Q: Why is breastfeeding so painful?

A: In the first week or two, this is usually due to poor positioning/latch. The following three guidelines can be helpful:

• Alignment. The infant must have ear, shoulder, and hip in one straight line when placed at the breast. This applies for any position the mom chooses.
• Bring infant to the breast. When the breast is taken to the baby, the baby latches onto the nipple rather that the areola and "nipple feeds" rather than breastfeeds. (A toe curling "ouch!")
• Chin and nose must touch the breast during the feeding. This is what keeps he nipple to the back of the infant's mouth (the soft part of the mouth).

Q: My milk has just "come in" and my breasts are so hard. What do I do?

A: Feed the baby. You may need to express some of the milk so that the breast can become soft enough for the infant to latch onto. Cold compresses on the breast for about 20 minutes several time daily will help also. Warm compresses make it worse. "Engorgement" usually occurs if the breast isn't being relieved of the newly produced milk. Early and frequent feeding at the breast is the best way to prevent engorgement. It usually last 24-48 hours. Speak to a triage nurse if you need help.

Q: Should I limit the time I feed my baby on the breast? How do I know when to feed from both breasts or just one side?

A: Lactation guidance no longer recommends that infants limit feedings to a certain number of minutes. Watch the baby, not the clock. As long as the infant is swallowing while breastfeeding, keep her on that breast. When she stops swallowing or comes off naturally, offer a burp and then the other breast if she acts hungry. If she is hungry, she will take the second breast. If not, she will act uninterested. 

Q: What foods should a breastfeeding mother avoid?

A: Very little in the mother's diet actually causes problems. Foods such as onion, broccoli, cabbage, and Italian spices can change the flavor and smell of the milk and some babies acknowledge this change. They might not form a complete seal at the breast due to this change, therefore causing more air intake during feeding. Some babies react to cow's milk protein that can pass into mother's milk. If the infant seems to be in distress after feeding, a trial elimination of cow's milk products can be tried for a couple of weeks. If you do this, be sure and get your dietary calcium through another source. Caffeine may affect the infant, so limit this until you get to know your baby better and can judge if this is the case in your baby. Also, don't force liquids. Drink to thirst or if your urine appears concentrated.

Q: My baby has been breastfeeding well, but recently it has become painful. What's happening?

A: The most common cause after 2 weeks if painless feeding has been established is a yeast infection. You may feel burning as the infant feeds and breast can remain painful to touch after the feeding. Call our office or your physician's office for guidance. The infant needs to be evaluated for thrush and both of you may need to be treated with an antifungal medication. If your nipple is cracking and possibly bleeding, it may also be a bacterial infection and your physician needs to be consulted.

Q: How do I know if I have mastitis?

A: Mastitis is an infection of the tissue of the breast. Symptoms include fever, soreness, redness and firmness of part of the breast, and flu-like symptoms. Call your physician for treatment. It is okay that you continue to fed the infant while you have mastitis - in fact, it is important that you do so. The milk needs to flow to prevent further infection or damage to the breast.

Q: My breasts aren't red and I don't have fever, but they have a sore lump. What should I do?

A: Lactating breasts often have lumps even as far as up under the arms. They are not usually sore. Soreness may be a blocked milk duct. Warm compresses over the lump and massages above the lump toward the nipple usually works. They usually resolve in 24-48 hours. If not, seek medical help.

Q: I have a painful white blister on my nipple. It hurts to feed. What's up?

A: This is similar to the above question but the blockage is at the point of exit for the milk. Again, warm moist compresses and expressing the milk to unplug the opening. Seek medical help if it persist greater than a day or so.

Q: I think my milk supply is less than it should be. How do I build it back up?

A: It's a "take and make" process. Offer the breast more often so that your body is encouraged to increase the supply. If this is not possible, pump for about 10 minutes after the infant breastfeeds. This should communicate with your body that more milk is needed. Have you started on a birth control pill lately? This often decreases milk supply. Discuss this with your physician. Other options can be discussed over the phone in an attempt to find what is best for you.

Q: How long can I store milk - at room temperature, in the refrigerator, or in the freezer?

A: There are many numbers floating around regarding milk storage, but to make it simple and be within safe limits you can use the following guidelines:

• 3 HOURS at room temperature
• 3 DAYS in the refrigerator
• 3 MONTHS in the freezer

As with formula however, any time the infant takes milk from a bottle, he must complete that bottle within an hour. Once he has gotten saliva into the milk, it cannot safely be saved for later use.

Q: When can I offer a bottle? What bottle nipple should I use? What about a pacifier?

A: If breastfeeding is well established (usually after 3 weeks), it really doesn't matter. Most babies go back and forth easily at this age. This will be governed by your lifestyle. It is important that moms who plan on returning to work soon establish an alternative feeding method for the babysitter to use. Whatever type nipple the baby uses is best for that baby. In most cases, infants do best with a nipple that has a wide base and long nipple. Choices include Nuk and Avent, but there are many other types. Buy one of each and see what works best. The same is true with a pacifier. Most breastfed infants spit the pacifier out initially.

Q: My 2 month old baby used to take 20 minutes or longer to feed. Lately he has shortened the time to10 minutes or less. Is there something wrong with my milk?

A: It is normal that the more proficient the infant is at obtaining the milk, the shorter the feeding. If the infant is gaining well and acts happy and content, all is well. Welcome to the wonderful world of breastfeeding!