Module 6: Breastfeeding Challenges

In addition to learning how to breastfeed there can be some other factors which can impact how ‘easy’ breastfeeding is, how confident you might feel about feeding your baby as well as whether you decide to stop breastfeeding.

Growth Spurts

These generally take place:

between 7- 10 days
between 2-3 weeks
between 4-6 weeks
at around 3 months
at around 4 months
at around 6 months
at around 9 months

Growth spurts can last for 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 are big developmental leaps.

It can be easier to meet your babies needs and just go with it. Your baby may feel all over the place, being unable to settle and could need more food, as well reassurance and safety as his brain develops and his world changes. Your baby could be more cuddly, could wake more and may just need to cling on to you.

How you might feel during growth spurts and with cluster feeds

Tired and frustrated and feeling like you are doing something wrong – you’re not! But do reach out for some support so you can be reassured.

Chances are you could also be feeling hungry and thirsty so make sure you have plenty of food and water to hand around the house and when you are out and about.

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) and it can feel like something is wrong – not enough milk or too much wind. This can be totally normal behaviour and it’s just about 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 breast milk to satisfy their baby and they may search for other solutions but it can be easier just to feed as much as your baby needs, to wander about with your baby to soothe him, to bounce on a gym ball to help him settle and to 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 at night.

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 and it can be the reason that formula is introduced as top-up feeds or becomes the main source of food.

If your baby is gaining weight but slowly, you need to see a breastfeeding specialist to talk through feeding, to check your baby’s latch, to check for a tongue-tie, to talk about your supply and to develop a feeding plan. It can also be worth talking through any other symptoms which could 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.

Sensitivity to the food you eat

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 fussy
being very unsettled
excessive vomiting
a rash or eczema
being very congested
diarrhoea
poo which can be green, mucusy or even bloody
a sore bum
itchy eyes

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 breast milk…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.

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 experience 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
congestion
swallowing difficulties
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 – treatment may include trying Gaviscon to ease 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

Tongue-Tie

The lingual frenulum is a membrane that connects the tongue to the floor of the mouth. A tongue-tie is when this membrane 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 breast, 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
slow weight-gain
being fussy when feeding
painful feeds
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 for Tongue-Tie
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.
laleche.org.uk has a great page of information, as well as links to local support groups and phone support.

YOU NEED TO KNOW…

Opinions, support and advice around breastfeeding can be very
conflicting – if your baby has lost weight or you are very sore from feeding, you need to speak to a breastfeeding specialist for more support.

Breastfeeding often doesn’t come naturally, it is a skill to be learnt and it is ever changing so good support can be crucial. You are not doing anything wrong if it doesn’t feel natural and if it is harder than you ever imagined.

Why women stop breastfeeding

The UK has the lowest rate of breastfeeding in the world – only 1 in 200 women breastfeed their children after they reach their first birthday. Statistics show that 80% of women start breastfeeding at birth but half of those babies have formula by the end of the first week.

Breastfeeding author Dr Amy Brown surveyed women who had stopped feeding, she found that 80% of the women who stopped in the first 6 weeks didn’t want to stop but felt that they couldn’t continue. Brown states that the vast majority of women who stop feeding do so due to their experience rather than an inability to feed.

As a practitioner who works with postnatal women, much of my work is about reassurance and normalising feeding, sleep, growth spurts and meeting the changing needs of a baby. In my day-to-day work I see a couple of reasons for stopping breastfeeding…

1. Our culture can set mothers up to fail with expectations of routines, babies who sleep through the night, babies who settle themselves and who ‘should’ be more independent.
Every baby is different but it is so normal for babies to need and want to cling and to be close to his parents, especially mum. Biologically babies are meant to wake in the night for food, comfort and reassurance and they are unable to settle themselves if they are upset.

This can make breastfeeding hard and it can knock the confidence of a breastfeeding mum who is concerned that she is not making enough milk for her baby or that she is doing something wrong because her baby wakes frequently in the night or won’t settle away from her. I am in no way against formula – at all – but it has been sold at the saviour of parents who want more sleep, babies who feed less often and babies who seem more settled. The bigger picture is that it is has undermined the normal behaviour of new and young babies and our expectations are often not based on the reality of life with a new baby.

2. There are a few feeding issues which can sometimes be difficult to correct because of a lack of support and services.

Slow weight-gain – mums need support and reassurance and there may a reason behind the weight-gain such as food sensitivity or a tongue-tie. A good feeding plan could also make a huge difference to milk production and weight gain.

Tongue-tie – this can have a huge impact on feeding if babies are unable to feed well and if nipples are sore and becoming injured. There are currently not enough trained health professionals who can diagnose and treat a tongue tie so many are missed and waiting lists for referrals can be long. With support, some women are able to persevere and keep going but others have to stop because it is too damaging physically and mentally.

Painful feeds – this can be due to a tongue-tie or it could be due to a problem with positioning and attachment. Some breastfeeding support can help with this but there are not enough breastfeeding specialists within the healthcare system to identify and correct simple feeding issues, as well as provide support and reassurance to women who want to continue to feed.

If you plan to breastfeed, it can be helpful to know where to go for support and to have this in hand from the end of your pregnancy.

Find out more about…

local breastfeeding support groups such as La Leche League
breastfeeding specialists who are trained to provide support:
La Leche League provides reliable and professional support but also ask your midwife & health visitor if there is anyone you can see in hospital and when you get discharged from hospital
online sources of support and information:
La Leche League and KellyMom
Helplines:
NCT Breastfeeding Line 0300 330 0771 (8 am – 10 pm daily)
National Breastfeeding Helpline: 0300 100 0212 (9.30am-9.30pm daily)
La Leche League Helpline: 0345 120 2918 (8am-11pm daily)

As you go through this module and the resources, you can make notes, jot down your questions and start to develop your action plan for labour, birth and life with your baby.

And please don’t hesitate to message me below to arrange a conversation with me to talk through your questions.

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Welcome To Your Antenatal Course

1. Labour
2. Birth
3. Pain Management
4. Labour & Birth Challenges
5. Meeting Your Baby
6. Your New Baby
7. Relax & Breathe Resources