Breastfeeding is a remarkable bonding experience between a mom and her newborn. But it can be sometimes accompanied by hurdles that require patience, understanding, and expert guidance. From the discomfort of sore nipples to the often undiagnosed issue of tongue-tie, and the occasional infections that might arise, these common problems during breastfeeding can momentarily overshadow the joy of nurturing your little one.
Here we'll delve into 7 common breastfeeding problems, shedding light on their causes, symptoms, and some tips to overcome them.
1. Latching
Poor latching can be painful, but don’t get discouraged. A common problem is that a baby’s latch can be too shallow. A shallow latch can put too much suction on the nipples, which can be painful and even cause cracking.
Our advice:
Continue to practice latching with your baby. Try to get your baby's mouth around most or all of the areola, the darkened part of the breast surrounding the nipple.
You can also try to:
- Tilt your baby’s chin down
- Tickle the upper lip with your nipple
- Wait for a yawn-like response before placing your nipple in your baby's mouth
If you think the latch is bad, gently pull your baby away and give it another try.
2. Engorged breasts
It's common to experience some breast engorgement in the first weeks after giving birth. This is due to an increase in milk production and extra blood flow, which causes vascular congestion and swelling. It can be accompanied with a low-grade fever too, but this doesn't necessarily mean you have an infection. Breast engorgement commonly decreases as your body adjusts.
Symptoms include firm, swollen, hard breasts that may be warm and painful to the touch. Your baby may have difficulties latching.
Our advice:
- Before feedings, encourage milk flow by putting a warm, moist washcloth on the engorged breast for 10-20 minutes. A warm shower can also help.
- Feed your newborn baby frequently, at least 8-12 times in 24 hours. If only one breast is engorged, offer that one first.
- Make sure your baby is latching well. If your breast is too hard, latching may be difficult. Try hand expressing or pumping a little bit of milk before nursing.
- If your baby is unable to breastfeed, hand express or pump frequently.
- Between feedings, put cold compresses or an ice pack on your breasts to help reduce swelling. Some women prefer to use cold cabbage leaves, although there’s not enough evidence to suggest these work better than cold compresses or ice packs [1], [2].
Breast engorgement typically decreases as your body adjusts. If it doesn't go away in a couple of weeks, you have fever that doesn't subside, or you experience symptoms of mastitis (see below), contact your provider or a licensed lactation consultant for guidance.
3. Sore nipples
Sore nipples are very common and vary in terms of severity. Some sensitivity is normal, especially early on. Many mothers experience a "pins and needles" sensation during let-down (a response from your body that cause breastmilk to flow), which can be uncomfortable. This discomfort often improves with time.
Another source of sore nipples can be poor latching. A shallow latch from your baby can cause pain and bruising of your nipples. Your baby may even bite your nipple.
Other causes of sore nipples might include:
- Plugged ducts
- Poorly fitted pumps
- Excessive milk production
- Nipple irritation from eczema/psoriasis
- Over cleansing the nipple
- Possible infection
Our advice:
- Continue to practice latching with your baby
- Try different breastfeeding positions
- Try loose-fitting bras and clothes to alleviate pressure on your nipples
- Consider using a nipple shield under the guidance of your provider
If pain continues or you experience any of the conditions above, reach out to your provider or a licensed lactation consultant for guidance.
4. Low milk supply
Low milk supply is one of the most common reasons for stopping breastfeeding [3]. A nationwide research study found that 50% of mothers stopped breastfeeding because of their perceived insufficient milk supply [4].
However, it is completely normal for your breasts to feel softer and for feeds to become shorter [3].
Our advice:
Ensure that your baby is properly latching to your breast. This will increase the likelihood of allowing your breastmilk to flow, also known as the let-down reflex. Some other methods you can try include:
- Make sure your baby is latching
- Offer both breasts at each feed
- Switch breast sides frequently
- Express milk after breastfeeding [3]
- Use galactagogues, which includes herbs and supplements that increase milk supply
- Consider donor milk
Galactagogues
Galactagogues are synthetic or plant molecules that help maintain and increase milk production [5]. Research shows that galactagogues can potentially increase milk production [6]. Some galactagogues come in the form of medications, while others may come in the form of herbal supplements, such as:
- Fenugreek
- Goat's rue
- Milk thistle
Speak with your provider or a licensed lactation consultant to see if galactagogues are right for you.
Donor milk
Donor milk is breastmilk from other moms that has been donated for use [7]. The American Academy of Pediatrics recommends donor human milk as the preferred feeding for preterm infants when the milk of the mother is unavailable [7].
Human donor milk is often pasteurized, which kills off both the good and bad bacteria in the milk. This means that the microbiome of donor milk is nonexistent [8], [9]. However, research shows that if nursing mothers add some of their own expressed breastmilk into pasteurized donor milk, the microbiome of donor milk can be safely re-established [10]. Make sure to consult with your healthcare provider before starting on donor milk.
Low breastmilk production can occur in some women. If you continue having low breastmilk production, consult your healthcare provider or a licensed lactation consultant for further help.
5. Tongue-tie
Tongue-tie is a condition that occurs from birth that restricts the tongue’s range of motion. It is also called ankyloglossia.
This occurs because of a structure in the tongue called the frenulum. The frenulum is a small band of tissue under the tongue that connects to the bottom of the mouth. Babies with tongue-tie have a short frenulum, which restricts the tongue's movement.
This can make it hard for your baby to latch because your baby uses the middle of the tongue, and not just the tip, for suction while breastfeeding [11]. Anywhere from 0.1% to 10% of babies have tongue-tie, depending on the criteria used to evaluate the frenulum [12].
Our advice:
Research on tongue-tie is ongoing. Consult with your provider or a licensed lactation consultant to help with tongue-tie.
6. Plugged milk ducts
Plugged milk ducts are normal, but can be painful. This occurs when the milk doesn’t drain properly, causing it to build up.
Plugged milk ducts may feel like a tender sore lump in the breast. Some other symptoms you can experience are:
- Swelling and redness near the lump
- Pain near lump
- Pain during milk let-down
Plugged ducts do not have high fever as a symptom. If you are experiencing a fever greater than 100.4 F, along with other symptoms, you may potentially have an infection.
Our advice:
- Consider using a warm compress to help relieve the sore area
- Ensure you are wearing a well-fitting bra; bras that are too tight can potentially compress the milk ducts
- Gently massage the suspected plugged duct area
- Consider changing breastfeeding positions with your baby
If lumps persist in your breasts, talk with your healthcare provider. A persistent lump may be a sign of something more serious, such as a fibroid, cyst, or cancer. Check your breasts regularly and keep an eye out for anything that may seem abnormal.
7. Breast infections (mastitis)
If you continue to experience inflammation and you have a fever—this may be mastitis. Mastitis is characterized by abnormally swollen and inflamed breast tissue, and can be accompanied by flu-like symptoms [13].
A common cause of mastitis is plugged milk ducts. A blockage in your milk duct causes breastmilk to build up and can result in a bacterial infection.
In addition, if there is a cut or abrasion on your nipple certain bacteria can enter, which can also lead to a bacterial infection.
Some symptoms to look out for include:
- Fever greater than 100.4 F
- Swelling or redness of the breast
- Tenderness
- Nausea
- Vomiting
- Yellowish discharge, or pus, from the nipple or surrounding area [13]
Our advice:
If you suspect you have mastitis or any type of infection and have not gotten better, consult your provider right away.
Some tips that can help are:
- Gently massage your breast
- Continue to breastfeed, use a breast pump, or express by hand
- Apply a hot compress on your breasts just before breastfeeding or pumping
- Apply a cold pack after breastfeeding or pumping to help reduce swelling and pain
- Avoid using bras that are too tight, which can potentially compress milk ducts
8. Yeast infections
Candida are common yeasts that cause an infection known as candidiasis. They thrive in warm, moist environments, so yeast overgrowth and infection most often occur on the skin of your breasts and nipples, mouth, vagina, and vulva. When the infection occurs in your breasts, it’s often called the Breast and Nipple Thrush (BNT).
Some symptoms of yeast infections of the breast to look for are:
- Bright pink or red nipples
- Cracked or flaky nipples
- Nipple soreness
- Achy breasts
That said, there’s still debate on whether these symptoms are actually caused by Candida yeasts, and there’s no evidence that antifungal medications are more effective than just waiting for the symptoms to subside [14]–[16].
Oral thrush is caused by a specific yeast: Candida albicans. It’s also known as oral candidiasis, oropharyngeal candidiasis, or just thrush [17]. It commonly occurs in babies, and it’s thought it can be passed between mom and baby during breastfeeding.
Symptoms to look out for with oral thrush on your baby are:
- White or yellow patches or bumps on the cheeks or tongue
- White patches on your baby’s mouth and tongue
- Bleeding of bumps on the cheeks or tongue
- Cracked corners of the mouth
- Difficulty swallowing [17]
Our advice:
Some things you can do to help reduce the risk of yeast infections include:
- Washing your own and your baby’s hands often
- Washing all clothes, towels, and blankets that have come in potential contact with the yeast in hot water (above 130 F)
- Washing all of your baby’s feeding bottles
- Drying your nipples between feeds
- Changing breast pads often to help reduce moisture from leaky milk
Speak with your provider for additional ways to manage yeast infections.
If you are looking for other ways to keep your home tidy and your baby clean, consider looking at our blog post on microbiome-safe household cleaning products.
