Maggie McKay (Host): This is Children's Health Checkup where we answer parents' most common questions about raising healthy and happy kids. I'm your host, Maggie McKay. As a parent, there's so much to learn about breastfeeding and the common challenges that come with it. So today, our expert, Shannon Abbott, Registered Nurse and an International Board Certified Lactation Consultant at Children's Health, will fill us in on everything from how to tell if your milk supply is low, how to increase it, when it's time to reach out for help and much more.

Welcome, Shannon. Thank you for making the time to be here.

Shannon Abbott, BSN-RN, IBCLC: Thank you for having me.

Host: There is so much to learn about breastfeeding, as we said. So let's start with what are the most common concerns or challenges that you see when it comes to helping parents who are breastfeeding?

Shannon Abbott, BSN-RN, IBCLC: Many times they are concerned does breastfeeding hurt, what if I have sore nipples, concerns about milk supply, whether it's oversupply or not enough, if they have plugged milk ducts, maybe pumping and returning to work. Those are some common questions.

Host: And what typically causes nipple pain in the early days of breastfeeding? How can breastfeeding parents find relief while still nursing?

Shannon Abbott, BSN-RN, IBCLC: Well, mild nipple soreness and tenderness can be very common in the first few weeks as you're learning, especially if the pain resolves with milk let down and a rhythmic suck then it's just the beginning and the learning process. We usually have a 30 second rule when you get a deep latch. If the pain does continue, then you definitely need to seek some help.

Nipple pain that lasts throughout the feeding, it can be perceived as moderate to severe pain, or you have nipple trauma. These are signs that damage is being done. Some of the possible causes is a shallow latch. You want to kind of observe for pinching while babies latch.

When the nipple released, is it creased or lipstick shaped? If you have persistent nipple pain, then you've looked to see if you have a continued shallow latch. Maybe there's variations in infant's oral anatomy, are you looking for tongue tie or a high palate? Looking at mom's nipple anatomy, baby maybe have a strong or unusual suck.

And you also want to see if she's pumping. Is there a misuse of pump and flange sizing? Or if she has a nipple infection, that can also cause nipple pain.

One way to deal with the nipple pain is correct the depth of the latch by getting infant to open, wider, and have optimal or closer positioning of the baby. When a deep latch is achieved, traumatized nipples can still heal with continued nursing. You just want to definitely fix the latch.

If the deeper latch does not have a noticeable improvement in comfort, then it's time to consider other factors causing nipple pain.

Host: Okay. And how can a breastfeeding parent tell if she truly has low milk supply, and what are some practical ways to increase it?

Shannon Abbott, BSN-RN, IBCLC: Sometimes low milk supply can be perceived by moms, so it may be a good idea to consult with a lactation consultant to gain a little bit more clarity. The first couple of weeks of breastfeeding is called the programming stage to establish the milk supply. And so the supply is based on supply and demand. The more we empty, the more we make.

You want to observe for milk transfer, like swallows, softening of the breast with feeding. The infant shows to be satisfied, relaxed, no longer showing feeding cues. That first week of nursing, you're looking at diaper counts, but another thing is steady weight gain and growth. Watching that baby's back up to birth weight by two weeks.

There's other things too to see, test weighing, which is weighing before and after feeding or having mommy have milk expression. But just assessing how much a mom can pump doesn't accurately gauge mom's milk production because a pump and a baby are different, but it can add information to the questions. Does she really truly have enough milk? If there's a confirmed low milk supply, you want to look at the possible causes of that and determine the most effective strategies for making more milk.

If the low milk supply is confirmed, you want to see what determines the most effective strategies of making more milk. Factors that can affect milk supply may be parent factors like health history, hormonal factors, medications, any condition that may be affect baby's effectiveness on removing the milk, birth related factors, delayed milk.

There's a lot of things to look at. So you want to gather information. When considering the basic strategies to boost it, you look at how many times is baby nursing or we are expressing the milk. You want to avoid long stretches, without nursing or pumping, so more than four to eight hours.

Is the baby or the pump emptying the breast effectively? Because frequent milk removal stimulates more milk making. You want to ensure that you do have a good latch and baby is transferring the milk effectively. Additional hand expression or pumping after a good feeding can also help boost the supply by increasing the stimulation and emptying the breast well.

Host: Shannon, what causes clogged ducts and mastitis, and what steps can breastfeeding parents take at home and with medical support when this happens?

Shannon Abbott, BSN-RN, IBCLC: Well, clogged ducts can cause tenderness, lumps, or redness, and that's when it can be very uncomfortable. Less severe types of clogged ducts can be resolved with just one really good nursing session or a pump session. Some of the causes could be ineffective nursing, where you leave the breast too full after feedings, having problems with overabundant supply, restricted or missed feedings, baby sleeps longer stretches at night can cause some clogged ducts, or there's a delay in nursing, or sometimes moms actually wean too fast. The body has to adapt. Promoting early and exclusive nursing is a preventive way and not skipping feedings. Feeding on cue and having good nursing technique.

You want to remove the milk often and remove it well. Loosen any tight clothing. You want to have proper fitting bras. You can massage gently before and during nursing and pumping. Vary the baby's position, maybe the nose or chin pointing towards the affected area. A warm shower, warm compresses before feeding or expressing can help.

Sometimes the heat can increase the swelling, so you want to limit it to about 10 minutes or short periods of time. Between feedings you can add cold to reduce that swelling. Most important is to choose the heat or the cold on which method feels most effective and soothing for mom.

Host: What are the signs of oversupply? How can it be managed to avoid issues like discomfort or forceful letdowns?

Shannon Abbott, BSN-RN, IBCLC: Well, you also want to see if baby is gaining more weight than considered average. If the nursing parent and the baby are happy and comfortable, then they don't meet the definition of oversupply and it truly isn't a problem. But overabundant milk production can also make nursing challenging for the baby.

It can be very fast flow, causing baby to pull back or clamping down, biting to try to slow the flow. Baby can be coming off and on and coughing and sputtering, or the breast may remain uncomfortably full after feedings. Sometimes with an oversupply, they can have recurrent clogged ducts and mastitis. To help with the fast flow, you can position baby in sidelying or laid back position or where the head is above the nipple. Can nurse more often before you actually start to feel full. Nursing baby when they're drowsy or sleepy, frequent burping breaks. Hand expressing or pumping before baby feeds.

These are kind of, can kind of help the baby with a really fast flow. An oversupply could also be caused by overstimulation of the breast. So if baby's feeding really well, mom may be pumping too much after each feeding, causing an overproduction.

Full breasts make milk production slower and not completely emptying the breast when pumping can also try to slow down that milk production, maybe try one-sided nursing. However, it is encouraged to make changes over a period of time so that your body has time to recognize the full breast and adjust the volume. Discuss the oversupply issue with mom's provider, if there's no changes in supply after all of these interventions.

Host: Shannon, what advice do you have for those who may feel guilt, anxiety, or pressure around feeding their baby, quote unquote the right way, and when is the right time to reach out for help?

Shannon Abbott, BSN-RN, IBCLC: Some moms can find breastfeeding, emotionally overwhelming. The American Academy of Pediatrics recommends exclusive breastfeeding for the first six months and continued breastfeeding, along with the appropriate complimentary foods as long as mutually desired by mom and child for two years and beyond.

It is important to look at the mutually desire because everybody's situation is different. Not all moms are able to exclusively breastfeed for one reason or another. And it's not uncommon to have those feelings of guilt when they're unable to breastfeed or need to stop earlier than they had planned.

Acknowledge the feelings is normal. If a mother was able to achieve some of the breastfeeding goals and, remind her to praise herself and focus on those positives. Baby was able to get the first three or four days of that initial first milk colostrum or maybe she was able to breastfeed for a month or so, or partially.

Those are all positive things for moms to, to remember that she was able to do some of those things. Society can apply pressure on moms. There's a lot of pressure to breastfeed exclusively for a certain amount of time, or maybe mom has a strong emotional attachment to breastfeeding and feel a sense of loss or failure when they can't continue.

Sometimes hormonal changes too. The postpartum hormonal fluctuations, intensify the emotions and it's harder to cope with that disappointment or sadness associated with not breastfeeding. It's important for mom to acknowledge and accept those feelings of guilt that they're valid and allow herself to grieve the loss, you know, of the breastfeeding experience that she had hoped for.

Definitely seek support. You can talk with your partner, your family, friends, or a lactation consultant. And talking about your feelings can help. If the guilt is overwhelming, consider seeking support from a maybe a counselor or a therapist who specializes in postpartum mental health. But it's important that moms realize that they're not alone.

There are other mothers who have probably experienced the same feelings of guilt and can connect with other people who can now also support them.

Host: I think that's so important. Support groups. My friends all had their babies before me, and they all said, you've gotta go to this class for new moms about breastfeeding. It was actually not just a class, that's all they did at this place. It was called the pump station, and I'm still friends 20 years later with many of the moms in that group because it's such a bonding thing and everybody's clueless and there's so much to learn and it can be stressful, but I really believe in the more prepared you are ahead of time, the better. Do you agree with that?

Shannon Abbott, BSN-RN, IBCLC: Yes, breastfeeding classes are amazing. Talking with family and friends are also great, but having that support along the journey because things change and you may have new challenges or new questions, and that support is very, very important to have.

Important to remember that anytime a parent has concerns or questions about breastfeeding that they contact a lactation consultant.

Host: Thank you so much for sharing your expertise on this crucial topic. This has been so helpful and educational.

Shannon Abbott, BSN-RN, IBCLC: Thank you for having me.

Maggie McKay (Host): Again, that's Shannon Abbott. Visit children's.com/newborns for more helpful tips for breastfeeding parents. Thank you for listening to Children's Health Checkup. If you found this podcast helpful, please rate and review or share the episode and please follow Children's Health on your social channels.