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Worcestershire Health and Care NHS Trust

Common Breastfeeding Problems

Most problems encountered when breastfeeding are temporary and often the result of incorrect positioning or attachment to the breast. They can usually be resolved by making some simple changes without the need to stop breastfeeding.

Painful Nipples

Breastfeeding should not be painful

Mothers with sore or damaged nipples need help with positioning their baby so they should contact their Health Visitor, Midwife, NCT counselor or go to a breastfeeding support group. Nipple shields are not helpful, they may prevent the
baby learning to attach well. Most creams or sprays are not effective and may cause allergic reactions in Mothers or babies but a purified lanolin may be helpful for a short time while the Mother learns to attach her baby more effectively.

Breast Engorgement

Breasts may become full and hard due to the increased blood supply that is required for milk production, or when the milk supply comes in a few days following the birth of the baby. Breast engorgement can also occur if the baby is not using up all the milk at each feed, if the baby is not feeding often enough or if there are problems with positioning.

To help with engorgement

  • gently massage the breasts to encourage the let-down reflex (the natural reflex that stimulates the flow of breast milk)
  • express milk after a feed if your baby has not fed enough to soften the breast
  • take a warm bath or put a warm compress on the breast just before a feed
  • offer the baby frequent feeds.

Ibuprofen can be used to help reduce inflammation, and paracetamol can help relieve pain.

Encouraging the baby to breastfeed frequently while properly positioned is the most effective method of treating and preventing engorgement.

Blocked Ducts

Occasionally Mothers may experience a lumpy area in the breast caused by a blocked duct. This may be caused by infrequent feeds, an ill fitting bra or poor positioning and attachment.

  • Offer more frequent feeds on affected side
  • Ensure good positioning and attachment
  • Massage the lumpy area during feeds
  • If area becomes painful and not improving with the above the Mother should see her GP

Any lump that does not resolve quickly or persist should be checked by the GP.


Mastitis is inflammation of the breast that, if left untreated, can develop into a more serious infection. It is usually caused by bacteria that enter the breast through cracks in the nipple, or bacteria that is transmitted from the baby’s mouth or throat during breastfeeding, or as a result of blocked milk ducts. Signs of mastitis include some or all of these:

  • A red area on the breast which may be painful to touc
  • A lumpy breast which feels hot to touch
  • Whole breast aching
  • Flu-like symptoms - this can be very sudden onset

Breastfeeding should not be interrupted as this will make mastitis worse

Self-Help Measures:

  • Keep feeding
  • Offer more frequent feeds
  • Drain affected side more effectively by offering that side at every feed and express after feeds
  • Get help with positioning and attachment
  • Feed baby in different positions under arm or lying down
  • Warm bathing
  • Massage affected breast before feeds
  • Rest
  • Paracetomol to reduce temperature and pain
  • Ibuprofen to help to reduce inflammation
  • Antibiotics may be required if the Mother has a high temperature or the self-help measures have not resolved the problem in 24 hours

Slow Weight Gain

Mothers are often concerned that their babies are “not getting enough” milk or that their milk is not adequate for their baby. In reality almost all Mothers can produce enough milk for their babies needs.

The baby is getting enough milk if they:

  • are hungry at the start of the feed and full and contented at the end
  • are relaxed while feeding
  • have plenty of wet nappies and have regular soft, yellow-coloured bowel movements
  • are gaining weight (although the amount of weight gained will vary with each baby)

There are some babies whose weight gain may be slow - possible reasons are:

  • poor breastfeeding technique
  • possible low milk supply
  • The baby may not be feeding enough; babies need to feed at least 8 times a day in the early weeks
  • Use of a dummy - this may hide the babies feeding cues
  • Mothers may not allow feeding to be baby-led but time feeds so reducing the time
  • Trying to get the baby into a routine so making the baby wait for feeds

The Mother should contact her Health Visitor, Midwife or breastfeeding counselor if she is concerned about her baby’s feeding. It is particularly important to seek medical advice promptly if the baby seems unwell.