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Breastfeeding Problems and Solutions

Michael Brian

Pinching, Cracked Nipples, and How Much Is Enough

What if I feel a pinching sensation?

While a bit of initial discomfort is to be expected in the first two to four days of breastfeeding, persistent pain usually means your baby is not latching on properly. To improve Baby's latch-on, be sure his mouth is wide open as he takes the breast; both of his lips should be turned out (everted). When your baby takes the breast with mouth open wide, he'll have a "fish mouth" look as he nurses, and you should not be able to see your nipple. Be sure your baby's tongue is between his lower gum and your breast. (If you pull down gently on Baby's lower lip, you should be able to see his tongue.) If his bottom lip is pulled inward instead of outward, use the index finger of the hand that is supporting your breast to pull out that lower lip. (You may need a helper to take a peek under the breast and do this for you while Baby is latched on.) This "lower lip flip," as we call it, may be all that's needed to keep your infant from tight-mouthing your nipple.

If your baby doesn't get onto the breast well at the first try, take him off (break the suction with your little finger inserted into his mouth) and try again, waiting for that wide-open mouth. Don't settle for a less-than-great latch-on: Be patient, keep trying, and soon your baby will learn exactly what to do.

How can I tell if my baby is getting enough milk?

In the first few weeks, many mothers worry about whether their babies are getting enough breast milk. There's no handy way to measure the ounces going in, and the amount of milk you can pump bears little relation to how much milk your baby is getting from the breast. It's better to watch the baby for signs that he is getting enough to eat. Do you notice a few drops of milk leaking from the sides of your baby's mouth and hear him swallow after every one or two sucks? Does he seem content after a feeding? By the fourth day after birth, your baby should wet about six diapers a day. Pale, almost water-colored urine suggests baby is getting enough milk to stay adequately hydrated; darker, apple-juice-colored urine suggests that he is not. Baby's stool output is another helpful indicator. Within a day or two of your milk coming in, your baby's bowel movements change from sticky black meconium to "milk stools." These are yellow, seedy, mustard-colored and the consistency of cottage cheese. Babies between 1 and 4 weeks who are getting enough milk will produce at least two to three of these stools a day, often more. If a lot of urine and stools come out in the diaper, rest assured that enough milk is going in. (During the second or third month, some breastfed babies may have only one bowel movement a day while still getting enough milk.) You'll also observe that your breasts feel softer after a feeding in which baby takes plenty of milk.

The bottom line is baby's weight gain. After the normal initial loss of five to seven percent of their birth weight (five to seven ounces for an average 6-pound baby), babies should regain their birth weight by two weeks of age. As a general guide, a baby getting sufficient milk should gain four to seven ounces a week, or a minimum of a pound a month. If you think your baby is not getting enough milk, take immediate steps to improve nursing (a lactation consultant or your doctor can help) and take your child to the pediatrician every few days.

What if I have cracked nipples?

Cracked nipples are usually caused by improper latch-on. When your baby doesn't get enough breast tissue into his mouth, all the sucking pressure is concentrated on the nipple.

Try feeding Baby first on the side that is the least sore. Usually the most uncomfortable part of a feeding is the minute or two of sucking it takes to trigger your milk-ejection reflex. Once the milk is flowing freely, nursing will probably be more comfortable. Mothers with sore nipples are often tempted to nurse less frequently, but this aggravates the problem, since your breast can become engorged, making it more difficult for Baby to latch on. Try to feed more frequently while being vigilant about proper latch-on. After nursing, you can massage medical-grade ultrapure lanolin ointment onto the cracked area. If the crack does not improve within a day or two, call a lactation consultant. If it becomes infected (if your baby has thrush, for example, the yeast can infect your breasts), your doctor can prescribe medication.