If a client reports any of these common problems, listen to her concerns and give advice and support. Make sure she understands the advice and agrees.

Baby is not getting enough milk

• Reassure the woman that most women can produce enough breast milk to feed their babies.
• If the newborn is gaining more than 500 grams a month, weighs more than birth weight at 2 weeks, or urinates at least 6 times a day, reassure her that her baby is getting enough breast milk.
• Tell her to breastfeed her newborn about every 2 hours to increase milk supply.
• Recommend that she reduce any supplemental foods and/or liquids if the baby is less than 6 months of age.

Sore breasts

• If her breasts are full, tight, and painful, then she may have engorged breasts. If one breast has tender lumps, then she may have blocked ducts. Engorged breasts or blocked ducts may progress to red and tender infected breasts. Treat breast infection with antibiotics according to clinic guidelines. To aid healing, advise her to:
  • Continue to breastfeed often
  • Massage her breasts before and during breastfeeding
  • Apply heat or a warm compress to breasts
  • Try different breastfeeding positions
  • Ensure that the infant attaches properly to the breast
  • Express some milk before breastfeeding

Sore or cracked nipples

• If her nipples are cracked, she can continue breastfeeding. Assure her that they will heal with time.
• To aid healing, advise her to:
  • Apply drops of breast milk to the nipples after breastfeeding and allow to air-dry.
  • After feeding, use a finger to break suction first before removing the baby from the breast.
  • Do not wait until the breast is full to breastfeed. If full, express some milk first.
  • Teach her about proper attachment and how to check for signs that the baby is not attaching properly
  • Tell her to clean her nipples with only water only once a day and to avoid soaps and alcohol-based solutions.
  • Examine her nipples and the baby’s mouth and buttocks for signs of fungal infection (thrush).