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• My baby is very sleepy.  What can I do?
• My baby is fussy.  What can I do?
• I have sore nipples.  What can I do?
• My breasts are too full.  What can I do?
• I have plugged ducts and a breast infection.  What can I do?
• My baby is not able to breastfeed.  What can I do?
 

My baby is very sleepy.  What can I do?

Some babies sleep too long between feeds, and some babies fall asleep before they are full.  These babies often don’t get enough milk.  This can also make a problem for you as your breasts will get very full and uncomfortable.

If your baby is very sleepy, these ideas can help.

Feed your baby often

Feed your baby at least every 3 hours.  For example, if you start feeding the baby at 9:00 a.m., start the next feeding by 12:00 noon at the latest.  Before you begin, massage your breast to bring your milk down. 

Be sure to nurse your baby at least 8 times in 24 hours.  At night, it’s okay to let your baby sleep for one 6-hour stretch or two 4-hour stretches as long as your baby has enough wet and dirty diapers.

If you want to know more, read the section called Signs Baby is Breastfeeding Well.

Waken your baby

About half an hour before a feeding is due, watch for signs of waking, such as stretching and moving.

These are ways to help your baby wake up:
• undress and change the diaper;
• stroke and talk to your baby; or
• do ‘baby sit-ups’; be sure to support your baby’s head well. 

Watch how your baby sucks

Make sure your baby is sucking deeply and slowly, and doing lots of swallowing.  See the section called Getting Started.  Whenever you notice that your baby has stopped nursing or is falling asleep, massage your breast by stroking down towards the nipple.  This will make some milk ready when your baby starts sucking again. 

If this doesn’t work, try to waken your baby by doing a diaper change and more ‘baby sit-ups.’  It might help to switch your baby to the other breast, but be sure to go back to the first side at least once to get the richer milk.  Once your baby has grown out of being sleepy, always finish the first breast well. 

For a few days, count wet and dirty diapers to see if your baby is getting enough milk.

If you think your baby is not getting enough milk, get help.  See the section called Getting Help.

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My baby is fussy.  What can I do?

Babies can be fussy for several reasons. 

Hunger can make a baby fussy.  If your baby is hungry, you may just need to nurse more often. 

Milk that comes too quickly can make a baby fussy.  Some mother’s have very fast milk flow.  This is called an “overactive letdown.”  It makes a baby gulp air and feel uncomfortable.  Then they want to feed more and they may gain weight quite quickly.  Overactive letdown can also cause a baby to choke or cough while feeding, and spit up a lot.  It is more common in the baby’s first month.  These babies may also have explosive, watery stools and many wet diapers. 

Overactive letdown can be corrected.
• Nurse your baby often, every 2 to 3 hours.
• Start nursing before your baby is wide awake.
• Express some breastmilk before you begin nursing so your baby won’t have to deal with quite so much milk.
• Lie down or lean back while nursing so your milk will be flowing uphill.
• Let your baby nurse a longer time on the first breast before switching to the other side.
• Stop and burp your baby whenever your baby gulps, coughs, or chokes.

Milk that comes too slowly can make a baby fussy.  If your milk letdown is slow, you might need to get your milk flowing before starting to nurse.  To learn how to express your milk, see the section called Expressing, Storing, and Feeding Your Baby Breastmilk. 

There are other reasons for fussiness too.
• Your baby may need to burp or have a bowel movement.
• Some babies are more sensitive, and need more of your soothing touch.  Learning your baby’s cues will help you know what your baby needs. 
• The baby may be reacting to something you have eaten.  This is not common, but it can happen, and it can produce a rash, diarrhea, vomiting, or sleeping problems.  If you think this might be happening, see the section called Getting Help.
 

Not all fussiness is related to breastfeeding.  If these ideas don’t help, your baby may be sick.  Check with your doctor or nurse practitioner.

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I have sore nipples.  What can I do?

Sore nipples are usually caused by a poor latch, so start by checking your baby’s latch.  See the section called Getting Started and make sure your baby is latching correctly. 

Put some breastmilk or water on your nipples after feedings.  Creams may make your sore nipples feel better, but they will not help them to heal.  If your nipples continue to be sore, get help.  Sometimes a shield over the nipple is used for a short time if a mother has inverted nipples, or a baby is unable to suck well.  Do not try a nipple shield unless you have seen a lactation consultant first.  See the section called Getting Help.

If you have been breastfeeding with no pain, and then you get sore, burning, or itching nipples, you may have a yeast infection in your breast.  Yeast infections are more common after using antibiotics.  Eating live yogurt culture or taking one acidophilus tablet a day can help to prevent a yeast infection. 

Your baby may also have a yeast infection.  Look for a diaper rash or white patches in the baby’s mouth that do not wipe off.  These patches are a sign of ‘thrush.’ 

Call your doctor or nurse practitioner if you or your baby have signs of a yeast infection.  Both you and your baby need treatment.  If treatment does not help, call the Breastfeeding Clinic, a public health nurse, or a lactation consultant.

Remember, washing your hands before nursing helps to prevent infections.

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My breasts are too full.  What can I do?

Normally, your breasts will feel full when it’s time for your baby to nurse.  They shouldn’t hurt if you are feeding your baby at least 8 times in every 24 hours.  If your baby misses a feeding, your breasts may become too full.  This can also happen if your baby isn’t latched on well or isn’t nursing long enough.  If your breasts feel hard, hot, and painful, this is called ‘engorgement.’

A very full breast is a problem for a couple of reasons.  Hard full breasts are difficult for a baby to latch onto, so then the baby gets even less milk and your breasts become more engorged.  Engorged breasts can lead to plugged milk ducts or a breast infection.  If this fullness is not dealt with, it can damage the milk-producing cells, and this will cut down on the amount of milk you make. 

Make sure your baby feeds long enough to soften one breast well.  Massaging your breasts while your baby nurses will help to empty them.  If your breasts are still engorged, then you need to remove more of the milk.  Express some milk from your breasts until they feel comfortable.  See the section called Expressing, Storing, and Feeding Your Baby Breastmilk.

After nursing, apply cold to your breasts for 10 to 15 minutes.  You can use soft ice packs, or a bag of frozen vegetables.  Your breasts should feel better after just 1 or 2 feedings.  If you still have engorged breasts, see the section called Getting Help.

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I have plugged ducts and a breast infection.  What can I do?

A plugged duct feels like a hot, painful lump in your breast. 

If you have a plugged duct, warm your breast with moist heat using a warm, wet towel, or lower your breast into a sink full of warm water, or take a hot bath or shower.  Then, before and during feedings, massage your breast firmly starting at the chest and moving toward the nipple. 

Let your baby nurse as often and as long as possible.  Try nursing your baby in different positions in order to drain your breast as much as you can.  Make sure that you aren’t wearing a tight bra or any clothing that is blocking the flow of milk from your breasts. 

A plugged duct can lead to a breast infection which is called ‘mastitis.’  If you have mastitis, your breast will feel painful and hot, and you may have a lump or a red streak.  You might also have a fever and feel like you have the flu.  If you can’t clear the plugged duct and you are still feeling sick, call your doctor or nurse practitioner.  Be sure to continue to breastfeed and get lots of rest.  The milk you produce when you have mastitis will not hurt your baby.

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My baby is not able to breastfeed.  What can I do?

If your baby is premature or sick or unable to latch well, you can still feed your baby expressed breastmilk.

Expressed breastmilk is milk that has been removed from a mother’s breast and then fed to a baby using a cup, bottle, or supplementary nursing system.  See the section called How to feed expressed breastmilk to your baby.  Breastmilk is excellent food for premature babies and for babies who are not strong enough to suck.  These babies need the special fats in breastmilk.  Breastmilk is very good for them as it helps to protect them from infections and from serious bowel disease. 

If breastfeeding does not work out for you, you can express milk for your baby for as long as you want.  The cost of a breast pump is still less than the cost of formula, and if you use formula, your baby is more likely to develop infections.  See the section called Expressing, Storing, and Feeding Your Baby Breastmilk.