Mother sitting down while holding and breastfeeding her infant

Lesser-Known Breastfeeding Issues: Knowledge from a Lactation Consultant

Terressa Patterson RN BSN MS IBCLC
In partnership with Dr. Brown's Company

Breastfeeding is often presented as a natural and instinctive process, but it can come with unexpected challenges, some of which aren't commonly discussed. Knowing about these issues can help mothers feel better prepared and empowered to address them.

Milk Blebs (Milk Blisters)

Milk blebs are small, painful white spots on the nipple caused by a blocked milk duct. They can cause sharp pain during feeding or pumping and may persist if left untreated. Applying warm compresses, using olive oil to soften the skin, gently exfoliating with a soft washcloth, and nursing, hand expressing, or pumping frequently can help resolve them. If the bleb does not clear, a lactation consultant or healthcare provider may assist in removing it.

Vasospasms

Vasospasms or Raynaud's phenomenon occur when the blood vessels in the nipple constrict, often triggered by cold temperatures, a poor latch, or even stress. This can cause sharp, burning pain and discoloration of the nipple (white, purple, or blue). Keeping the nipple warm and improving the baby's latch can help relieve symptoms.

Nipple Dermatitis

This is an inflammatory condition that causes red, itchy, or scaly skin on the nipple. It can result from baby's saliva, frequent washing, certain creams, or allergic reactions to laundry detergents. Using hypoallergenic products, air-drying nipples after feeds, and applying nipple cream can reduce irritation.

Lip and Tongue Ties

Lip and tongue ties, medically known as labial frenulum restriction and ankyloglossia, can present significant challenges for breastfeeding. These conditions occur when the tissue connecting the upper lip to the gums (labial frenulum) or the tongue to the floor of the mouth (lingual frenulum) is too tight, restricting movement. Babies with a tongue tie may struggle to achieve a deep latch, leading to nipple pain, inefficient milk transfer, and prolonged or frequent feedings. Lip ties can prevent the upper lip from flanging outward properly, further impacting latch and suction. Signs of a possible tie include clicking sounds while nursing, excessive gassiness, reflux-like symptoms, and a mother experiencing persistent nipple pain or low milk supply due to inadequate milk removal. If a lip or tongue tie is suspected, an evaluation by a pediatric dentist, ENT specialist, or lactation consultant trained in oral restrictions can help determine if intervention, such as a frenotomy (a simple procedure to release the tie), is necessary. Early identification and treatment can make a significant difference in breastfeeding success and comfort for both mother and baby.

Hyperlactation

Some mothers produce more milk than their baby needs, leading to challenges such as excessive leaking, engorgement, plugged ducts, or mastitis. Babies may struggle to latch due to a forceful letdown or develop gassiness from an imbalance of foremilk (higher in lactose) and hindmilk (richer in fat).

Possible causes of oversupply include:

  • Pumping too frequently in the early days to "boost" supply.
  • Hormonal sensitivities that naturally lead to higher production.
  • Overuse of galactagogues (herbs or foods that stimulate milk production).

Colors of Milk

Breastmilk is not always white or cream-colored—it can come in a variety of shades, all of which are usually normal.

  • Yellow: Colostrum, the first milk, is rich in antibodies and nutrients. Mature milk may also appear yellow if your diet is high in beta-carotene (e.g., carrots, sweet potatoes).
  • Blue or thin: This often reflects foremilk, which is waterier and hydrating for the baby.
  • Green: Foods like spinach or green drinks can tint your milk green.
  • Pink or red: This may result from blood (due to cracked nipples or a burst capillary). While it is safe to feed your baby, consult a healthcare provider if this persists.
  • Brown or rust-colored: Known as "rusty pipe syndrome," this happens when old blood from the milk ducts mixes with milk. It usually resolves on its own and it is fine to feed this milk to the baby.

It is important to note that while most milk color variations are harmless, persistent unusual colors or milk with a foul odor may warrant evaluation by a healthcare provider.

It is also worth acknowledging that these physical challenges can take a toll emotionally. Many mothers feel guilt, frustration, or even sadness when breastfeeding challenges occur. For mothers experiencing postpartum depression (PPD), these emotions can feel amplified and may impact milk supply. Reaching out for professional help and leaning on supportive family or friends can make a significant difference. Breastfeeding is a journey filled with learning, growth, and the opportunity to adapt to what works best for you and your baby.

DISCLAIMER: THIS CONTENT DOES NOT PROVIDE MEDICAL ADVICE
The information contained is for informational purposes only and is NOT intended to be a substitute for professional medical advice, diagnosis, or treatment. You should not rely solely on this information. Always seek the advice of your healthcare provider.

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