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Breastfeeding: Common issues

It may take several weeks before you and your baby settle into a comfortable routine and for you to feel confident about breastfeeding.

This doesn't mean that you will have a lot of problems. It means that you and your baby may take a few weeks to get to know one another and how best to nurse.

The early weeks also have some changes that are part of establishing breastfeeding.

Sore nipples

Having some nipple tenderness is common. If you have sore nipples that are not improving, call your lactation resource.

Important

It is not normal to have blisters, cracking, bleeding, or pain during or between feedings. If you do, call your health care provider or lactation consultant.

To reduce sore nipples:

  • Express a little milk before a feeding to get the milk to let down before your baby starts nursing.
  • Try a different position.
  • Dab a little breastmilk into the sore area with clean hands.
  • Use warm compresses.
  • Keep your nipples dry. Change your bra pads often.
  • Apply a little USP-modified lanolin or hydrogels on your nipples. Follow the manufacturers' instructions.
  • Avoid products that contain petroleum or alcohol.

Engorgement

Sometime between the third and seventh day, your milk volume increases. Your breasts swell with extra fluid in the tissues around your milk ducts.

As your milk volume increases, this can cause your breasts to feel full and warm. Your breasts can become so full that it is hard for your baby to latch on and nurse comfortably.

Engorgement can also happen if you miss a feeding, or if weaning occurs too suddenly.

Your body will naturally adjust your milk supply. Engorgement should lessen as breastfeeding is well-established.

To lessen engorgement, try the following.

  • Feed your baby often: eight to 12 times every 24 hours.
  • Massage your breasts before and during feedings.
  • Hand express or pump milk for relief, to make latch-on easier, or if you miss a feeding.
  • Try different nursing positions.
  • Let your baby drain the first breast before offering the second breast.
  • Relax and get comfortable.
  • Take ibuprofen (such as Motrin® or Advil®) for discomfort. Follow the package directions. The American Academy of Pediatrics has approved using ibuprofen while breastfeeding.

Tip

Babies do not need water.

Avoid feeding formula unless it is medically necessary. This can cause your baby to nurse less often.

Breast pain

Two common causes of breast pain are plugged duct and mastitis. Both need to be treated, but you do not need to stop nursing.

Plugged ducts

A plugged duct is a milk duct that does not drain properly. The area becomes tender, and there may be a painful lump. That area of the breast may look red.

Did you know?

Causes of a plugged milk duct can include:

  • tight-fitting bra
  • making too much milk
  • pumping often and then breastfeeding.
  • sleeping on your stomach
  • any time milk stays in your breast too long (due to skipped breastfeedings or using formula in addition to breastmilk).

If the blockage is in the nipple, the clogged pore may look like a small white pimple.

A plugged duct does not make you feel sick or cause a fever.

To prevent or treat a plugged duct:

  • Follow the suggestions for treating engorgement above.
  • Wear a bra that fits well. Make sure the bra does not leave indentations.
  • Breastfeed at least every two hours, starting on the affected side.
  • Massage the affected area.
  • Drain the affected breast before offering the other breast.
  • Apply moist heat for comfort for a few minutes.

If left untreated, a plugged duct can cause more serious problems. Call your health care provider if you have had a plugged duct for three days, if your symptoms get worse, or if you have a fever.

Watch for signs of a breast infection, including:

  • fever
  • chills
  • aching
  • increased breast pain.

Mastitis

Mastitis is an infection of the breast. The infection is in the tissue and not in your milk. You can and should continue breastfeeding.

Bacteria entering your breast through a crack in the nipple or skin can cause mastitis. A plugged duct or incomplete emptying of your breast can also lead to mastitis.

Signs of mastitis include:

  • fatigue, chills, and flu-like body aches
  • fever higher than 101 degrees Fahrenheit
  • red, hot, and swollen breast tissue
  • pain that is intense in one spot.

If you have or think you have mastitis:

  • Follow the tips to treat a plugged duct above.
  • Call your health care provider.
  • Call a lactation resource to talk about possible causes of the mastitis and ways to prevent it from happening again.
  • Accept help from others so you can rest.

Inverted nipples

A nipple that tucks in rather than sticks out when stimulated is called an inverted nipple. Breast changes during pregnancy often correct this condition.

Even if the nipple does not change, there may not be a problem. Some babies have no problems latching on.

If your baby is having difficulty latching, you can pump for a few minutes just before nursing. This will draw out the nipple.

If you have questions or concerns, contact your lactation resource.

When to call your lactation support resource

Call your health care provider if you have any of the following.

  • pain that lasts after initial latch-on
  • nipples that are cracked, red, bleeding, bruised or blistered
  • unsure if your baby is feeding effectively
  • unsure if your breasts are being drained well enough
  • if you are using a nipple shield.

When to call your health care provider

Call your baby's health care provider if your baby:

  • has a change in his activity level (doesn't wake to feed or is too agitated to sleep)
  • refuses to eat for more than two feedings
  • is throwing up often or with force
  • has more than 12 liquid stools a day
  • fewer than four to six wet diapers a day (baby older than 3 days) or if your baby has no stools or pellet-like stools
  • is sleepier than usual.

Pacifier use

Tip

The American Academy of Pediatrics recommends waiting until a breastfed baby is 3 to 4 weeks old before giving a pacifier. By then, breastfeeding is usually going well.

There are times that babies want the comfort that comes from sucking but aren't hungry.

If your baby is sucking for comfort, her sucking pattern will be different. There is sucking but rarely any swallowing. The rate may start out rapid and then slows as your baby feels comforted.

It's OK to offer your breast or finger or your baby's hand for comfort. It is best to delay offering a pacifier until your baby is about 3 to 4 weeks old.

The more time your newborn spends nursing in the first weeks of life, the more milk you will make. Regular pacifier use in the early weeks may affect milk supply and slow weight gain.

Bottle use (for breastmilk)

In general, it is best to wait to use a bottle until breastfeeding is well-established (typically in four weeks).

If your baby cannot latch-on or eat due to medical reasons, you can still express breastmilk and feed your baby from a dropper, spoon, cup or bottle. If you use a bottle, use a nipple that is slow flow.

Before you start using a bottle, please call your lactation resource.


 

Source: Allina Health's Patient Education Department, Beginnings: Pregnancy, Birth and Beyond, sixth edition, preg-ahc-90026, ISBN 1-931876-25-8

First published: 10/04/2002
Last updated: 01/29/2013

Reviewed by: Allina Health's Patient Education Department experts