Breastfeeding challenges can impact how straightforward breastfeeding is and how confident you might feel about feeding your baby.
Breastfeeding Challenges: Growth Spurts
These generally take place between 7- 10 days, between 2-3 weeks, between 4-6 weeks, 3 months, 4 months, 6 months and 9 months.
Spurts can last a few days but for some babies it is more likely to be a week or more especially at 4 months and 9 months when there is a big developmental leap.
It can be easier to meet your baby’s needs and go with what they need. Your baby could need more food, as well reassurance/safety as their brain develops and their world is changing. Your baby could be more cuddly, could wake more and may just need to cling to you.
How might you feel? Tired and frustrated and feeling like you are dong something wrong – you’re not! Chances are you could also be feeling hungry and thirsty – make sure you have plenty of food and water to hand around the house and when you are out and about.
Breastfeeding Challenges: Cluster Feeding
Some babies will have feeds that are close together, it can feel almost constant and this can be in the evening when babies can also be more fussy.
Babies can be on and off the breast, not wanting to settle anywhere but on mum (and sometimes on someone else). It can feel like something is wrong such as not enough milk, too much wind. This can be totally normal behaviour and it’s just riding it out, getting support and working together.
This is a huge stealer of confidence, leaving everyone feeling like feeding is not working. Some parents worry that there is not enough breastmilk to satisfy their baby and may search for other solutions. But it can be easier to feed as much as your baby needs. You can wander about to soothe him, bounce on a gym ball to help him settle and accept that your baby may want to be held if he wakes every time you put him down.
For some babies cluster feeds are about filling up so they can sleep for a longer stretch.
Breastfeeding Challenges: Slow Weight Gain
This is an issue that comes up a lot in my postnatal sessions – it causes a great deal of worry, stress and tears. It can also be the reason that formula is introduced as top-ups or the main source of food.
If your baby is gaining weight but slowly see a breastfeeding specialist to talk through feeding, to check your baby’s latch and for a tongue-tie and to develop a feeding plan. It can also be worth talking through any other symptoms which may mean your baby is being affected by reflux or cow’s milk protein allergy, as these can impact weight-gain.
La Leche League states: “A gradual drop from one percentile line to the next is unlikely to be a problem unless his weight is already low for his age. Heavier newborns often show ‘catch-down’ growth—they gain weight steadily but drop gradually against the chart lines.
Dropping against the chart is more of a worry for lower weight babies. If your baby’s growth curve drops across two lines of the chart or if his weight is below the lowest line of the chart – see your GP to check for any underlying medical reasons, talk to a breastfeeding specialist about a feeding plan to get more milk into your baby.
If your baby has plenty of wet/pooey nappies and looks healthy – sleeps, bright & alert, happy, meeting milestones – try to be reassured and focus on feeding.
Breastfeeding Challenges: Food Sensitivity
Babies can sometimes be sensitive to other foods – the most likely common problem foods are: cow’s milk products, eggs, soy, wheat, corn and peanuts.
While most babies are totally fine with whatever you eat, some will display signs that could be a reaction:
*being very unsettled
*a rash or eczema
*being very congested
*poo which can be green, mucusy or even bloody
*a sore bum
Some babies can have a mild reaction to certain foods, while others will have quite a severe reaction. This can be instant or it can take up to a day for symptoms to show.
Cows milk protein is the most common problem food and some breastfeeding mums eliminate milk products to see if it eases the symptoms – if your baby is sensitive to a particular food, it can take 2-3 weeks to see a difference.
Kellymom wrote about sensitivity to cow’s milk protein and cleared up some confusion that can sometimes exist: “If your baby is sensitive to diary it is highly unlikely that the problem is lactose intolerance…babies are more likely to be sensitive to proteins, which pass through breastmilk…So, if your baby is sensitive to dairy, switching over to lactose -free products won’t help but eliminating it could make a difference.”
The kelly-mom website also went onto say that a significant amount of babies with cows milk protein allergy will also react to soy and that most will also be sensitive to goat and sheep milk. Most babies will outgrow the sensitivity to cows milk protein – many by 6-18 months and most by 3 years old.
Breastfeeding Challenges: Reflux
This is defined as the regurgitating or vomiting of feeds, which can also be accompanied by heartburn. The NICE guidelines states that 4 in 10 babies experienced reflux – the symptoms can range from mild to severe – and that for 9 in 10 babies it will get better on its own. It is more likely to occur in babies who are premature, have a low birth weight or have a cow’s milk protein allergy.
For many babies reflux involves regular spitting up but their weight-gain is good and they are happy so they don’t need any treatment. But if it is bothering your baby, there can be a number of symptoms.
Mild symptoms can include: frequent spitting up and vomiting, gagging & choking when feeding, lots of hiccups, fussy with disturbed sleep. Your baby may arch his back and squirm if he is uncomfortable or in pain.
Severe symptoms can include:
*slow weight-gain or even losing weight
*a baby who is very unsettled, with long periods of crying – some babies can refuse to feed and become upset because it hurts.
*blood in his poo
*bile (which can look green/yellow) or blood in vomit
See your health visitor or GP if your baby is experiencing symptoms.
Other ways to ease symptoms:
*feeding little and often – making sure the latch is good
*it can also be helpful to just use one breast during a feed – switching too often can cause more spitting and vomit
*your baby might need to feed in a more upright position – and then staying upright afterwards as he digests his feed
Breastfeeding Challenges: Tongue-tie
The lingual frenulum is a membrane that connects the tongue to the floor of the mouth – a tongue tie is when this is short or too tight and it can affect the mobility of the tongue. Tongue tie often runs in families so it can be worth getting your baby checked out as soon as possible.
Your baby’s tongue is important in feeding – he needs to be able to move it well and to be able to move it over his lower gum to be able to breastfeed well. A tongue-tie can be mild or it can be severe, which can have a huge impact on feeding.
Signs of a tongue-tie can include:
*problems latching – some babies are unable to latch at all and others struggle to get a deep latch, which can cause pain and damage in the nipple
*losing suction and coming off the breastfeed, which may be accompanied by a clicking noise
*a struggle to manage faster flowing milk, which can cause coughing and spluttering
*almost constant feeding because babies are not getting enough during a feed
*being fussy when feeding
*damage to your nipples, which may bleed
*your nipple can be misshapen after a feed – looking more like a lipstick
*you may be engorged or develop mastitis
*your milk supply can be affected – it can be low if your baby is not able to stimulate enough milk production or there can too much milk if your baby is feeding often
I have seen mums who feel broken when feeding is an ongoing battle with an unsettled baby and damaged nipples which can cause fear and tears before and with each feed. Some women need to stop breastfeeding because it is affecting their mental health and their ability to look after themselves and their baby. Good support can make a huge difference.
Assessment & Treatment
When a baby is assessed and a tongue tie is diagnosed, it can be snipped to enable greater movement of the tongue – with ongoing breastfeeding support, this can work well, the symptoms can ease and feeding becomes much easier.
For NHS treatment, referrals to a tongue-tie clinic can probably be made by a midwife, health visitor or GP – although this can vary from area to area and sometimes only GP referrals are possible. The sooner a referral is made, the sooner a baby can be seen and breastfeeding problems are more likely to be resolved.
Help with feeding
La Leche League support can be beneficial right from birth – they can’t assess or diagnose a tongue tie but they know the signs and can talk to you about seeking a referral.
La Leche League has a great page of information.
If you and your baby are experiencing struggles and any breastfeeding challenges, please make sure you get some support for you as well – get along to good groups, you can get involved with Mother Cuppa Postnatal Groups and see a breastfeeding specialist to get good feeding support and reassurance.
Janine Smith | A specialist in pregnancy, birth and early parenting