Breastfeeding Problems,
Positions & Nutrition Requirements

Reviewed by James Brann, M.D.
Learn about common breastfeeding problems in this article.

Remember, even the seemingly worst breastfeeding problems can usually be overcome.

Your breast milk is probably one of the best gifts that you could ever give to your child. The beneficial effects of breastfeeding are immeasurable as it ensures your child's proper growth and development. The components of breast milk are perfectly tailored according your child's developmental and physical needs. It contains properties that protect your child from various diseases and infections and promote brain development. Your breast milk's effects are long-lasting as it can greatly influence your child's overall health until adulthood. Additionally, breastfeeding is the best way to strengthen the bond between you and your baby. Without a doubt, your breast milk is one of nature's greatest gifts to mankind.

Although exclusive breastfeeding for the first six months results in healthful effects, it is estimated that only 70% of mothers in the United States breastfeed their babies after birth. From this group, only 30% are breastfeeding at six months, in spite of support from the American Academy of Pediatrics and Word Health Organization. The decreasing numbers of breastfeeding women are attributed to many factors, such as insufficient knowledge about the beneficial effects of breast milk, widespread campaigns of formula milks and early return to work. Some mothers have simply stopped breastfeeding because they find it too complex, tiring and time-consuming.

Basics of Breastfeeding Section

Start Breastfeeding Immediately after Birth

If you have decided to breastfeed your baby, you can start breastfeeding right after your baby is born. Breastfeeding as soon as possible encourages early mother and child bonding and decreases your risk of hemorrhage. Your baby's suckling stimulates the release of oxytocin, a hormone that causes uterine contractions.

Newborns are active right after birth, with strong sucking reflexes. Additionally, your baby can find his way onto your breast when his cheek or lip is stimulated. This is called the rooting reflex.

Not all babies are prepared to breastfeed right after birth. Some immediately latch-on the breast. Other babies might like to nuzzle against the breast as they familiarize themselves with their mothers' scent and touch. If breastfeeding is not indicated after delivery, your baby may be placed against your chest to initiate skin-to-skin contact and bonding. Early sensory contact is beneficial to your baby's mental and physical growth development.

The Most Common Breastfeeding Positions

There is no definite best position to breastfeed your baby. It depends on your baby's size, your health condition and your baby's and the feeding location. Choose a position where you are comfortable and where your baby can latch-on to your breast without difficulty. Positioning might vary but it is important that your baby does not have to turn his head to breastfeed in all positions. His nose should be in alignment with your nipple. The most common breastfeeding positions are listed:

Cradle hold
The mother sits and the baby's abdomen is positioned against the mother's chest. The baby's head should be in alignment with the body. With the baby at the left breast, the mother places and supports the baby's head and body by her left forearm. Her left hand supports the baby's buttocks as the right hand guides the breast to the baby's mouth. This position is not recommended if latching or milk transfer is a problem.

Cross-cradle hold
This position is a combination of the cradle hold and the football hold. With the baby at the left breast, the mother supports the baby's head and body by her right forearm and hands. The mother's left hand guides the breast to the baby's mouth. This is helpful in early feedings.

Football (clutch) hold
The mother holds the baby under her arm in the same way that a football player clutches the ball as he runs. As the mother sits, a pillow is placed to support the baby. The baby's head is positioned at level of the breast. With the baby on the left breast, the baby's body and legs are placed under the left arm, and the head is supported by the left hand. The other hand guides the breast into the baby's mouth. This position is recommended to women with abdominal incisions or large breasts and to premature babies.

Side - lying
Side-lying allows mothers to breastfeed their babies as they lie down. To breastfeed using the left breast, the mother should lie on her left as the baby is positioned parallel to her body. The baby's head should be facing the breast.

How to Initiate Latching-on

Latching-on is the creation of a tight seal around your nipple and most of your areola through your baby's mouth. Your baby must correctly latch-on for him to obtain an adequate amount of breast milk. An incorrect latch-on could cause nipple soreness.

To initiate latching-on, lightly run your nipple along your baby's upper lip, from one corner of his mouth to the other. As your baby opens his mouth, bring him towards your breast, ensuring that his chin touches your breast first. You might initially feel some discomfort but if your nipple continues to hurt after a minute, your baby might be latching-on incorrectly. Using your index finger, pull down your baby's chin to bring his lower lip out. Your baby's lower lip should be covering more of the areola than the upper lip.

If you observe your baby's upper and lower lips touching at the corners of the mouth or if you hear clicking sounds, your baby is not latching-on right. You might need to reposition your baby and latch-on again.

How Frequency do You Breastfeed?

During the first week after birth, your baby needs to be breastfed every two to three hours or at least eight times a day. There is a need to wake up your baby if four hours have already passed since the start of the previous breastfeeding. After the first week, it is encouraged to feed your baby on demand. Allow your baby to breastfeed as he desires, which is characterized by active breastfeeding, or the regular suckling and swallowing. Once your baby finishes feeding, he would usually release the nipple as his face and hands relax. Your baby knows when he is hungry or how long he needs to feed, and so, it is not recommended to limit the frequency and length of breastfeeding.

Observe for early signs of hunger, such as searching for the breast, awakening from sleep and sucking of lips, tongue and hands. It is not advised to wait for your baby to cry before feeding. To determine if your baby is getting enough breast milk, monitor his urine output and number of stools a day. Normally, an infant would have at least six wet diapers daily with pale yellow urine and have four or more stools a day. Monitor your baby's weight. Your baby loses weight during the first few days after birth but he should be regaining his weight by one to two weeks of age. Consult your physician if your baby is losing too much weight.

Can I Use a Pacifier for a Baby that is Breastfeeding

Pacifiers should not be used within the first four weeks of age or until breastfeeding techniques are fully established. Pacifiers must not be used to delay feeding.

Nutrition while Breastfeeding Section

Daily Calorie Requirement during Breastfeeding

Your daily calorie requirement is based on your weight, age, height and activity level. A 25 year old female athlete who stands 5'6 feet tall and weighs 135 pounds needs more calories than a 35 year old female accountant who stands 5'3 feet tall and weighs 147 pounds.

Physicians recommend that nursing mothers should add up 300 to 500 more calories in their diets mainly to support the production of breast milk. During breastfeeding, your body needs around 800 more calories each day to produce 25 to 35 ounces of breast milk. Thus, if your pre-breastfeeding daily calorie requirement is calculated at 1900 calories, it is increased to 2400 calories per day once you start breastfeeding your baby. Do not go on a weight reduction diet as it can compromise the quality and quantity of your breast milk.

If you are breastfeeding, you must not immediately attempt to lose weight. During the postpartum period, which is the first six weeks after your baby's birth, your body goes through many changes as it returns to its pre-pregnant state. Hormonal fluctuations and emotional stresses can cause fatigue. And so, dieting is not recommended as you need all the energy to keep up with the increasing demands of motherhood. Give your body enough time to recover from the stresses obtained during labor.

Increase Your Fluid Intake When Breastfeeding

During lactation, most mothers tend to drink fluids excessively to replace the body fluids lost during breastfeeding. Though increased fluid intake is essential in nursing mothers, excessive consumption of fluids can result in decreased production of milk, according to the 1994 study of Dusdieker.

If your fluid intake satisfies your thirst needs, you are able to meet the fluid requirements needed for lactation. To ensure that you are adequately taking in enough fluids, have something to drink every time you sit down to breastfeed your baby. Because you are too preoccupied with your new role as a mother, there might be times that you forget to drink enough fluids. Thus, it is important that you watch out for early signs of dehydration, such as constipation and dark-colored urine.

Water is also obtained from the foods that you eat. Around 22% of water intake comes from a well-balanced diet. Thus, it is essential to consume the right kinds and amounts of foods during breastfeeding.

Vitamins and Minerals

If you are following a well-balanced diet, consisting of meats, fish, fruits and vegetables, there is no need for you to avail of vitamin or mineral supplements. However, it is recommended to give more attention to your calcium and vitamin D intake.

Calcium

Each day, around 250 to 300 mg of calcium is transferred from mother to child through the breast milk. According to a report by Thomas and Weisman published in the American Journal of Obstetrics and Gynecology, 25 to 30 grams of calcium, or 3% of the body's calcium stores, are lost after three months of breastfeeding.

Around 99% of calcium is stored in your bones and teeth. If your calcium stores are depleting, or if your dietary intake of calcium is insufficient, the body mobilizes the calcium from your bones and teeth into the blood circulation.

Though the lost bones are regained after breastfeeding, without the mineral that strengthens the alveolar bone, the structure that supports you teeth, you are at risk to develop gum diseases and tooth loss during the period of lactation. Decreased bone density during breastfeeding might also increase your risk for osteoporosis after menopause.

Lactating mothers must maintain a daily intake of 1000 to 1200 mg of calcium from various food sources. Breastfeeding mothers who are younger than 18 years old must consume around 1300 mg of calcium a day. Include foods that are rich in calcium. Milk, tofu, yogurt, calcium fortified cereals and bread, cheese, beans, collards, orange juice and broccoli are the best sources of calcium.

One cup of milk corresponds to 300 mg of calcium, thus, you need around 3 cups of milk to obtain your calcium needs. One cup of yogurt, 1/2 cup of tofu and 8 ounces of orange juice, 1 1/2 cups of cereals and 2 cups of hard cheese contain approximately 300 mg of calcium.

Calcium supplements might be necessary if calcium is not obtained from your diet. Take these supplements in two divided doses, two to three times a day.

Vitamin D

Ensure that your body has an adequate level of vitamin D. Calcium is not fully absorbed from the intestines if vitamin D is deficient. You need 200 IU of vitamin D a day, which is mainly obtained from sunlight. Brannon and other researchers agree that vitamin D is mostly synthesized when exposed to UV-B ray, which is abundant between 10:00 am to 2:00 pm. Exposure to sun 15 to 20 minutes during these hours, twice a week is recommended.

If the sun is inadequate, vitamin D supplementation is necessary. A cup of milk usually contains 100 IU of vitamin D.

Iron

You do not have to load up on spinach during lactation. Breast milk takes around small amounts of iron from your body, around 0.3 milligrams, each day. Iron is sufficiently obtained from well-balanced meals.

Breastfeeding Vegan Mothers

If you do not eat meat, milk and dairy products and eggs, you still have your alternatives. You can use vitamin B12 supplementation or add fermented soybeans and yeast in your diet.

Food to Avoid

  • Avoid eating shark, tilefish and mackerel which contain high levels of methyl mercury. This substance enters your breast milk and can damage your baby's nervous system. You can consume a sum of 12 ounces of fish and shellfish, such as shrimps, catfish and canned light tuna, a week.
  • Limit your caffeine intake to two to three cups daily. Excessive caffeine can cause irritation and difficulty in sleeping in infants. Additionally, caffeine inhibits the absorption of calcium.
  • Limit your alcohol intake to one serving a day. One serving of alcohol is equivalent to 12 ounces of beer, five ounces of wine or 1.5 ounces of 80-proof liquors. You should breastfeed 2 hours after the intake of one alcohol serving. Defer breastfeeding for an additional two hours for each extra serving consumed.

Breastfeeding Problems Section

There are many breastfeeding problems women have when they first start breastfeeding after the delivery of their newborn baby. This is perfectly natural, as breastfeeding an infant presents many unusual challenges during the first few weeks of life. Some of these challenges women expect, whereas others come as a surprise.

Breastfeeding an infant takes time and patience. Fortunately most moms and babies go on to enjoy a long, healthy and joyous breastfeeding relationship after they solve the most common breastfeeding problems.

Below we'll discuss some of the more common problems associated with breastfeeding. Many of these problems surface in the first few weeks after delivery. If your problem results in pumping your breasts for a short time period, make sure to educate your self on how to store breast milk, click here.

Engorgement

Engorgement occurs when the breasts swell because of increased milk production. Engorgement is common early on and sometimes late in the postpartum period. Most early engorgement happens when the breast produce large quantities of milk initially to support a newborn baby. This usually happens when the milk first comes in, somewhere between 2 and 3 days postpartum, though it may take as many as seven days to occur.

Most of the time early engorgement resolves itself in a few days. However if your baby isn't able to remove the milk enough from the breast, as may be the case when your baby doesn't latch on properly. Engorgement may continue and lead to more serious conditions.

Signs of engorgement include breasts that are painful and swollen. The breasts may also be rigid and warm. The best treatment for engorgement is frequent removal of milk from the breasts. It is important that your baby have a proper latch on so they can remove milk efficiently from the breast. Sometimes you may need to express a little milk before your baby latches on to help encourage a proper latch on. A soft breast is much easier to latch onto than a rigid one.

Massaging the breasts may also help relieve discomfort caused by engorgement. The best treatment for late engorgement is prevention. You can prevent breast engorgement by encouraging your baby to feed on demand, and allowing your baby to empty your breasts completely each time he feeds. For occasionally flair ups cool compresses may help. You may need to use a warm compress if your milk doesn't let down quickly enough.

Here are some other tips for minimizing the effects of engorgement:

  • Use mild pain relievers to help reduce inflammation. Acetaminophen and ibuprofen are safe during breastfeeding.
  • Avoid using your breast pump for longer than 10 minutes at a time. Too much stimulation can contribute to engorgement and promote excessive milk production.
  • Use warm showers to help express milk between your baby's feedings.
  • If you have late engorgement you can use heat packs to help reduce the discomfort.

Sore nipples are one of the most common problems associated with early breastfeeding. During your pregnancy you probably noticed that your nipples were more sore than usual. Nipple soreness usually continues until after the first week postpartum. Normal nipple sensitivity usually subsides after your baby has suckled for about one minute. If pain extends beyond this period of time your nipples have undergone some trauma or tissue damage, most likely the result of an improper latch on.

When your baby doesn't latch on correctly, your nipples may become red, irritated, cracked, bruised and even blistered. If redness and pain persist beyond a few days, you should consult a lactation consultant to help evaluate your baby's latch on and help you correct any problems you may be having.

Nipple tenderness that occurs long after you establish breastfeeding may be because of a yeast infection. Babies commonly develop a yeast infection in the mouth called thrush. This can spread to your nipples causing red, painful cracked sores. If you suspect your baby may have thrush consult with your doctor to get proper treatment started for your baby and your nipples.

Ankyloglossia

This condition is sometimes referred to as "tongue-tie." Sometimes babies are born with their frenulum connected to the bottom of the mouth. This may prevent your baby from latching on correctly. If your baby has this condition your doctor can perform a procedure called frenuloplasty to help improve your babies latch-on.

Plugged Milk Ducts

When milk remains stagnant in certain ducts of the breast you may develop plugged ducts. Typically a woman has hardened lumps or areas of the breast when a duct is plugged. Many causes contribute to plugged ducts including engorgement or failure to empty the breasts. Changes in feeding and even wearing poorly fitting bras may also contribute to this condition.

The best treatment for plugged ducts includes frequent feeding and emptying of the breasts. If you are not feeding your baby on demand but have plugged ducts, consider changing your routine and feeding your baby more often. This may help relieve any symptoms you have.

Mastitis

Mastitis occurs when the breast becomes infected. Usually mastitis forms as a red, tender and swollen area of the breast. Many women develop a fever, chills and other flue like symptoms. If you develop mastitis, your doctor will likely prescribe antibiotics to remove the infection. You may also need to take anti-inflammatory agents to help reduce pain and discomfort. It is important you continue breastfeeding during this time to help relieve the condition.

Breast Abscess

Breast abscess usually develop in women who have a history of breast problems including mastitis. This condition usually results from improper early treatment of mastitis. Signs of an abscess are similar to the signs of mastitis, including a red, tender and swollen area of the breast. Usually patients with a breast abscess will need to take antibiotics and drain the abscess using needle aspiration. In some severe cases incision and drainage of the abscess may be necessary.

Milk Ejection Reflex Problems

Some women have an overactive milk ejection reflex. This occurs when milk production and ejection occurs at a rate that is too fast for the baby to swallow effectively. If this is a problem your baby may cough and gag when your milk lets down. Usually nursing your baby in a semi-upright position helps relieve this problem. You may also limit the amount of milk ejected by compressing the ducts during the first few minutes of nursing.

Nipple Vasoconstriction

This condition causes the nipples to fade or turn white during breastfeeding. This usually results from cold exposure. Increasing the temperature in the room and nursing while wearing warm clothing can help prevent this condition. Occasionally drug treatment may be necessary to help reduce pain.

Care For Irritated Nipples

Many women experience nipple irritation during breastfeeding. The more traumatized your nipples, the more likely you are to develop an infection. An infection is dangerous as it can lead to mastitis or a breast abscess.

The most common reason for nipple irritation after breastfeeding is established is yeast infection. Other factors may cause sore nipples however. Some women find allowing their nipples to air out for 10 minutes after nursing helps reduce inflammation and irritation. There are other agents including lanolin cream that may help relieve dry, cracked and irritated nipples. This product is safe to use during breastfeeding.

Later Breastfeeding Problems

Once breastfeeding is established most mothers and babies will go on to enjoy a healthy breastfeeding relationship. There is a chance your baby may start biting after he or she starts growing teeth. This normally happens when your baby is four to ten months old. Biting the nipples can cause pain and injury. Fortunately you should be able to teach your baby not to bite your nipple simply by removing them from your breast immediately after biting for a short time.

Weaning

Some mothers experience some problems when they start weaning. Most doctors and healthcare organizations recommend you breastfeed your baby for at least the first 12 months of life. Human milk is the best food for your baby.

You can wean successfully if you do so gradually. One way to do this is to stop one breastfeeding session each day every four to five days. Most mothers will cut out the midday feeding initially until they work themselves up to zero sessions every day. After babies are 12 months old they can start drinking cows milk I most cases.

Some mothers wean there baby to a bottle and then a cup whereas others wean their baby direct to a cup. Engorgement is the most common problem associated with breastfeeding. Usually you can void this if you wean gradually over a longer period of time. You should avoid pumping when weaning to prevent your breasts from overproducing milk during weaning.

Remember, even the seemingly worst breastfeeding problems can usually be overcome with a little patience and care. If you are having trouble breastfeeding, be sure to consult with a lactation consultant or your doctor, who can help you solve any latch on problems and help you set up a joyful and rewarding breastfeeding relationship with your baby.


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