Frequently Asked Questions - Common Concerns and Challenges
Issues that can often be overcome with appropriate information and support
Very unlikely. Occasionally, a baby who has been nursing well will suddenly refuse the breast for no apparent reason. This is called a nursing strike. It is very rare that a baby will wean on his own during his first year, and weaning usually happens gradually. On reviewing the situation, a cause for the nursing strike can sometimes be identified. Common causes include: an earache or stuffy nose, a scary sound that happened while breastfeeding, a different lotion or deodorant, too many bottles or pacifiers or a recent change in routine. Nursing strikes can last from 2-4 days.
During the time that your baby is refusing to nurse, you will need to express your milk either by hand or by pumping, in order to maintain your milk production. Do this as frequently as your baby would normally nurse. If your baby has refused several feedings, you can offer your expressed milk in a cup. Avoiding bottles and pacifiers is recommended during this period in the hope that your baby's sucking urges will encourage him to start nursing again.
Spending lots of time skin-to-skin with your baby can be very helpful. You can also try:
- taking a warm bath together
- making the breast available while baby is sleepy, especially when he is just waking up
- singing to or rocking your baby while holding him skin-to-skin
- nursing in a different position or location
Do not try to make your baby breastfeed; rather just hold him (skin-to-skin when possible) and let him take the lead when he is ready to try again.
As long as your baby is still having the same number of wet and soiled diapers, there is no reason to panic. It is normal for a baby at around this age to change his nursing pattern. When a baby starts nursing non-stop for a few days it usually means that he is growing. After a few days of frequent nursing, your baby will fall into a new nursing pattern with your recently increased milk supply. We call these episodes “growth spurts” or “frequency days”.
The term “growth spurt” (also called frequency days) describes times when babies seem to nurse non-stop for a couple of days. It is believed that this is how the baby tells the mother’s body to increase milk production. Babies usually have several “growth spurts” in the first 6 months. They often occur at 10 days, 3 weeks, 6 weeks, 3 months and 6 months. But they can occur any time. After about 48-72 hours of frequent nursing, a baby will return to a more regular routine of nursing, rest and playtime.
There could be a few reasons but a common cause of sudden nipple pain is thrush, or a yeast infection. This pain often feels intense or “burning” with shooting pains deep into the breast. It occurs both while nursing and between feedings. It is not improved with correcting baby’s latch. (For more information see FAQs Thrush.) Other causes for sudden nipple pain can be:
- teething or other changes in your baby’s mouth that affect how he latches on
- changing nursing patterns (if your baby spaces out his feedings, flow may be faster and he may adjust his latch to cope)
- use of an ineffective breast pump
- skin reactions such as eczema and psoriasis
- skin infections such as herpes and chicken pox (You would also see sores on your breast.)
Thrush is an infection of the breast by yeast (Candida albicans). This same yeast can cause vaginal yeast infections, infect a baby’s mouth and cause a diaper rash. C. albicans is found on and in everyone’s body. Sometimes the balance between the different normal flora of the body gets out of whack and yeast can take over, resulting in symptoms of a yeast infection.
The first step in treating thrush is to get an accurate diagnosis from your healthcare provider. There is no reliable lab test for thrush. If your doctor diagnoses thrush, it is essential for both you and your baby to be treated for thrush at the same time, even if only one of you has symptoms. Yeast is easily spread and thrives in warm moist environments such as your baby's mouth and your nipples.
Thrush on the nipples can be very difficult to treat and should be done with the guidance of a healthcare provider. There are many treatment options from topical anti-fungal creams to anti-fungal oral medication; your doctor can help you decide the correct treatment to choose. An alternative health care practitioner, such as a naturopathic doctor, can provide guidance with the use of nutraceuticals and homeopathy. The most important part of treatment for thrush is to complete the treatment, even after your nipples begin to feel better. Tell your doctor if you are not feeling better within the first week of treatment. You can find a list of treatment options to discuss with your doctor in the information sheet on Thrush, available from your La Leche League Leader.
Your baby may have white patches on the inside of his cheeks, roof of his mouth, inside of his gums or on his tongue that cannot be wiped off. He may also have a persistent, painful diaper rash. Occasionally, babies are fussy at breast when they have a yeast infection.
Persistent nipple pain in the early weeks of breastfeeding that isn’t improved with a deep latch, or nipple pain that appears after several weeks or months of pain-free nursing, may be caused by thrush. Additional symptoms can include:
- Itchy or burning nipples that appear bright pink or red, shiny, flaky, and/or have a rash with tiny blisters
- Cracked nipples becoming deep without bleeding, often in a fold at the base of the nipple. Occasionally cracks are seen on the front surface of the nipple in a crevice
- Shooting pains in the breast during or after feedings
- Deep breast pain
- Nipples sting more after the feeding rather than during the feeding
The most common cause of nipple pain is a shallow latch. This means that your baby does not have enough breast tissue in his mouth. Babies need a deep latch to get enough milk. If your baby is not latched correctly, you may notice a crease across the tip of your nipple when it comes out of your baby’s mouth. Or it may be shaped like a new lipstick, or white at the tip. If the pain doesn’t resolve or you’re having difficulty getting a deeper latch, consider having a lactation expert (A LLL Leader, International Board Certified Lactation Consultant, or knowledgeable health nurse) observe your baby at breast.
Preferably, human milk should be refrigerated or chilled right after it is expressed. Acceptable guidelines for storing human milk are as follows:
At room temperature (19-26°C, 66-78°F,) for 4 hours (ideal), up to 8 hours (acceptable)
In refrigerator (4°C, 39°F) for 72 hours (ideal); up to 8 days (acceptable)
In freezer compartment of refrigerator with a separate door (-18°C, 0°F) for 3-6 months.
In deep freezer (-20°C, -4°F) for 6 months (ideal); up to 12 months (acceptable)
You can thaw your frozen breastmilk by holding it under cool running water. Gradually increase the water temperature to heat it to a comfortable feeding temperature. This is a temperature that feels warm, not hot, on your wrist. Periodically mix the milk in the bag or bottle by swirling gently, as it defrosts. Milk can also be thawed in a refrigerator overnight. Do not thaw or heat your milk in a microwave or directly on the stove.
Thawed milk should be kept refrigerated and used within 24 hours. If it hasn’t been used by that time, it should be discarded or refrozen. However, repeated freezing and thawing will affect milk quality.
Unfortunately, there is no clear answer to this question as there is no research about whether it is safe or not. Until recently, the standard answer was to discard any breastmilk left in the bottle after a feed. However, recently it has been suggested that it might be okay to store breastmilk in the fridge for a short time. The current thinking is that bacteria growth is possible, but not likely, because fresh breastmilk has anti-bacterial properties, and a breastfed baby has a strong immune system to deal with any bacteria that do grow. If the breastmilk has been frozen and thawed some of these properties are lost. The final choice is yours; let common sense be your guide. If the baby's next feeding of pumped breastmilk ends up being 7 or more hours later (because he slept through the night, for example) or the breastmilk was stored in the fridge for several days before being fed to the baby, you may choose to err on the side of caution. To avoid wasting precious breastmilk, mothers usually prepare bottles with a small amount, 1 to 2 oz (30 to 60 ml), to start a feeding. More breastmilk can be added to the bottle if needed.
Yes. Expressed human milk can be kept in a common refrigerator at the workplace or at a daycare centre. Check that the refrigerator temperature is 4C (39F) or less. Both the US Centers for Disease Control and the US Occupational Safety and Health Administration agree that human milk is not among the body fluids that require special handling or storage in a separate refrigerator.