Common Problems in the first weeks of Breast Feeding
|Letdown / ejection
doctor tells me I have inhibited let-down reflex. Please tell me what is it?
Will I be an incomplete mother always?
No, no don't panic. It's not that bad. Very
often sucking difficulties may also result from a child not getting enough milk. This is
usually because the reflex, which is essential to enable the milk to come out of the
breasts, is temporarily inhibited. This is the ejection / let-down reflex.
It does not merely release the milk but causes muscular contraction in the breast,
which forces the milk out. This ejection reflex can be inhibited for a number of reasons.
In a maternity ward, it may be because a mother is afraid or embarrassed by the unfamiliar
environment or the presence of the strangers, or depressed or nervous about her motherhood
or perhaps her future. The reflex is also inhibited if the mother worries too much about
her milk, and lacks confidence in her ability to satisfy her infant. Now tell us what's
bothering you and if you can't solve it yourself, talk to us.
How do you diagnose if the mother has
irregularities in the ejection reflex (the `let-down reflex)?
Many common problems with breast-feeding
result from inhibition of ejection reflex. This causes symptoms like: baby fussing
at the breast, baby crying again only a short time after having been fed
or the milk seems suddenly to have disappeared.
To make a diagnosis, see if you feel
tense, prickling let down sensation beneath your nipples when the baby begins
to suck. However, many successful nursing mothers do not feel these sensations in the
early weeks of nursing and some large-breasted women never feel them at any time.
Your judgement of whether the reflex works
properly or not may therefore have to be based on whether the baby seems to be getting
milk, rather than on probing what you, the mother can feel. The ejection reflex is easily
influenced by the mothers psychological state. Hence treatment must be psychological
How you can help yourself:
- Before putting the baby to the breast, try to calm down, for
instance by resting for some time, having something nice to drink, etc. This should become
a ritual, repeated before each feeding session. For instance you might make a cup
of tea and drink it, or lie down with closed eyes for five minutes.
- Be sure to sit or lie down in a comfortable position and
that you can remain undisturbed.
- Make sure that your baby is sucking strongly, is in a good
position, and not causing you pain.
- Routine and habits may be important. If possible you should
feed in the same place each time i.e. in a particular corner of the house, in one
special chair and so on.
- Sometime for this kind of problem, scheduled feeding is said
to be helpful. But give the baby a say in establishing the schedule according to his
needs. Starting when an infant wakes up in the morning, you should feed him regularly
throughout the day, for instance every two or three hours, thus conditioning
both the breasts and the infant for scheduled feeding hours.
|Too much milk
women usually complain of?
- When the milk starts flowing, breasts may feel full
- Some women have no discomfort at all, others have heavy,
stony hard, engorged breasts, and pain.
- A brief spike of fever even a single chill may
occur at this time. It is sometimes called milk fever and it is not due to
bacterial infection, and need not cause great alarm. If it persists for more than 24
hours, it may be something serious.
What causes engorgement?
- These symptoms are partly due to an increased amount
of tissue fluid in the breast, which decreases spontaneously after some days.
- They are also due to excess milk in the breasts, because at
first milk production is poorly adjusted to demand, and often there is enough for two
How do I solve this problem?
- The simple answer to this problem of engorgement is
to express excess milk which provides rapid relief of the pain and other symptoms.
This may also, by reducing the pressure within the breasts, allow the freer drainage of
the tissue fluids, and quicker resolution of the condition.
But if I express the excess milk,
wont the breasts continue to produce more milk than necessary?
Will the amount of milk production go on
increasing indefinitely if I express the excess milk?
These fears are not justified, as in such a
case, after a week or two, production almost always decreases to match the demand of the
infant. Also the need of the baby increase, and he becomes more efficient at emptying the
breast. At any rate, when congestion due to tissue fluid has decreased, the pressure in
the breast decreases and you will feel more comfortable. At this stage, you can safely
stop expressing and let your breasts adjust naturally to the infants demand. There
is less risk of breast abscess at this time so the need to keep on emptying the breast is
In any case, the excess milk from
high-yielding mothers is extremely valuable, because one can use it for other babies who
are in need of extra milk (Breast Milk Banking). Human milk is especially important for
premature babies, yet their mothers often find it difficult to express enough for them.
|Too little milk
have little milk during my first few weeks, and am feeling very anxious about it. Will the
production increase? Will low production now be harmful for my child?
* Doctor, I delivered 7 days ago but
have too little milk, my baby is always hungry? Please help!
Some mothers have too much milk before
their breasts have adjusted, while others have too little. This does not necessarily mean
that you will be less efficient milk producers later on. Most can produce enough milk and
are able to feed a baby normally after two weeks or so. But during these few weeks, while
you wait for milk to increase, you are in particular need of support, encouragement, and
supervision, so that you do not give up.
If your infant loses too much weight (more
than 10 % of his birth weight), or shows signs of dehydration,(create hyperlink) you can
give the child-expressed breast milk (EBM) from the Breast Milk bank so that the energy
needs are met. Or, if EBM is not available, you can give carefully controlled
supplementary feeding, which of course is not as good.
find my baby is too tired to suck properly. What could be the reason & what can I do?
This could be either due to a problem in
the child or effect of some drugs given to the mother. Sedatives given during
delivery may reach the foetus through the umbilical cord. The infant then may be too
sleepy to suck properly. This may last for some days after birth (you have not mentioned
your baby's age).
Jaundice and other illnesses may
have the same effect. In neither case, however, is there any reason to postpone the
breast-feeding sessions. The child should be offered the opportunity to suck even though
he may not seem interested. If he can be persuaded to suck for a few minutes at a time,
this is very valuable, and should be repeated 6 8 times daily.
A word for your family - In such cases the
most important task for you all is to keep up the mothers spirits by reassuring her
that her infant will wake up soon, and become stronger and more satisfying to nurse.
though I produce enough milk, my child has difficulty sucking and most often remains
hungry. Why does this happen and what can I do to help him?
Most babies suck easily and naturally. But
occasionally a baby seems to have to learn to suck. For you this is an
exercise in patience. You should not give up trying, but at the same time you should not
exhaust herself (or the infant) by incessantly trying to succeed. You should allow
yourself and the baby time to rest and regain strength in between the sucking periods.
Usually, the presence of a person whom you know, and who is kind and calm is likely to
help you. But if you don't like it you may better try alone.
A baby sucks because this is a reflex that
he is born with. To start the sucking reflex something has to touch the babys hard
palate. Normally, it is the nipple that touches the palate, but to do this, it has to be
right inside the babys mouth. If a nipple is very short, it may not go far
enough into the mouth to start the reflex. This is the reason why flat nipples may cause
problems in the early days. Most flat nipples are sufficiently protractile for normal
sucking once they have been stretched a little. But some help may be necessary in the
first few days.
If a breast is engorged, the nipple
may be stretched flat and not easy protractile. The baby can only chew at the
tip of the nipple, and cannot get it far enough into the mouth to suck properly. As a
result, the baby fails to extract milk, and also harms the nipple. The infant then becomes
impatient, cries and turns away from the breast and from the despairing mother. On such
occasions, the assistance of an experienced and calm person is invaluable.
Just see, which of the above apply to you.
Write in again, it helps many more like you.
I feel I
produce enough milk but my problem is that I have flat nipples and my breasts feel full,
heavy and painful. As a result of my flat nipples my baby is not able to suck enough milk
and remains hungry and cranky. What do I do?
The management of flat nipples
however much engorgement contributes to the problem is this:
- Try to manipulate the nipple a little, to make it more erect
and easy to grasp.
- It is often helpful to remove some of the milk so that the
breast becomes a little softer you can either express by hand, or use a breast
- Gently and patiently, put the infant to the breast for
another try. One drop of milk left at the tip of the nipple may act as an
- Remember that the nipple and the areola (the dark skin
round the nipple) must both be put well into the babys mouth. Sometimes to do
this you have to press the baby rather firmly on to the breast. Dont be afraid to do
this if you think the breast is going to block the babys nose, use a finger
to hold the breast clear of the nose dont pull the babys head away!
If the baby still does not succeed, let it
suck through a nipple shield for a few days, until engorgement subsides and the nipple has
|Too Big Nipples
time I try to feed my baby she starts crying and refuses to feed. I produce enough milk,
but I do not know why my child reacts like this and what do I do?
Sometimes nipples are too big. An
infant may seem to gag and choke if the nipple is so long that it goes past the hard
palate and touches the soft palate. Your baby may react by fighting. When put to the
breast he may turn his head, cry, and move his arms and legs. This can easily be corrected
by holding the infant a little away from the breast.
A similar effect is produced when a mother
has too much milk and it flows too fast out of the breast due to a forceful
ejection reflex. The milk fills the infants mouth too quickly, and chokes him. In
this case, the mother should express some milk before she feeds the infant.
All these are reasons why a baby may seem
to refuse the breast, and yet in most cases the mother has more than enough milk, and
keeps wondering why the child is refusing feed.
I have been breast-feeding regularly
for some time, but now I have suddenly developed soreness and redness on my nipples.
Breast feeding now has become very painful. Help me, I'm worried. What should I do?
When nursing, you must hold the baby close
enough for its chin to touch her breast. Frequent, short nursings promote speedy
healing. Let the baby suck first on the least affected breast. The initial sucking is the
strongest, and thus the most painful. Again, if both sides are equally painful, very
careful hand milking may elicit the ejection reflex, and the baby can then be put to the
breast when the milk flows. You can apply a thin coat of edible oil to the nipple between
feedings. This often gives symptomatic relief.
A mothers nipples may become sore at
any time during lactation, but it is more common in the early weeks. It may encourage you
to know that the soreness seldom lasts more than a week (although one week in this case
may seem a very long time for you).
The most common kind is the positional
sore nipple, which is self-explanatory.
Soreness can also result from:
- Sudden exposure to the unaccustomed action of sucking;
- Faulty sucking technique
- Letting the infant suck too long in a bad position
- Soreness is more likely to occur in engorged breasts; and
- When the nipples are flat and it is difficult for the baby
to grasp the nipple properly.
- Bite by older children (with milk teeth).
Sore nipples do not have nice looking
wounds. Often one sees a little redness. But the nipples are so well supplied with pain
fibers that even very small lesions are extremely painful. The pain is worst when the baby
first begins to suck, and the skin is stretched. It gets less as nursing proceeds,
especially after the ejection reflex is working, and the milk is flowing. The early pain
is often so strong that a mother may be found bracing her whole body to take
it. Sometimes the severe early pain inhibits the ejection reflex, which leads to
When nursing, you must hold the baby close
enough for its chin to touch her breast, and so that nipple and areola can both go
completely inside its mouth.
If, in spite of taking these precautions,
sore nipples start to develop, there are a number of things that have proved helpful:
- It may sound brutal but frequent, short nursings
promote speedy healing. It would seem logical to suppose that letting the nipples
rest for as many hours as possible would have a healing effect. This is
however not the case. If a crust is allowed to cover the wound, it only cracks open again
as soon as the baby sucks. The wound however heals in spite of frequent feeding.
- Let your baby suck first on the least affected breast. The
initial sucking is the strongest, and thus the most painful. When the ejection reflex has
started to work, change him over to the sorest side.
- If both sides are equally painful, very careful hand milking
may elicit the ejection reflex, and the baby can then be put to the breast when the milk
flows. If oxytocin preparation are available (either in the form of a nasal spray or of
tablets which are absorbed through the mucosa of the mouth) this may be the kind of
situation in which they are helpful in eliciting the ejection reflex.
- Nursing the baby in a different position from usual may also
help. In this way, the parts of the nipple, which are subjected to most traumas by
sucking, are changed.
- You can apply a thin coat of edible oil to the nipple
between feedings. This often gives symptomatic relief. Lanolin and Vaseline are good and
harmless agents, and do not have to be removed before the baby sucks. But you must allow
the skin to dry before applying the ointment. Wetness held on the skin by the ointment,
makes the skin softer and weaker.
- Never apply tincture of benzoin or surgical spirit. They
cause severe pain, and can damage the nipple skin even more.
- There are several substances of both modern and traditional
origin that people claim are helpful for healing sore nipples, such as lemon-juice,
oestrogens, disinfectants, vitamin-E-containing ointments, etc. Some of the recommended
methods for treating sore nipples are dramatic, others more ordinary. In the end, only the
common sense and general experience of the doctor can help you decide whether or not to
encourage or discourage any particular remedy.
- If a nipple becomes extremely sore, it may become necessary
to temporarily discontinue breast-feeding until the nipple responds to treatment. But it
is essential, both to prevent an abscess forming and to maintain milk production. You
should express the milk (either manually, or if that is too painful, with a pump).
Unfortunately, in this situation, the milk production often diminishes. It may be
necessary to stimulate it to increase again.
sore nipples(due to thrush):
nipples are persistent, it may be because the baby has a thrush
infection in his mouth which has spread to the nipples.
Whenever a mother has sore nipples, she
must always check her baby for thrush so that it can be treated before the soreness
becomes persistent. A baby with thrush has a white coated tongue or white lesions that
look like milk curds inside the cheeks. If you are not sure, try to wipe them away. If you
can remove the white easily, it is milk, if you cannot remove it, then it is probably
thrush. You can treat thrush with gentian violet (0.5-1 per cent), or lapis (2 per cent)
which you apply twice daily for 5-7 days, repeat the treatment.