Top Testers' Clinic with Dr Philippa Kaye: Breastfeeding Special

"Try to have lots of skin to skin contact, as this may help them latch on. You can try removing the shield after they have started feeding, or after the let down reflex has occurred so that they don’t have to work too hard to get the milk initially, or remove the shield when switching between breasts. Breastfeeding and weaning off nipple shields aren’t always easy so please ask for help and support!" Dr Philippa Kaye

Blocked duct dilemma

Q: "Can blocked milk ducts be avoided? And how do you remedy them when they do happen?" Lesley

A: "Milk ducts can become blocked during breastfeeding. What this means is that there can be a build up of milk from the gland which cannot be drained during breastfeeding. A blocked duct can lead to a tender, red lump in the breast, and can also lead to mastitis.

"To try and treat the blocked duct keep feeding on that side, as this encourages the milk to flow and hopefully unplug the duct. Using warm compresses on the breast before the feeds can be helpful, as can massaging the breast during feeds to try and treat the duct. You can even use an electric toothbrush or vibrator to try to massage the breast.

"If your breast becomes red, hot and tender, or if you become unwell you may have developed mastitis, an infection of the breast so please seek medical advice." Dr Philippa Kaye

Learning to latch

Q: "I’m pregnant with baby 2. When I had my daughter, she was premature and 4lb and struggled to latch so I pumped. Unfortunately I got mastitis and despite continuing to pump it killed my supply. I really want to breastfeed my next baby, so do you have any advice on how to either get him to successfully latch or a good pumping schedule that will allow me to build up a good stash to get him to at least 6 months on breast milk?" Laura

A: "Breastfeeding is not as easy as it is sometimes made out! Both you and baby need to learn how to breastfeed, it takes time and practice and please ask for help and breastfeeding support if you need it.

"To try to get a good latch, firstly make yourself comfortable with plenty of cushions/pillows to help support you and the baby. You hold baby close to your body, so that their nose is at the level of your nipple. The rest of their body needs to be level with the baby’s body facing your body, as opposed to them twisting their head to the breast – hence the pillows to help give support!

"Now let your nipple brush their top lip, this will trigger a reflex where the baby opens their mouth wide and their chin comes up to touch the breast. Aim to get as much of the breast as possible into the breast, not just the nipple. When you look at the baby’s lips, more of the areola will be seen above the baby’s top lip than bottom and their lips will be turned outwards, rather like a fish. A good latch will not be painful, but there might be a tugging sensation as they suck to trigger the let down of milk. After feeding the nipple should look normal, not flat or pinched.

"Importantly, if the latch is painful, or you aren’t sure it is correct, then insert a clean finger into the corner of their mouth to break the suction between them and the breast so you can remove the breast comfortably. Mastitis can occur even with a good latch, so if you are concerned please see your doctor." Dr Philippa Kaye

Bedtime breastfeeding

Q: "I'm still breastfeeding my baby to sleep at night – any advice for how to wean them off?" Abbie

"Oh, the struggle of sleep is very real! Ideally, (and I know very well as a parent, that things are not always as they are written in the leaflet or book) you would put your baby down to sleep when they are relaxed and awake, as opposed to when they are sleeping. This means that your baby will will learn to go to sleep themselves as opposed to in your arms, so when they stir in the night, and find themselves not in your arms, that they might drop off again. But I understand it isn’t always easy!

"If you are still breastfeeding and this suits both you and your baby and you are happy then of course you can continue. However, as you have written asking how to wean them off there are various different things to try. For example, you could try to gently rouse your baby slightly after feeding to try and put them down more awake. Or if you want to feed them but would like someone else to be able to do so, then you could try pumping and giving the breastmilk in a bottle, before again, trying to rouse them gently before putting them down. It might take a few days for everyone to get used to the new state of affairs!" Dr Philippa Kaye

Weight loss worries

Q: "I'm due my 10th baby and I always massively struggle with breastfeeding. With my 9th baby last year, I thought we were doing well. He seemed content after every feed, was sleeping well and showed no outward signs of being hungry. Then day 6 he was weighed, and we ended up in hospital as his weight had dropped too much. I stopped and put him on formula as soon as we got his blood levels back to normal as I was terrified he was being starved. I'd desperately like to breastfeed this time, but at the same time I'm scared to try because trying and failing has caused PND in me so many times." Kayleigh

A: "I am so sorry that you have struggled so much, not just with feeding but with your mood and postnatal depression, and also with anxiety about feeding. We are all aware of the huge benefits of breast milk, to both mum and baby, but we are lucky to live in a time when formula milk, clean water and the ability to sterilise bottles are all available. As a doctor, I feel that the phrase ‘breast is best’, is not helpful to women, rather that we should move to ‘fed is best’.

"What matters most is that baby is fed, and that both you and baby are happy. Breastfeeding which leads to postnatal depression can affect both you as a parent and your baby. If you want to try feeding then try some of the tips above but I imagine after trying 9 times you may have read something similar before! Hopefully there will be breastfeeding support available, not just in your local hospital or birthing unit, but also in your local community, for example breastfeeding cafés, where you can get one to one support and help, not just for the physical action of breastfeeding but for the emotions that go with it.

"And remember, however you feed your baby, you are still feeding them, which is the most important thing. The huge amount of pressure put upon women to feed is not helpful for many and can cause real harm – please get the help that you need." Dr Philippa Kaye

Breastfeeding blues

Q: "How do you get over the grief of not being able to breastfeed?" Louise

A: "I am sorry that you have not had the breastfeeding experience that you wanted and that this is still affecting you. It is really common to have difficulties breastfeeding and for people to feel real guilt and grief around not feeding. The first thing to remember is that it isn’t your fault, and that you are doing your best as a parent, not matter how you feed your baby.

"However if you are still struggling with your grief around feeding weeks or months on after stopping, then I would recommend that you speak to your health visitor and GP. How is your mood? Have you noticed that you are low or tearful, as perhaps there is a larger issue going on which needs to be addressed. It may be helpful to consider some kind of talking therapy or other support to help manage your grief, so please see your doctor." Dr Philippa Kaye

Tongue tie troubles

Q: "I haven't been able to breastfeed as my baby is tongue tied and couldn't latch properly because of this. I spoke with my health visitor about being referred for this to be sorted, but was told because baby is eating fine from the bottle I'd have to go private as it was cosmetic. I'm worried that when I get to the weaning stage it may affect his speech. Any advice you could offer would be most welcome." Naomi

A: "The tongue is made up of muscle which is attached to the mouth. If a baby has a tongue tie, the skin which attaches the tongue to the floor of the mouth is short and tight. This means that the baby cannot move their tongue freely. These can affect feeding and if it does then they can be referred to have the tongue tie cut.

"You ask though if a tongue tie affects eating later in life as well as speech, but this is not common. The tip of the tongue is used for making some sounds like ‘n’ or ‘t’, but not for many others such as ‘m’ or ‘b’. If there are difficulties with speech a referral to a speech and language therapist can be helpful, but generally speech issues are not related to a tongue tie." Dr Philippa Kaye

Spice things up

Q: "I have read and been told that there is no need to avoid spicy food when breastfeeding. However, on the 2 occasions I have had very spicy food, my baby has been very uncomfortable those days (screaming without an obvious reason) and vomiting lots more than usual (suffers from reflux). I don’t want to try it out a 3rd time to see if the same happens, but I was wondering if there is evidence of others having experienced the same as me?" Shahada

A: "Breast milk is naturally creamy and has a sweet taste, from the natural milk sugar (lactose) and fat in breast milk. However, the food you eat can affect the flavour of your breast milk, as can medications, alcohol and smoking. In fact, the food that you eat when you are breastfeeding may even affect your baby’s tastes and palate and preferences later in life!

There is no evidence that eating spicy food when you are breastfeeding causes harm to your baby. In fact, getting used to lots of different flavours during breastfeeding may also help them have a wide palate later on. Colic, is unfortunately common and we don’t know why it occurs, and is unlikely to be due to you eating spicy food and breastfeeding." Dr Philippa Kaye

When to wean

Q: "When will I know my baby is ready to self-wean? How do I stop feeding? And how is best to maintain an extended feeding journey but also have some time away occasionally? Is it possible to pump this late in a journey when you haven’t before?" Claire

A: "There are various signs that your child is beginning to self wean from breastfeeding, for example they are less interested in breastfeeding, they feed for shorter periods or are distracted and playing at the breast. But the decision to wean from breastfeeding is not just about the baby but also about you and when you feel the time is right.

"You can try to stop feeding in various ways. By the age of one your child will also be eating solid food but will still be drinking lots of milk. You can try dropping one feed at a time and replacing it with milk (if they are over one, if they are under a year then formula milk is used), or making feeds shorter and topping up with milk. Some people find that their baby naturally drops feeds as they replace them with food until they are feeding just first thing in the morning and last thing at night, or even just at night. And yes, you can start pumping at this point if you would prefer." Dr Philippa Kaye

Please note: this advice is not personalised or meant to replace individual advice given to you about your child by your doctor or medical team. As always, if you are concerned about your child’s health then please seek medical advice.

Pics: Getty

Read more:

• Mastitis and breastfeeding: signs, symptoms and how to treat it
• How – and when – to stop breastfeeding
• Mixed breast and bottle feeding: how to make it work