Common feeding challenges

If you are having problems breastfeeding or expressing, you are not alone. We have listed some common challenge with breastfeeding or expressing here, and what you can do.

Problems with suck feeding or latching

Babies born premature or sick can have complications that will affect their ability to suck on the breast. This is common while your baby is maturing and their muscle tone is improving. If this continues, a feeding specialist such as a speech and language therapist can help to manage this.

A condition called tongue-tie can make it more difficult for some babies to breastfeed. Tongue-tie happens when the strip of skin that attaches the baby’s tongue to the bottom of their mouth is shorter than usual. This means they may have more difficulty latching on to the breast or feeding from a bottle. The NHS website has some more detailed information about tongue-tie.

Low milk supply or decrease in milk supply

Some mothers experience low milk supply when breastfeeding or expressing if they have to be away from their baby after birth, or if they are feeling stressed or anxious. When you have to express for a long time, it can be difficult to maintain your milk supply. Sometimes the amount you express can start to decrease. This can happen suddenly or more gradually. It is usually temporary and may not mean that you are losing your milk supply. With help, these problems can be resolved.

If you are expressing, try not to focus on the amount of milk that you are producing, but do ensure you are expressing 8 to 10 times every day, including at least once at night.

Staying as relaxed as possible when breastfeeding or expressing can help with milk flow. Here are some other tips:

Express or breastfeed with your baby close by or while having skin-to-skin with your baby. Many neonatal units encourage parents to express milk at cotside to be near their baby. Some units can provide you with a screen if you want to have some more privacy. If expressing with your baby close by is not possible, having a photo of your baby to look at or something that smells of them when you express can help.

If you are breastfeeding, offer your baby both breasts at each feed. Change between the breast you start with each time.

Massage your breasts before or during breastfeeding or expressing.

Listen to relaxing music or meditation while breastfeeding or expressing.

Try and plan your expressing or breastfeeding routine, or change the times that you express to fit in with your lifestyle. This is useful for helping your milk flow and re-establishing your pattern. It is also useful if you have other children or commitments.

Increase the amount of times you express.

If you are expressing, cover up the bottles while you are pumping so you cannot see how much you are collecting. For example, some parents find it helpful to put socks over the bottles.

Change the method you use to express. For example, if you are double-pumping (pumping both breasts at the same time), you could try single-pumping with extra massage. You could also use something to hold the funnels in place, such as a bra, which means that you can massage and double-pump.

Express in short bursts. For example you could express for 15 minutes, have a break for 15 minutes, then express for 15 minutes again – and repeat this several times.

Although it is difficult, don’t be hard on yourself if your supply is low or decreases. Whatever you can produce will still benefit your baby.

Some parents tell us that expressing regularly for their baby can be a tiring experience, and it can sometimes be difficult to keep going. It is important to remember that everyone’s situation is different and you should do what is best for you.

If you are worried about having a decrease in your milk supply, or are finding breastfeeding or expressing difficult, ask your midwife or neonatal nurse to refer you to a feeding specialist. Feeding specialists are very understanding and can look at your baby's feeding and expressing plan and offer practical advice, help and support with breastfeeding and expressing.

Sore or cracked nipples

Sore or cracked nipples is a common problem with breastfeeding and expressing. It can happen when your baby is not positioned or latched on well. Speak to your midwife, neonatal nurse, health visitor or feeding specialist as soon as possible so they can support you.

To help prevent sore nipples when expressing with a breast pump, make sure the funnel is the correct size. If friction is created while expressing, you may need a larger size of breast shield. If the skin surrounding the nipple (areola) is being pulled into the neck of the funnel, you may need a smaller size.

Always apply the highest comfortable vacuum setting that will produce milk. Applying the highest vacuum setting will not speed up milk flow and may make your nipples sore. It is important to follow the instructions for the pump you are using.

The NHS website has more information about things you can do to treat sore or cracked nipples.

Blocked milk ducts

Milk is carried to the nipple through tubes called ducts. Sometimes the milk ducts can become blocked. Blocked ducts can happen when the breast is not well drained, and this means it can be more of a risk for mothers who are expressing their milk, or who are switching between expressing and breastfeeding. Signs and symptoms of blocked ducts can include a hard lump in the breast, which may be painful.

If you think you have blocked ducts, talk to a neonatal infant feeding specialist or neonatal nurse on the unit for more support.

To help with blocked ducts, you could:

• Massage the affected area before and during breastfeeding or expressing.

• Breastfeed or express more regularly, or use a breast pump.

• Use a hot towel on the affected area or take a hot shower before breastfeeding or expressing – some find that using something cold is more effective.

• Make sure that your baby is positioning and latching on well for their feeds.

• Avoid underwired bras and tight clothing.

• Take ibuprofen, if it is safe for you to do so (check with your healthcare team if you are unsure).

If you have blocked ducts, do not stop breastfeeding or expressing, as this can make the symptoms worse. Your milk will still be safe to use. Speak to your midwife, neonatal nurse, health visitor or feeding specialist if you need any support.

If blocked ducts are left untreated, this can lead to a breast infection called mastitis.

Mastitis

Mastitis happens when milk leaks from an untreated blocked duct into the surrounding breast tissue. This makes the breast become inflamed and painful. This can be caused by infection.

Signs and symptoms of mastitis are similar to the symptoms of blocked ducts (above). Your breast may feel more painful and your skin may feel hot and get redder. Symptoms include a red, painful swollen area on one or both breasts and a hard area or lump in the breast. You may also have flu-like symptoms, a temperature and a general feeling of being unwell. Some women get a burning pain in the breast or occasional nipple discharge.

If you think you have mastitis, talk to a neonatal infant feeding specialist or neonatal nurse on the unit for more support.

Mastitis can be easy to treat. If you have mastitis, try the techniques to treat blocked ducts. This aims to keep the breasts as empty as possible and reduce any inflammation. If you have symptoms of mastitis and they don’t improve after 24 hours or get worse, see your GP as you may need treatment with antibiotics. If mastitis is left untreated, it may lead to a breast abscess, which can require surgery.

If you have mastitis, do not stop breastfeeding or expressing, as this can make the symptoms worse. Your milk will still be safe to use.

The Breastfeeding Network have a useful leaflet with information about how to prevent and manage mastitis.

Thrush

Thrush is a yeast infection that can cause pain when breastfeeding or expressing. Babies can also get thrush in their mouths. The infection can be passed between you and your baby through breastfeeding.

The symptoms of thrush include pain or a burning feeling in both breasts after breastfeeding or expressing. The nipple or areola can also change colour and become flaky and shiny.

The symptoms of thrush in babies include white or yellow spots or patches on the gums, lips, tongue or elsewhere in the mouth that cannot be wiped away easily. Your baby may also appear more unsettled than normal.

If you think you or you baby has thrush, talk to your neonatal nurse, health visitor or GP, as it can easily be treated with creams or anti-fungal tablets. Both you and your baby should be treated.

Low oxygen and heartrate in babies

Some babies have periods of low oxygen (desaturations) and/or low heart rate (bradycardia) when they are starting to bottle feed or breastfeed. This is normal in some cases and will improve with time, but can be a sign that your baby is not ready for feeding yet. If this happens, it may need to be looked at by a doctor or a speech and language therapist who specialises in swallowing.

Low oxygen and heart rate while feeding can also be a sign of reflux. Reflux happens when some of the partly digested milk or food in the stomach comes back up the tube from the mouth to the stomach (oesophagus). This is common in all babies, but is more common in babies born premature or sick. We have more information about reflux.