When you become a parent, suddenly, everyone around you has advice to give on everything from diaper choice to infant feeding. It is usually well intended, but sometimes the very advice you’re given is wrong. Today, I want to review a few of the most common breastfeeding tips I see, given that they are sometimes not the best.
Idea #1: Just use a nipple shield to help with latch issues and pain!
Better Advice #1: Nipple shields have their place as a tool to help some lactating parents get their baby to the breast directly. But they have long been overused, particularly right after birth. Staff in the hospital don’t always have enough training on how to help adjust the latch in newborns, so it can be tempting to use a shield to get the baby to the breast and start sucking. Unfortunately, this can actually backfire and lead to ineffective, decreasing milk production and worsening latch and suck. It also DELAYS lactation care when the hospital sends you home with your newborn. This is why, overall, I do not consider nipple shields to be the best idea (with rare exceptions for individual situations).
Nipple shields can sometimes decrease nipple pain from latch issues. But this is a temporary crutch, NOT a fix for the breastfeeding issue. If you were given a shield, then this is a RED FLAG indicating you need immediate lactation support until we remove the shield and sort out the underlying issues.
Idea #2: Massage your breasts to prevent plugged ducts and other issues
Better Advice #2: Stop the breast massage. Full stop. Anyone telling you to massage your breasts firmly is well-meaning but wrong and following outdated advice. Your breasts are made of delicate glandular tissue with a network of microscopic milk ducts, nerves, and blood vessels all woven together. Breast tissue is very easily bruised and traumatized, which leads to swelling and pain, which then heads down the cycle of engorgement, squished milk ducts (they aren’t plugged ducts!!), mastitis, and even abscess.
The only “massage” you should ever do on your breast tissue is lymphatic drainage techniques, which are so gentle you can barely feel them. I call these maneuvers the Tippy Tappy, Stroke the Kitty, and the Jello Jiggle.
Idea #3: Use APNO (All Purpose Nipple Ointment)
Better Advice #3: APNO – I call this AP-NOpe. This combination cream is made of three ingredients: an antibiotic, antifungal, and steroid. This means it treats bacteria, yeast, and inflammation of the skin. No lactation-related breast issue needs all three of these types of medicine. It’s like trying to swat a fly with a shotgun – and not even hitting the fly – clearly not a good idea all around. Adding insult to injury, some ingredients in AP-NOpe can actually worsen the nipple’s irritated, delicate skin and cause increasing nipple pain.
The steroid does decrease inflammation, which is why it often helps decrease pain, but it isn’t a good idea without proper medical supervision. Steroid cream can help, but it can also cause side effects if used improperly, and the over-the-counter dose is not strong enough for many skin issues related to lactation. As always, if the help you’re getting isn’t actually helping, seek a higher level of care with an IBCLC or Breastfeeding Medicine Physician.
Idea #4: Your newborn will nurse every three hours
Better Advice #4: Newborns have widely varied feeding patterns, sometimes waiting a few hours between feeds and other times nursing again just 20 minutes after the last feed ended. When pediatricians like myself say “every three hours,” this means feeding your baby at a minimum of every three hours from this feed’s starting time to the next feed’s starting time. But this is the MINIMUM, not the maximum. If your baby wants to feed more often, go for it. I assure you, they will usually develop a flexible pattern of feeding and sleeping. However, calling it a ‘schedule’ is generally an unrealistic expectation for a newborn.
Idea #5: Any advice starting with “You should do what I did…”
Better Advice #5: Sure, it’s possible your friend/family/coworker/neighbor may have good advice. But often, the same symptom, ripple pain, for example, can be caused by a wide variety of causes. So, what worked for that person may not be right for you. In fact, it may make things worse! Anecdotal advice and empathy from other parents can be invaluable. However, anecdotal advice cannot replace appropriate medical evaluation and treatment when things aren’t an easy fix.
All too often, I see parents told the typical ‘normal’ breastfeeding advice when they really need specific problem-based advice. Or they get problem-based advice, but it is advice for the wrong problem. Things can get pretty complicated this way! I feel like there is a pattern here: seek a higher level of care if things aren’t getting better quickly with your current plan. Breastfeeding issues can get complicated and cause a lot of suffering quickly, and it’s always easier to address a (hopefully) simple issue early on.
So much information is available at our fingertips about many topics, including lactation. This is awesome – we always have somewhere to turn for help. But it’s also challenging – determining which advice and source is the best when so many contradict one another is overwhelming. Take a deep breath – you’ve got this. Learning to do my best and parent in a way that may not be perfect but is right for my family has been a journey. The same can be said about learning which sources to listen to and which to tune out.
When in doubt, seek someone out with the right credentials who can back up their advice with a discussion of what evidence there is or isn’t about any particular statement. Go up the ladder to a higher level of care if you aren’t getting answers or aren’t improving with the current care you’re receiving. Just like with any other medical issue, you move up to a more specialized professional as the topic gets more specific and difficult to manage. Let them guide you to determine what tips are actually a bad idea and what advice will actually help you.
