The problems of breastfeeding in most cases can be from lack of experience and inadequate knowledge on the intricacies of breastfeeding. Also, it can be from cultural beliefs, health and socio-economic influences. As a follow up article on the problems of breastfeeding part one, outlined below are additional problems and challenges of breastfeeding that are quite common. The World breastfeeding week ends today. Mothers should be supported to encourage exclusive breastfeeding.


Babies are born with the natural instinct for breastfeeding. If you poke a baby’s cheek with your finger, the natural response is for the baby to turn to that side with the mouth open. This is called the rooting reflex. Nipple confusion arise from the baby’s difficulty to switch from bottle feeding to breastfeeding. In new born babies introduced to pacifier or bottle feeding, they may have difficulty latching onto the breast.  For older babies, they may start preferring the bottle feeding to breastfeeding.

In fact, breastfeeding is difficult for the baby than bottle feeding. So, it is normal for the baby to prefer the easy one. You will often hear parents say the baby stopped breastfeeding on its own. This is so because the baby was most likely introduced to a pacifier or bottle feeding. Note that not all babies will develop nipple confusion. One cannot tell which baby will have nipple confusion, therefore, prevention is key by avoidance of the stimulus.


The nipple is a small conical structure on the breast. A normal nipple should point outward and not appear flatten. A flattened or inwardly drawn nipple poses a great deal of challenge as one of the problems of breastfeeding. This makes latch on difficult. It is important for an inverted nipple to be discover early. This could be during breast self examination or usually at the antenatal care booking clinic during the clinical breasts examination.

Hence, necessitating breast preparation before delivery. So, attempts are made to pull the nipples out. Using the Hoffman exercise, the thumbs are placed on either side of the flat or inverted nipple on the left and right side of the areola. A slight inward then firm outwards pressure is applied on the areola. This manoeuvre should be repeated circumferentially at least 5times a day.

Also, a suction cup device, hard plastic breast shells or syringe can be used to attempt pulling out the flat or inverted nipple. Using a syringe, the other end away from the plunger is cut circumferentially, the cut end is applied to the breast around the nipple. The plunger is withdrawn and the suction pressure pulls the nipple out. Several attempts will be needed to make the nipple point out. This can be done before each feeding episode. The breast shells are worn inside the bra, they put pressure around the nipple making it protrude.

Whereas, the aforementioned methods may give results though not permanent, some expert have questioned their efficacy. Surgery has been advocated and one of such procedure is the nipple piercing. The flat or inverted nipple is elevated and pierced leaving a small horizontal bar to keep it elevated.


Mastitis is the inflammation of the breast tissue resulting from infection or breast engorgement. Both or one breast might be affected. Affected individual could have breast pain, mild fever, malaise, nausea or vomiting. Treatment depends on whether the woman is breastfeeding or not. If she is breastfeeding, she should continue even on the affected breast. Manual expression of milk after breastfeeding will also help if the mastitis is due to engorgement.

If she is not breastfeeding, a tight fitting bra can be use, usually, the bra size she uses when she was not pregnant is advised. Medication can also be used to suppress breast milk production. For infectious mastitis, antibiotic is recommended.


A breast abscess is formed when pus collect in the breast. Mastitis or secondary infection of a galactocele can result in breast abscess. Affected women come down with breast pain, fever, nausea or vomiting. The nipple may discharge pus; the surface of the breast may be warm, appear red-like, swollen; and there may be a punctum. Treatment here is by incision and drainage of the pus. Breastfeeding should be withheld on the affected breast.


Unsupportive work place policies are a major contributor to the uptake of exclusive breastfeeding. Women are a significant part of the work force in most countries. Married women will want to have babies since nature did not confer them with the advantage that they can afford to wait too long. So, in the course of their career progression, a child might come into the picture. They need all the support within and without to get through this period of raising a healthy child. An exclusively breastfed child will fall ill less often thereby, reducing the burden on the health system. Also, mothers will take less time away from work to take their babies to the hospital.

However, the work place might not be conducive enough to support exclusive breastfeeding. Maternity leaves should be at least six months to allow for exclusive breastfeeding and it should be a paid leave. Some organization do not have crèche where these babies can stay while their mothers work and intermittently come to breastfeed. Those that have crèches have no breastfeeding breaks.

Also, some mothers do not get the require duration of maternity leave as stipulated by law. Reason being that they have not spent up to six months at the said employment before delivery. Despite the reduction in the official leave period, some do not get paid during the period while they are on leave. For this reason, the law makers should take responsibility for making laws that will encourage exclusive breastfeeding. Also, enforce and ensure compliance with the law both in the public and private sectors. The Ministry Of Women Affairs should be in the vanguard of ensuring compliance with the laws. Also, ensuring women on maternity leaves are paid.