Breastfeeding – Common Problems

Sore Nipples

Until you get used to breastfeeding, your nipples may become sore and raw due to the baby’s sucking or even incorrect positioning. Some ways to protect your nipples from becoming sore or cracked are:

  • Check the baby’s position when feeding. Make sure that your baby’s mouth is over your areola, and not just on your nipple. Also make sure that the baby is directly facing your breast, and is not stretching your breast away from your body.
  • Hand-express some breast milk and leave a few drops on the nipples before your baby begins to nurse. This will help protect your nipples.
  • Leave some milk on the nipples after your baby is done nursing, then air dry your nipples for 10-15 minutes , or longer.
  • Rinse your nipples with warm water (no soap).
  • Change positions (“holds”) when feeding your baby.
  • Change the baby from one breast to another.
  • Breastfeed frequently so that your baby will not be as frantic and then suck more vigorously.

If your nipples become sore, try:

  • Nursing on the least sore side first;
  • Limit the nursing time on the sore nipple to 10 minutes, but the feed the baby more often – every 1 to 2 hours;
  • Express a small amount of milk to soften the areola area if it is getting firm as mature milk is being produced;
  • Change nursing pads frequently;
  • Apply a sparing amount of lanolin cream on nipples after airdrying some breastmilk on them;
  • Wear breast shells in between feedings.

After a couple of weeks of nursing, your body will be used to the extra wear and tear on your breasts, and the sensitivity will decrease. However, if these problems continue, please call your health care provider or the Strong Memorial Breastfeeding Support Line at 275-9575.


By the third to fifth day after your baby is born, your first milk (colostrum) begins to change to mature breastmilk. Your breastmilk production will increase causing your breasts to become firmer, bigger and sometimes tender. This lasts for two to three days. Engorgement may develop if your baby does not adequately remove enough milk from your breasts. Engorgement causes your breasts to become hard, painful and hot. It is not uncommon to have a low grade fever (less than 100 degrees Fahrenheit).

You can prevent engorgement by:

  • Breastfeed your baby frequently, at least 8-10 times in 24 hours;
  • Avoid giving your baby supplemental feedings of water or formula for the first three weeks;
  • Do not delay feedings or skip breastfeedings;
  • If you miss a breastfeeding or cannot get your baby to latch on, express your breastmilk;
  • When you decide to wean your baby do it gradually.

If your breasts become uncomfortably full, try the following suggestions:

  • Apply warm, moist compresses to your breasts for 5-10 minutes or take a warm shower, before you feed the baby;
  • Hand express some milk to soften the areola after using moist heat. This makes it easier for baby to attach to the breast;
  • Use gentle massage before and during breastfeeding to encourage more complete emptying of the breast;
  • Apply ice/cold compresses to your breast after breastfeeding to relieve the discomfort and decrease excess swelling more quickly;
  • If your baby feeds on only one breast, use a breastpump or hand express some milk from the other breast during the engorgement period;
  • If you cannot latch your baby on or your nipples are flattened, use a breastpump or hand express to soften the areola and shape the nipple. Continue to express milk every 2 hours, for 10 minutes a side until your baby can latch on;
  • If your nipples remain flatter, wear breast shells with the small opening back, in between feedings. This will help draw out your nipples, making it easier for the baby to latch on. Do not wear them at nighttime while sleeping.
  • Avoid bottles and pacifiers during the engorgement period to prevent nipple confusion.


Thrush is a common yeast infection that can occur when the mother or baby have been treated with antibiotics or can be contracted at the time of birth if the mother has a vaginal yeast infection. Thrush is the most common cause of sore nipples after a period of “normal” nursing. The mother complains of shooting pains in the breast during or after a feeding or of itchy, burning or tender nipples. Her nipples and breast may also appear reddened or bright pink. Sometimes there are cracks at the base or on the tip of the nipples. The baby may have a diaper rash or white patches on the inside of the mouth, gums or tongue.

Thrush can be treated and breastfeeding can and should continue during treatment. Both the mother and baby need to treated. There are oral medications and creams that are used to treat thrush. Contact a Lactation Consultant if you think that you or your baby may have thrush for more information and assistance.

Plugged Duct

A plugged or clogged duct can sometimes occur in your breast especially if you are delaying or skipping feedings. Sometimes it can occur from pressure on a duct, from a bra, or the position you use to hold the baby. It is usually a firm, tender, warm lump. There is no redness on the breast and no fever associated with a plugged duct. If you think you may have a plugged duct try the following suggestions:

  • Apply warm compresses to the breast before and after feedings;
  • Massage the area well when breastfeeding stroking downward toward your nipples;
  • Start the feeding on the breast with the plugged duct more frequently;
  • Nurse the baby in a position that points his or her chin toward the plugged area of the breast;
  • If a plugged duct does not resolve in 24-48 hours contact your health care provider or Lactation Consultant.

Breast Infection (Mastitis)

Mastitis is an inflammation and/or infection in the breast tissue. Symptoms include chills, and fever above 100 degree Fahrenheit, redness or red streaking on the breast, a tender area and swelling in the breast. Some mothers may experience a headache, body aches and nausea, feeling like she is coming down with the “flu”. Fatigue can contribute to the development of mastitis. If you think you may be developing a breast infection do the following:

  • Contact your health care provider for an evaluation and/or antibiotic therapy;
  • Apply warm, moist compresses to breast especially before feedings;
  • Apply ice/cold compresses after feedings to reduce swelling;
  • Breastfeed the baby on the affected breast as tolerated or use a breastpump to express the milk every 3 hours;
  • Take acetaminophen or ibuprofen for fever, inflammation and pain;
  • Complete the full prescription of antibiotics as ordered or the infection may return;
  • Rest as much as possible, get extra help with chores and other children as needed;
  • Drink plenty of fluids and eat nutritious foods;
  • Contact your health care provider or Lactation Consultant for more information or assistance or if there is no improvement in 24-38 hours or symptoms worsen.
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