Common Problems

Sore and cracked nipples

The main cause of sore nipples is incorrect positioning of the baby at the breast. If you cannot improve her position yourself, or your nipples are not healing you can get help from your midwife, a lactation consultant, or the La Leche League.  To help heal sore and cracked nipples:

  • Express a few drops of breastmilk, gently spread it on the nipples, and allow to dry.
  • Leave nipples uncovered or loosely covered between feeds to help them heal.
  • Avoid using soap on the nipple.
  • Pain may be helped by taking paracetamol two tablets every four hours up to four times a day; prolonged (for more than a couple of days) or excessive use may be harmful, see your health professional if pain continues.
  • Pain may also be caused by blocked ducts and/or nipple and breast infections.
  • Seek professional help.

Engorgement/Breast fullness

Breast fullness occurs usually 24-48 hours after birth. This means that the breasts have become distended and are hot and painful to touch.  To relieve breast fullness and engorgement you can try:

  • Frequent feeding. Make sure baby is attached well to avoid sore, cracked nipples.
  • If the areola is too swollen, gently express enough milk to enable your baby to get onto the breast correctly.
  • Using different feeding positions or feeding lying down.
  • Warm showers before feeding can help, let the warm water run on the breasts for a few minutes
  • Applying cool face cloths on the breast between feeds.
  • Wearing a comfortable, non-restrictive, supportive bra.
  • Using paracetamol, two tablets every four hours up to four times a day (see your health professional if pain continues).

Blocked ducts and breast infections (Mastitis)

Breast lumps while breastfeeding may mean that you have a blocked duct.  To help clear blocked ducts try:

  • Feeding frequently from the affected breast, but continue to feed from both breasts.
  • Changing breastfeeding positions
  • Hot showers or warm face cloths to the affected breast to help keep the milk flowing.
  • Gently massaging any lumpy areas towards the nipple.

A painless, persistent lump should be checked by your midwife or doctor. You may have a breast infection if you have aches and pains, fever, feel shivery like you have the flu, or have a painful pink or red area on the breast. If you have any of these symptoms contact your midwife or doctor as soon as possible.

To help recover from a breast infection:

  • Keep breastfeeding baby as advised. The breast heals more quickly if kept from getting too full. The milk is fine. It is the breast tissue that is infected, not the milk.
  • Take two paracetamol tablets every four hours up to four times a day as required for pain; prolonged (for more than a couple of days) or excessive use may be harmful, see your health professional if pain continues.
  • Drink extra fluids.
  • Get plenty of rest. Try to sleep when baby sleeps.
  • To help prevent breast infections and blocked ducts, avoid wearing tight clothing or poorly fitting bras.

If you are having problems or concerns with breastfeeding, talk to your midwife, lactation consultant or La Leche League.

Drugs and Breastfeeding

  • Before taking any medication talk to your midwife or other health professional about the effect of the drug in your breastmilk.
  • Over-the-counter medicines from the chemist and alternative medicines may pass through the breastmilk. It is best not to use these when breastfeeding unless discussed with your health professional.

Using Breastmilk Substitutes

  • If you are considering using breastmilk substitute (formula), it is important that you discuss this with your midwife, or other health professional.
  • You need to think about the ongoing expense of formula and equipment, as this will affect your family budget.
  • Use a breastmilk substitute that is suitable for your baby’s age.
  • The Ministry of Health advises that ordinary, unmodified cow’s milk should not be given to babies until they are at least twelve months old. This is because cow’s milk contains higher levels of protein and salt which are unsafe for a young baby’s immature kidneys. It also does not have the vitamins and minerals a growing baby needs, especially iron.
  • Consult your midwife or other health professional for further information on preparing formula as it is important to make up the formula correctly, following the instructions carefully, using the correct equipment and sterilisation techniques.

Problems associated with Feeding your Baby

Weight Loss in Babies

  • Babies can lose up to 10% of their birth weight in the first few days but should get back to what they weighed at birth within a week.

Spilling (baby bringing up milk)

  • Some babies spill after each feed, and some hardly ever do so. Spilling can occur because the valve effect at the top of the stomach is still developing because babies have liquid feeds and because they lie down after feeds. This allows milk to come back up.
  • Spilling usually stops between three and twelve months.
  • Spilling is different from vomiting where she empties her stomach forcefully.
  • You need to see your doctor if the spilling is severe (you are concerned she is spilling a large amount of her feeds), she has poor weight gains, your baby vomits violently (projectile vomiting), the vomit is green or you are worried.

Coping with a spilly baby is easier when:

  • baby is dressed or changed before feeds when the stomach is not full
  • she is winded several times during feeds
  • a towel is used to cover yourself after feeds to catch the milk
  • you have lots of large bibs
  • a towel is put under baby wherever she is sitting or lying
  • after feeds baby is sat up on your lap or carried
  • raising the head of the cot or bassinette is not effective and may risk your baby wriggling down under the covers, becoming trapped or overheating or suffocating.


  • Reflux is really a more severe version of spilling. Milk and stomach acid can come up from baby’s stomach and burn or cause discomfort.
  • Some babies become unsettled with reflux. They may cry, be a fussy feeder and not sleep well. They may arch their back and extend their legs out.
  • However, acid studies have shown It is very difficult to tell if the fussiness, arching and other signs of discomfort are truly from reflux or from a fussy/colicky baby.
  • Acid reflux gradually improves and usually disappears by one year of age.
  • Methods to cope with spilling can help with reflux. Feed thickeners and medications can sometimes help to reduce reflux and unsettledness. Talk with your midwife or other health professional about these options.


  • Some babies don’t need to be winded after feeds, while others become unsettled with wind and need winding at every feed.
  • When winding it helps to keep baby upright to your shoulder or sitting on your knee with her back straight.
  • Some people believe when breastfeeding that wind may be caused by food you have eaten.


  • Many babies hiccup after feeds and winding. This is normal, does not need any attention and baby will grow out of it.


  • The cause of colic is unknown. A colicky baby is unsettled and often cries for long periods of time.
  • Your baby may draw her knees up and be hard to comfort. This may be followed by a peaceful period and then the crying starts again.
  • It usually happens during the first months of life at the same time of the day or night.
  • Caring for a crying, colicky baby is very stressful. Discuss colic or wind medication and your feelings with your midwife or other health professional.

As well as colic being stressful itself for babies and parents, many studies have shown that stress, depression, “the blues” and other coping or health problems in mothers (and fathers) can cause colicky babies. Most strategies aim to improve coping strategies while the baby naturally grows out of the colic with time.