Common concerns

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 for the first seven to 10 days. If you have sore nipples that are not improving, call your lactation resource.

• 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.
• Massage your breasts gently.
• Use warm compresses.
• Keep your nipples dry. Change your bra pads often.
• Use a healing cream after feeding. Some options are a USP-modified lanolin nipple cream or an organic softening nipple salve. Check with your health care provider or lactation resource for product suggestions.
• 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. This is known as engorgement. Your breasts can become so full that it is hard for your baby to latch on and nurse comfortably.

Engorgement can also happen at any time while you are feeding, if you miss a feeding, or if weaning occurs too suddenly.

To prevent engorgement, try the following.

• Avoid giving formula unless your health care provider gives you instructions to use it. Giving extra feedings other than your breastmilk will cause your baby to feed less often. This can make engorgement worse.
• Hand express or pump before feedings and express a little milk to help soften the area around your nipple. This will help your baby latch easier and lower the chance of discomfort.
• Apply warmth to your breasts for up to five minutes before feeding to help with milk let-down. A warm, moist washcloth works well for this.
• Try different nursing positions. This can help your breast drain better during feeding.
• Let your baby drain the first breast before offering the second breast. If your baby is satisfied with just one breast, hand express or pump enough milk from your second breast until you are comfortable.
• Use a cool compress for up to 20 minutes of any hour.
• Take ibuprofen (such as Motrin^® or Advil^®) or acetaminophen (Tylenol^®) for discomfort. Follow the package instructions.

During the first one to two weeks, your body will adjust your milk supply. Engorgement will lessen as breastfeeding becomes well-established.

Breast pain

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

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. 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:

• Wear a bra that fits well, provides support and can easily be unhooked with one hand.
• Breastfeed at least every two hours, starting on the affected side. Have your baby's chin pointed toward the plugged duct when you start feeding. This helps to increase the suction in the duct area and can help move the plug toward the nipple and unplug the duct. When your baby has a pause in feeding, change position on your breast. This will help empty other ducts.
• Massage the affected area often. Massage from the outside of your breast toward the nipple when feeding.
• Drain the affected breast before offering the other breast. If your baby isn't fully emptying your breast, you can try massage, hand expressing or pumping.
• Stand under a warm shower and let the warm water run over your breasts for five minutes. Massage the affected areas.
• Alternate warm and cold compresses. Use one or the other for 20 minutes of any hour.
• Take ibuprofen (such as Motrin^® or Advil^®) or acetaminophen (Tylenol^®) for discomfort. Follow the package instructions.

If left untreated, a plugged duct can cause more serious problems. Call your lactation resource for more ideas or to make an appointment.

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.

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
• temperature higher than 101 F
• 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 (listed 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 trouble latching, you can pump for a few minutes just before nursing. This will draw out the nipple.

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

When to call your lactation resource

Call your lactation resource if you:

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

When to call your baby's health care provider

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

• has a change in their 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
• has 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