cheeks or roof of the mouth (if you gently try to wipe the spots with a clean cloth, they won't come off)
  • there may be a white gloss on your baby's tongue or lips
  • your baby might feed for shorter periods, or seem unsettled during and between feeds

Read more about oral thrush in babies.

Treatment for thrush

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.

Stop thrush spreading

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:

  • wash hands thoroughly, especially after nappy changes
  • use separate towels
  • wash and sterilise dummies, teats, and any toys your baby may put in their mouth
  • change your breast pads often
  • wash all towels, baby clothes, and bras (anything that comes into contact with the infected area) at a high temperature to kill off the fungus

Can I breastfeed if I have thrush?

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.

Sore nipples

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!

What causes sore nipples?

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.

latching.jpg

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.

latching2.jpg

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.

latching3.jpg

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.

latching4.jpg

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.

Other possible causes for sore nipples:

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.

Tips for soothing sore nipples:

  • some women find rubbing their own breastmilk onto their nipples can be soothing. Others find that products like Vaseline or lanolin can help with dry or cracked nipples (although there is little evidence to show what really works well)
  • after each feed, let your nipples dry before getting dressed. Also, change your breast pads after every feed
  • avoid using soap, as this can dry out your skin
  • if possible, only wear cotton, non-underwired bras
  • it's best to avoid using nipple shields and breast shells as these don't help your baby attach properly
  • try not to shorten feeds – doing so won't ease the pain and may reduce your milk supply

Videos:

What can I do about sore and painful nipples when breastfeeding?

How do I know if my baby is properly latched on?

Mastitis

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).

What are the symptoms of mastitis?

Usually, mastitis affects one of your breasts, but can sometimes affect both. Signs and symptoms of mastitis often develop quickly and can include:

  • red patches on your breast – the sore areas feel swollen, hot, and painful to touch
  • a lump or hard area on your breast
  • feeling tired, run down and feverish - you may have flu-like symptoms

What causes mastitis?

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:

  • your baby not latching on properly
  • missing feeds, or not feeding often enough
  • feeding from one breast more often than the other
  • an injury that damages a milk duct or gland

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.

How to treat mastitis

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.

Self-help methods

There are various ways you can help ease the pain and inflammation:

  • get plenty of rest. Take your baby to bed and feed frequently (8 to 12 times every day, including night time). If you have other children, ask for help from family and friends
  • express your milk in between and after feeds to make sure all your breast milk is removed
  • drink lots of fluids
  • medication such as paracetamol and ibuprofen can reduce pain. Although some paracetamol can enter your breastmilk, it's not enough to harm your baby
  • avoid wearing tight, restrictive clothes and bras which can restrict milk flow
  • ease the pain by putting a warm flannel over your breast. Warm showers and baths may also help
  • massage the affected area. If it's not too painful, gently massage on and around the affected area

How to prevent mastitis

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 possible, breastfeed exclusively (avoid using formula to top up, or a dummy)
  • feed frequently and on demand - long gaps in between feeds can create a build-up of breastmilk
  • make sure your baby latches on properly – try different breastfeeding positions to work out which is most comfortable
  • wait for your baby to finish feeding - usually, they'll release when they're finished
  • when you want to stop breastfeeding, try cutting down your feeds gradually (don't suddenly go longer between feeds)
  • avoid tight clothing and bras – if possible, wear loose clothes that don't put pressure on your breasts

If you'd like some confidential breastfeeding advice, call the National Breastfeeding Helpline 0300 100 0212 (9.30am-9.30pm, seven days a week).

How long does mastitis last?

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.

Reflux

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.

What is baby reflux?

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

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:

  • spitting up frequently
  • abdominal pain
  • feeding difficulties
  • seeming unsettled and grizzly after a feed

These symptoms can lead to your baby not gaining weight, or even losing weight.

What is silent reflux?

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.

What are the symptoms of baby reflux?

Baby reflux symptoms include:

  • constant or sudden crying when feeding
  • bringing up milk during or after feeds (regularly)
  • frequent ear infections
  • lots of hiccups or coughing
  • refusing, gagging or choking during feeds
  • poor weight gain
  • frequent waking at night

When should I go to the doctor?

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.

Treatment and medication for baby reflux

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.

How to help your baby with reflux

While there aren't really any remedies, there are some ways you can help with your baby's reflux:

  • feed little and often – smaller feeds stop your baby's tummy getting too full
  • burp your baby frequently during the feed
  • try to keep your baby upright (for at least an hour) after feeding – this should help keep the milk down
  • if you are formula feeding, your doctor or health visitor may advise you to use a thicker formula (that's less likely to be brought up), or one that does not contain cows' milk (if your baby is allergic to cows' milk)

Tongue tie

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.

What are the symptoms of tongue tie?

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:

  • your baby's tongue doesn't lift or move from side-to-side
  • their tongue may look heart-shaped when they stick it out
  • difficulty breastfeeding or bottle feeding (and weight gain may be slow)
  • frequent, long periods of feeding – but they seem unsettled and unsatisfied

How does tongue tie affect breastfeeding mums?

  • your milk supply may reduce, as your baby is not latching on and feeding well
  • you may have sore or cracked nipples, which can make breastfeeding painful
  • poor latching on and ineffective feeding may lead to engorged breasts – which can then lead to mastitis

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).

What is posterior tongue tie?

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.

What is the treatment for tongue tie?

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).

More help

Read more about tongue tie.

The Association of Tongue-tie Practitioners (ATP) has a directory of NHS tongue-tie practitioners.

Back to top