Lactation Insufficiency

Lactation Insufficiency

What problems can women have when they breastfeed? — Many women are able to breastfeed with no problems at all. But sometimes, problems can happen. Most problems can be treated so that you can keep breastfeeding. Breastfeeding has many benefits for both you and your baby.
Some common breastfeeding problems and their treatments are listed below. You can do many of the treatments on your own. You might also find it helpful to work with a breastfeeding expert, called a "lactation consultant," if you have problems.
Engorgement — Engorgement is the term doctors use for when the breasts are too full of milk. When the breasts are engorged, a baby can have trouble with "latch-on." Latch-on is another word for when a baby makes a tight seal with his or her mouth around the nipple and the dark skin around the nipple (areola) (figure 1). If your breasts are engorged they can feel swollen, hard, warm, and painful.
If your baby is able to latch on, breastfeeding will remove milk from the breast and help with engorgement. If not, you can use your hand or a breast pump to let a little bit of milk out between feedings (figure 2). If you use a pump, it's best to use it for just a few minutes right before a feeding. This will soften your breast without releasing too much milk, which can make engorgement worse.
You can also try the following home remedies to reduce the pain:
Use a cold pack or cool cloth on your breasts between feedings
Take a pain-relieving medicine, such as acetaminophen (brand name: Tylenol) or ibuprofen (sample brand names: Advil, Motrin)
Take a warm shower
Gently massage your breasts to start your milk flow
Sore or painful nipples — Some nipple soreness is normal during the first minute of each breastfeeding session. Nipple pain that lasts the whole breastfeeding session is usually not normal. It can be caused by nipple cracks, blisters, or bruises. Nipple pain can happen for different reasons, such as when a baby does not have a good latch-on. It can also happen if a baby has a condition called "tongue-tie," which is when the tongue cannot move as freely as it should.
The most important thing you can do to prevent and deal with nipple pain is to make sure your baby latches on the right way (figure 1). If your baby has tongue-tie, he or she might need surgery to release the tongue.
You can also try the following home remedies:
If your nipples are cracked or raw, you can try lanolin ointment (sample brand name: Lansinoh). If you think your nipple might be infected, call your doctor or nurse. Do not use vitamin E or honey on your nipples, because these can be dangerous for your baby.
Apply a cool or warm washcloth on your nipples
Take a mild pain reliever, such as acetaminophen (brand name: Tylenol) or ibuprofen (sample brand names: Advil, Motrin)
Wear breast pads between feedings to protect your nipples.
When your baby gets older and starts to get teeth, he or she might sometimes bite your nipple while breastfeeding. If this happens, you can position the baby so that his or her mouth is wide open during feedings. That will make it harder to bite. If your baby does bite you, try sticking your finger between your nipple and the baby's mouth and firmly saying "no." Then put the baby down in a safe place. This will help your baby learn not to bite. You can also offer a teething ring to chew on instead.
Blocked milk ducts — A blocked milk duct can cause a red and painful breast lump (picture 1). It can also cause a white plug at the end of the nipple.
If you have a blocked milk duct, try to breastfeed often. Make sure that your baby empties your breasts during feedings. Start with the breast that has the blocked milk duct, and use different breastfeeding positions to try to get the breasts as empty as possible. To help your milk flow better, you can also try taking a warm shower or gently massaging the breast. If your baby doesn't empty your breast, you can use your hand or a breast pump to remove more milk after the feeding.
Breast infections — A breast infection is called "mastitis." Mastitis can cause a fever and a hard, red, and swollen area of the breast. You might also have muscle aches or chills. If you have these symptoms, call your doctor or nurse for advice.You do not need to stop breastfeeding if you have mastitis.
To treat your mastitis, you can:
Take a pain-relieving medicine, such as acetaminophen (brand name: Tylenol) or ibuprofen (sample brand names: Advil, Motrin).
Massage your breasts during feedings.
Use a breast pump to empty your breasts after feedings.
Take antibiotic medicines, if your doctor prescribes them.
Nipple color changes — The nipples can turn white, blue, or red, and be painful. This is more likely to happen if you are very sensitive to cold. It can also happen if your nipple is injured, for example, if your baby doesn't have a good latch-on.
To treat this, you can:
Turn up the room temperature and wear warm clothes
Put a warm cloth over your breasts before and after breastfeeding
It's also a good idea to avoid things that make this problem worse. For example:
Avoid caffeine
Avoid nicotine (smoking or using e-cigarettes)
Do not take certain medicines that might make this problem worse. This includes some medicines for colds or migraine headaches, medicines used to treat attention deficit hyperactivity disorder (ADHD), and some diet pills. Ask your doctor if you're not sure about a particular medicine.
Should I see a doctor or nurse? — Talk with your doctor or nurse if you have problems with breastfeeding. Be sure to let him or her know if you have:
A blocked milk duct that does not get better after 3 days
A fever and a hard, red, and swollen area of the breast
Blood leaking from the nipples
Pain that lasts for the whole breastfeeding session
You can also talk to a lactation consultant (breastfeeding expert) for help.
All topics are updated as new evidence becomes available and our peer review process is complete.
This topic retrieved from UpToDate on: Mar 30, 2020.
Topic 15826 Version 7.0
Release: 28.2.2 - C28.105
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