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Common Breastfeeding Problems and How to Solve Them

Sore nipples, engorgement, blocked ducts, mastitis and worries about milk supply.

Before you use this guide: This is general educational information, not an individual medical assessment. We do not identify a clinician reviewer on this page, so please confirm personal health decisions with your doctor, midwife or paediatrician.

Most breastfeeding difficulties can be solved with the right support. Do not wait if you are struggling. Early help makes a big difference, and many problems are quick to fix once the cause is found.

Sore or cracked nipples

Some tenderness is common in the first days. Pain that lasts through feeds, or cracked, bleeding or blistered nipples, is usually caused by a shallow latch, but it can also come from tongue-tie, thrush or a poorly fitting breast pump.

• Ask a midwife or lactation consultant to check your positioning and your baby's latch. Often a small adjustment fixes it.
• Break the suction with a clean finger before taking your baby off.
• Vary your feeding positions.
• After a feed, express a little milk and let it dry on the nipple. A lanolin or hydrogel dressing can help healing.
• Avoid soap and alcohol-based products on the nipples.

Thrush

Thrush is a yeast infection. It can cause burning, stinging or shooting pains in the breast during or after feeds, or shiny, pink nipples. Your baby may have white patches in the mouth that do not wipe off, or a nappy rash that does not clear. Both of you usually need treatment, so see your doctor.

White, painful nipples

If your nipples turn white, then blue or red, and throb after feeds, this may be vasospasm, where the blood vessels narrow. Keep the nipples warm after feeding and see your doctor.

Engorgement

Breasts can become hard, swollen and painful when your milk comes in, usually around days three to five, or if you miss feeds.

• Feed often and wake your baby if needed.
• Hand express a little before feeds to soften the nipple area and help your baby latch.
• Use cool compresses or cold packs after feeds to reduce swelling, and a warm shower before feeds if it helps.
• Do not pump a lot to empty the breasts, which can make you produce more milk.
• Wear a supportive, well-fitting bra that is not too tight.

Blocked ducts and mastitis

A tender, hard lump may be a blocked duct. Keep feeding, starting with the sore side if your baby will, and massage the lump gently towards the nipple. Avoid deep or hard massage, which can make swelling worse. A warm compress before and a cold compress after feeds can help. Most blocked ducts clear in a day or two.

If an area becomes red, hot and painful, and you feel feverish, shivery or flu-like, it may be mastitis. Rest, drink fluids and keep feeding or expressing from that breast, which is safe for your baby. See your doctor if you do not feel better within 12 to 24 hours, or sooner if you feel very unwell. You may need antibiotics, and you should finish the course. Seek urgent help if you have a hard, painful lump that does not go away, or a high fever, because this could be an abscess.

Worried about supply?

Many mothers worry about low milk supply, but most make enough. Signs that your baby is getting enough include plenty of wet and dirty nappies, steady weight gain, and contentment after feeds. Frequent feeding, short growth spurts and soft breasts are normal and do not mean your milk is running out.

• Feed more often and make sure the latch is good.
• Offer both breasts and let your baby finish the first before switching.
• Have lots of skin-to-skin contact.
• Express after feeds if your baby is not feeding well, with help from a professional.
• Ask your doctor to check for any medical cause, such as thyroid problems.
• Be wary of products that promise to increase milk supply. The evidence for most is weak.

Too much milk or a fast flow

If your baby coughs, splutters or pulls away when your milk lets down, try feeding in a more reclined position so that gravity slows the flow, and burp your baby more often. Ask for help if this continues.

Baby-related issues

• A very sleepy baby may need to be woken for feeds, particularly in the first weeks and if jaundice is a concern.
• A baby who suddenly refuses the breast, sometimes called a nursing strike, can be stressed, teething or unwell. Stay calm, keep skin-to-skin contact, offer the breast when your baby is sleepy and express your milk if needed. Check with your doctor if it continues.
• Biting is common with teething. Stop the feed calmly, and try again.
• Tongue-tie can make feeding painful and slow weight gain. A trained professional can assess it, and a quick procedure may help.

When to get urgent help

• You have a fever with a red, hot or painful breast
• Your baby has fewer than about six wet nappies a day by day five, or dark urine
• Your baby is very sleepy, yellow, floppy or not waking for feeds
• Your baby is losing weight or has not regained their birth weight by about two weeks

Where to find help

Your midwife, health visitor or doctor, a lactation consultant (look for IBCLC), and breastfeeding support groups such as La Leche League can all help. Many areas also have national breastfeeding helplines. If breastfeeding is not working for you, feeding your baby with formula or a mix is a valid choice, and you are still a great parent.

This content is for general information only and is not medical advice. Every pregnancy and every baby is different. Always talk to your doctor, midwife or paediatrician about your own situation, and seek urgent care if you are worried.