Patient education: Common breastfeeding problems (The Basics)

What problems can happen during breastfeeding? — Many people are able to breastfeed with no problems at all. But sometimes, problems happen. Most problems can be treated so that you can keep breastfeeding. Breastfeeding has many benefits for both you and your baby.

Some common breastfeeding problems and their treatments are discussed below. Many treatments are things that you can do on your own, although some problems require help from a doctor or nurse.

You might also find it helpful to work with a breastfeeding expert, called a "lactation consultant," if you have problems.

Engorgement — "Engorgement" is the term doctors use for when the breasts are too full of milk. If your breasts are engorged, they might feel swollen, hard, warm, and painful. Also, your baby might have trouble with "latch-on." Latch-on is another word for when a baby makes a tight seal with their mouth around the nipple and the dark skin around the nipple (areola) (figure 1).

If your baby is able to latch on, breastfeeding will remove milk from the breast and help with engorgement. If not, you can use your hand or a breast pump to let a little bit of milk out between feedings (figure 2). If you use a pump, you can use it for just a few minutes right before a feeding. This will soften your breast without releasing too much milk, which can make engorgement worse.

You can also try the following home remedies to reduce the pain:

●Use a cold pack or cool cloth on your breasts between feedings.

●Take a pain-relieving medicine, such as acetaminophen (sample brand name: Tylenol) or ibuprofen (sample brand names: Advil, Motrin).

●Take a warm shower.

●Gently massage your breasts to start your milk flow.

●Wear a bra that supports your breasts.

Mastitis — Mastitis is when part of the breast becomes inflamed and swollen. It is similar to engorgement, but usually affects 1 breast. The swelling in the breast puts pressure on the milk ducts. This makes the ducts narrower, so milk cannot flow to the nipple as easily.

The goal of treatment is to ease discomfort and get the milk flowing again. To do this, you can try the steps listed above for relieving symptoms of engorgement. In addition:

●Feed your baby when they are hungry. If milk is flowing from the breast with mastitis, you can feed your baby on that side.

●Only use a breast pump if you need to. Do not try to empty your breast completely, as this can make mastitis worse.

●Avoid using nipple shields.

●Drink plenty of fluids, and rest when possible.

If milk flow is blocked for more than a day or 2, this can lead to bacterial infection in the breast. This can cause additional symptoms like fever, aches, or feeling very tired. This needs treatment with antibiotics. If you have an infection, continue to breastfeed. You will not pass the infection on to your baby.

Sore or painful nipples — The most important thing that you can do to prevent and deal with nipple pain is to make sure that your baby latches on the right way (figure 1). You might feel a tugging or pulling at your nipples while breastfeeding, which is normal. But if you feel pain or rubbing, take the baby's mouth off of the breast, then have them latch on again.

Nipple pain that lasts for a whole breastfeeding session is not normal. It can be caused by nipple cracks, blisters, or bruises. Sometimes, nipple pain and problems latching on are caused by a condition called "tongue tie," which is when the baby's tongue cannot move as freely as it should.

You can also try the following home remedies:

●If your nipples are cracked or raw, you can rub a small amount of breast milk on them or try lanolin ointment (sample brand name: Lansinoh). If you think that your nipple might be infected, call your doctor or nurse. Do not use vitamin E or honey on your nipples, because these can be dangerous for your baby.

●Hold a cool or warm washcloth on your nipples.

●Take a mild pain reliever, such as acetaminophen (sample brand name: Tylenol) or ibuprofen (sample brand names: Advil, Motrin).

●Wear breast pads between feedings to protect your nipples.

●When your baby gets older and starts to get teeth, they might sometimes bite your nipple while breastfeeding. If this happens, try to position the baby so that their mouth is wide open during feedings. That will make it harder to bite. If your baby does bite you, try sticking your finger between your nipple and the baby's mouth and firmly saying "no." Then, put the baby down in a safe place. This will help your baby learn not to bite. You can also offer a teething ring to chew on instead.

Blocked milk ducts — A blocked milk duct can cause a painful breast lump (picture 1). The skin might look red. A blocked duct can also cause a white plug at the end of the nipple.

If you have a blocked milk duct, try to breastfeed often. Make sure that your baby latches on the right way (figure 1) and empties your breasts during feedings. Start with the breast that has the blocked milk duct, and use different breastfeeding positions to try to get the breasts as empty as possible. To help your milk flow better, you can also try taking a warm shower or gently massaging the breast. If your baby doesn't empty your breast, you can use your hand or a breast pump to remove more milk after the feeding.

You should not stop breastfeeding because of a blocked milk duct. Stopping can make the problem worse.

Nipple color changes — The nipples can turn white, blue, or red, and be painful. This is more likely to happen if you are very sensitive to cold. It can also happen if your nipple is injured (for example, if your baby doesn't have a good latch-on).

To treat this, you can:

●Turn up the room temperature, and wear warm clothes.

●Put a warm cloth over your breasts before and after breastfeeding.

It's also a good idea to avoid things that make this problem worse. For example:

●Avoid caffeine.

●Avoid nicotine (smoking or vaping).

●Do not take certain medicines that might make this problem worse. This includes some medicines for colds or migraine headaches, medicines used to treat attention deficit hyperactivity disorder ("ADHD"), and some diet pills. Ask your doctor if you're not sure about a particular medicine.

Should I see a doctor or nurse? — Talk with your doctor or nurse if you have problems with breastfeeding. Let them know if you have:

●Pain that lasts for the whole breastfeeding session

●Blood leaking from the nipples

●A blocked milk duct that does not get better after 3 days

●A fever of 100.4°F (38°C) or higher and a hard, red, or swollen area of the breast

●Flu-like symptoms, including muscle aches, chills, or feeling very tired

●Worries that you are not making enough milk

You can also talk to a lactation consultant (breastfeeding expert) for help.

More on this topic

Patient education: Breastfeeding (The Basics)
Patient education: Health and nutrition during breastfeeding (The Basics)
Patient education: Deciding to breastfeed (The Basics)
Patient education: Weaning from breastfeeding (The Basics)
Patient education: Pumping and storing breast milk (The Basics)
Patient education: Caring for your newborn (The Basics)

Patient education: Breastfeeding (The Basics)
Patient education: Common breastfeeding problems (Beyond the Basics)
Patient education: Deciding to breastfeed (Beyond the Basics)
Patient education: Health and nutrition during breastfeeding (Beyond the Basics)