My daughter nursed like a champ. She had a great latch, a top-notch suck. I felt almost suspicious of how easy it all was. Then at 10 weeks, everything changed. When I'd offer my breast, she'd scream wildly, frantically trying to push it away with her tiny fists. Within a day, she was staunchly refusing the breast altogether. As far as I could tell, nothing about me, her, or our routine was any different. So I put a lactation consultant on the case, and within an hour, she'd solved the mystery.
"This baby has reflux!" exclaimed Freda Rosenfeld, of Brooklyn. "It's what we call silent reflux because she's not spitting up a lot, but you hear that cry of pain after she burped? Classic." Rosenfeld pointed out that my daughter was just at the age when reflux -- silent or not -- starts to develop in babies. She told me to hold her upright so that she was sitting rather than lying down to nurse and recommended that I eat fewer acidic foods (like citrus fruit and soda). Voilà! Our nursing nightmare was over.
Of course, to an exhausted, aching, not to mention hormonal mom, getting to the root of what's wrong can be overwhelming. The only way you learn to breastfeed is through intense on-the-job training, says Portland, Oregon, lactation consultant Meg Stalnaker. To help you succeed at nursing, we sleuthed out the top five hang-ups. Identify your culprit and you'll soon be on the trail to breastfeeding bliss.
"When my baby latched on, it was excruciatingly painful, my nipples felt bruised and were nearly bleeding, and there was no sign of the pain getting better after almost a week." Nadia Hefni Foster, Los Angeles
- Sharp nipple pain while nursing
- Cracks, scabs, and blood on nipples
- Nipple looks long and pinched afterward
The Culprit: Poor latch
Successful breastfeeding begins with a good, deep latch. To do this, you want your baby's mouth to be wide open, so that she takes as much of the breast into her mouth as possible, says Mona Gabbay, M.D., an internal medicine specialist with a focus on nursing issues, in New Rochelle, New York. As soon as your baby's mouth opens wide to an angle of 90 degrees or more, bring her to your breast, aiming your nipple at her nose so that it ends up near the roof of her mouth. If you have trouble getting your little one to open wide enough, touch your nipple to her upper lip, tickle her chin, or pull down gently on her chin when she opens, to coax her a little wider. Baby's back, neck, and shoulders should be in a nice, straight line; she shouldn't need to turn her neck to nurse.
You'll know you're on target if the nipple looks round, almost as if it wasn't touched, when your baby comes off. If it looks distorted (for instance, the shape of a lipstick or screwdriver head), or if you can see a crease or fold, that means the nipple is getting pinched and you need to adjust your latch, says Dr. Gabbay.
"I seemed to choke my baby with every meal. It was disturbing to hear him gag and cough while trying to keep up with the waterfall of milk." Dana Marlowe, Silver Spring, Maryland
- Baby sputters, gags, or cries at the start of nursing session
- Milk shoots out of breast at intervals
- Lots of leaking
The Culprit: Forceful letdown
Leaking is incredibly common, and many women will experience milk spraying out of the breast, especially if it's been a while since you nursed. Neither of these things means there's a problem with your letdown. But if your baby is choking, gagging, or gasping at the start of the feed, or if he clamps down on the nipple or keeps pulling off, it may well mean he is getting too much milk too fast.
If you're dealing with an overactive letdown, the choking and gagging should last, at most, a few minutes. It may be repeated later in the feeding, however, when you let down again once or twice more, says Stalnaker. Fight gravity by starting off a nursing session lying down or leaning back, with your baby in a vertical position, says Stalnaker. She also suggests expressing milk for a minute or two before you nurse, either manually or with a pump. That way, you release the most powerful torrent of milk before your sweetie latches on. The good news: A forceful letdown tends to correct itself after a few months, as your milk supply becomes more regulated and your little one learns the ropes of breastfeeding.
If your munchkin sputters and coughs for the entire feeding session, the problem is more likely to be an over-abundance of milk. You can reduce your milk production several ways, says Dr. Gabbay. Try offering only one breast per feeding, applying frozen cabbage leaves to your breasts for a day or two, and sipping sage tea.
"My baby Max made a lot of noise when nursing and he kept falling off my boob. My nipples were getting chewed to bits -- raw and red." Allison Garber, Brooklyn
- Nipple pain and wounds even with a deep latch
- Baby tires easily while nursing
- Tongue looks heart-shaped
The Culprit: Tongue-tie
Garber's son had a tight frenulum (the band of skin that attaches the midline of the underside of the tongue to the mouth). Because of this, his tongue couldn't extend as much as it should, making breastfeeding a lot of work. "Babies use the tongue in a wavelike motion to express milk from the breast," says Dr. Gabbay. "So if the tongue is restricted, it may be difficult for your baby to get milk or it may require more energy, tiring him out." A tight frenulum can also cause nipple pain because the baby's tongue keeps rubbing against the nipple rather than the areola. A low milk supply and poor weight gain in babies are additional side effects of a tongue-tie.
If you're continuing to suffer from nipple pain despite a good latch, or your baby isn't packing on the pounds the way he should be, have a lactation consultant or pediatrician look to see if a tongue-tie might be to blame. "I took Max to an ear, nose and throat specialist who snipped the frenulum, giving his tongue more wiggle room," Garber explains. "The procedure took minutes in his office, and Max nursed easily for the first time that same day."