Breastfeeding FAQ - Beyond the 1st Week
Q: What are the signs of a breast infection?
A: The most common signs of mastitis are fever, body aches, breast redness, warmth and pain.
Mastitis is an infection of the breasts triggered by the milk not draining. The earliest sign is an aching breast. When discovered early, hot compresses and very frequent feedings will usually be sufficient to resolve the problem. When infection sets in, you might feel malaise with aching joints, nausea and vomiting, fever and flu-like symptoms. Don't stop nursing; emptying your breasts is essential to resolving the infection. However, oral antibiotics are often necessary, so call your physician. In the meantime, check your bra to make sure it is not too tight, continue the compresses over the entire breast to relieve blockage, rest as much as possible, drink plenty of fluids and nurse as frequently as you can beginning on the affected side. Frequent bouts with mastitis may imply improper nursing technique. If this happens, call your obstetrician or us. It may be prudent to have a lactation consultant observe your technique.
Q: When should I be concerned about thrush?
A: The classic symptoms of thrush include a nipple rash, white patches in the baby’s mouth and breast or nipple pain.
Some women describe a burning or itching pain in their breasts. If you have pain with feeding you and your baby should be seen.
Thrush is caused by a fungus called Candida Albicans. This is the same organism responsible for women’s vaginal yeast infections and also babies’ yeast diaper infections (not normal diaper rash). Candida Albicans are present in and on all bodies, but an infection occurs when the amount increases beyond normal. Yeast grows well in warm, moist, sugary environments, and milk ducts and baby mouths fit these requirements.
Signs of thrush in mothers: 1) red, itchy, flaky, cracked, burning nipples, 2) sore nipples unresponsive to basic treatment, 3) persistent breast pain or burning during or after feeding, 4) vaginal yeast infections.
Signs of thrush in infants: 1) white spots inside the cheeks, 2) white spots inside the lips, 3) difficulty eating (uncommon), 4) yeast diaper infections (copious amounts of persistent small red bumps in diaper area and into leg folds). **Please note: babies often have white tongues unrelated to thrush; therefore a white tongue alone is not used to diagnose thrush.
Q: How is thrush treated?
A: A small amount of thrush in a baby’s mouth is very common and not necessary to treat if there are no feeding problems and mom is not symptomatic.
Thrush is usually treated, after discussion with your healthcare provider, if mother is symptomatic or baby is having trouble feeding. Treatments include both topical antifungals (such as nystatin) and oral antifungals (typically Diflucan). Because yeast grows well in warm, moist environments it is important to look at your environment. Make sure breast pads and burp clothes are changed frequently. Many families boil pacifiers, and teething toys. Avoid sugary and fermented foods. Eating garlic and yogurt, and taking acidophilus or lactobacillus may also help!
Q: What do I do if my nipples are sore?
A: Seek consultation with a lactation consultant to make certain your latch is correct.
If the latch is correct and your pain continues, you need to be evaluated by a physician to make certain there is no infection or that you baby is not tongue-tied.
Q: What should I do if I get plugged duct?
A: Feed your baby while applying a warm compress and gently massaging around the plugged duct.
Other tricks include pointing the baby’s nose toward the lump. Massage in front of the lump to loosen the clog, then also massage behind. If you have problems with recurrent plugged ducts please call us.
Q: What do I do if I have persistent breast lump?
A: If your lump continues despite treating it like a plugged duct than you should be evaluated by your ob/gyn.
Sudden, tender lumps are usually a sign of a plugged duct (see above). Lumps that change with time are of no concern; these are usually related to small cysts that fill and are emptied of milk. Lumps that do not resolve should be evaluated by your ob/gyn.
Q: Why does my baby pull away from the breast?
A: Your baby can pull off for several reasons:
- to burp,
- at the very end if your baby is full and satisfied
- slow flow: Sometimes the flow slows down after the initial let down. Some babies become impatient with the slower flow. If this is the case try breast compressions while feeding.
- Rapid flow: Some women with a generous milk supply, may have a very strong let down with a rapid flow. These babies may choke while feeding or pull off the breast to control the flow. You can help this, by trying different positions including feeding your baby in a more upright position or utilizing the football position.
Q: What if the baby begins to lose interest?
A: Typically this occurs when the baby is more sociable at about 3 months and is interested in other activities.
Babies are easily distracted at this age and will pull your nipple, areola and breast with them to see what is going on. If you need to finish a feeding, go to a quiet room and relax - the feeding will proceed in a much smoother fashion.
Q: What if my milk turns a different color?
A: The color of colostrum is yellow-to-yellow orange and the color of mature milk is bluish white.
However, various foods ingested by the mother can change the color of human milk dramatically. Pink/orange milk has been associated with drinking orange pop/soda, which contains orange food dyes. Gelatin, fruit drinks and other forms of pop can produce similar results. Green milk may be seen after drinking GatoradeTM, kelp or natural vitamins from health food stores. There is no such thing as spoiled milk straight from the breast so ignore the color!
Q: When can I offer a pacifier?
A: It is generally recommended to wait until breastfeeding is well established to offer a pacifier.
Some babies have a high need for non-nutritive sucking. This need can be met with a breast, a finger or a pacifier. Once your milk supply is well-established, latching on is easy and comfortable, and your baby is gaining weight, then a pacifier can be offered if your baby is one with a strong need to suck.
Q: When should I offer my baby a bottle?
A: The timing will depend on how well the baby is feeding and your individual preferences. We are happy to talk to you about a plan. Many mothers are very concerned their baby will never take a bottle unless introduced at the “right” time. We find this is very individual for each baby.
In general if you are going back to work, it is common to introduce a bottle at 3 to 4 weeks of age or several weeks before you return to work. Many women find it helpful for the father or significant other to introduce the bottle. Some babies will take the bottle easily and others will need multiple tries and may have a preference as to the type of bottle nipple used.
Q: When should I start pumping?
A: This will vary depending on your baby’s needs, your milk supply, and your time apart from your baby. We are happy to discuss this with you as we see you and your baby.
If you are returning to work, many mothers find it helpful to build in an extra pumping session a couple of weeks before returning to work. This allows them to store up some milk. Remember it will take a couple of days between starting the extra pumping session for your body to start making more milk.
Q: How long can I store my breast milk?
A: The general recommendations for breast milk storage for a healthy full term infant (data from Human Milk Bank Association of North America, 2006):
Q: What type of pump is best?
A: This depends on your individual preferences and needs. Many women can get as much milk out with hand expression as with pumping. However, if returning to work a good double electric pump is probably more efficient. If you are uncertain about which pump is best for you, it may be beneficial to discuss this with a lactation consultant for your individual situation.
Q: What can Dad do?
A: Studies have shown that support from dad is essential for breastfeeding to succeed. There is a much higher chance of early weaning if dad does not support the decision to breastfeed. Dad’s are often wondering what they can do if mom is breastfeeding. There are lots of ways to help:
- comforting the fussy baby
- providing the non-nutritive sucking
- baby massage
- taking care of baby while mom takes a nap
- carrying a baby in a sling
- playing with the baby
- diapering
- keeping baby skin to skin
- bathing the baby
- caring for other children
- helping with household chores
And remember if it works for your family, once baby has breastfeeding well established, dad may give bottles of pumped milk.