Frequent problems during breastfeeding

Low Milk Production

In general, all mothers produce exactly the amount of milk their babies need. It is rare for a mother not to produce enough milk to feed her new born baby. When a mother notices that she isn´t producing enough milk, a number of things could be happening:

  • The baby isn´t in the right posture or isn´t latching on correctly, and as a result the breast isn´t being emptied and stops producing the amount of milk the baby needs. In these cases there is usually pain while feeding, or cracks. It is important that you review the section on the correct position, or contact someone to help correct the posture (a doctor, midwife, nurse, health centre, or a breastfeeding support group).
  • There is enough milk, but it seems that the breasts are “empty”: this usually occurs after the first few months of breastfeeding when the milk rising is not so noticeable. If the baby is content, growing well and fills 4-5 nappies a day, he´s getting all the milk he needs.

The Baby Gains Little Weight

Concern for the baby’s weight is very common among nursing mothers, but in most cases everything is fine. Do take the following into account:

  • The increase in a baby´s weight is measured on special graphs, and the best ones for breast-fed infants are those from the World Health Organization (WHO), made up from data collected from babies who received only breast milk for the first few months of life. They are available at:
  • The overall appearance of the baby is very important, how active he is, and whether he fills 4-5 nappies a day, etc.
  • Proper and progressive gain in length and weight is more important than the specific weight at any point in time. Approximate weight gain in the first year of life is:
    • 0-6 weeks : 20g/day
    • up to 4 months : 100-200g/week
    • 4-6 months : 80-150g/week
    • 6-12 months : 40-80g / week
  • Growth must be monitored by the paediatric service at the regular check-ups. It isn´t necessary to weigh the baby frequently in the pharmacy, as this can lead to confusion.
Peso edad niñas

Weight by age, girls

Peso edad niños

Weight by age, boys

Flat or Inverted Nipple

The shape of the nipple is usually not a problem when breastfeeding. Most cases of flat nipples are resolved when the baby begins to suck, but a little help may be needed during the first few days to get the baby to latch on.

To differentiate between an inverted nipple and a “flattened” one, the areola should be pressed between thumb and index finger, if the nipple comes out, it is not an inverted nipple, just flattened (and this will resolve itself little by little), but if the nipple sinks in deeper, it´s a true inverted nipple and it may be harder to get the baby to latch on, though not impossible.

When starting breastfeeding, we need to look at the following:

  • That the baby opens his mouth widely enough to take a good part of the areola, so that he can slowly begin to pull the nipple out.
  • There are those who advocate the use of a nipple liner, although there is a risk of problems later with the baby taking the breast directly.
  • Sometimes it may be necessary to use a breast pump to extract the milk before feeding it to the baby.
  • In some cases, direct breastfeeding is not possible. Consult a breastfeeding support group.
Pezón plano

Flattened nipple

Pezón invertido

Inverted nipple

Breast refusal

When the baby refuses the breast, this can due to poor posture or difficulty latching on, or if the baby is in pain (otitis , broken collarbone, etc.) or simply that it prefers one breast and not the other. Sometimes, after mastitis (inflammation of the breast), the baby may refuse it. If the problem persists once diseases have been discarded or posture corrected, the baby can continue feeding from one breast only.

The refusal of both breasts can occur because the baby is ill, or because of some change that has bothered him and that may have gone unnoticed:

  • Menstruation, pregnancy.
  • Change in the flavour of milk: the mother has eaten highly flavoured food or intensely flavoured drinks, mint etc…
  • Distractions, noise.
  • Change of mother´s soap or deodorant.
  • Maternal stress.
  • Disruption to the baby’s routine (house move, change of carer, etc.).
  • Sudden reaction by the mother to a bite.
  • Letting him cry repeatedly before offering him the breast.
  • A prolonged separation.


In every case, patience is necessary. Once diseases have been discounted, it may be helpful to:

  • Ensure a peaceful atmosphere during feeding, try different positions to find one comfortable for both.
  • Comfort the baby, stay with him, calm him before feeding, spread a little breast milk on the nipple to encourage him to latch on.
  • Express milk and offer it from a glass or spoon (bottles and teats may worsen the situation).
  • Don´t try to overfeed the baby to stave off hunger.
  • If the cause was a bite, try to avoid startling the baby with sudden reactions.


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