Main Menu:

• Inadequate Milk Supply
• Blocked Milk Duct
• Breast Engorgement
• Breast Mastitis (infection)
• Nipple Discharge
• Nipple Confusion
• Breast Pain
• Nipple Soreness
• Inverted or Flat Nipples
• Thrush
• Jaundice
• Additional Resources and References

Inadequate Milk Supply

The amount of milk produced is directly related to how often and how long the baby is breast-fed.  When an infant suckles at the mother’s breast, milk is brought out from the nipples.   This suction signals the mother’s body to make more milk.  Therefore, the less a mother breast-feeds (or manually pumps milk from her breast), the less milk her body produces.  This supply/demand relationship is established so that the baby can be weaned successfully.  The most common way to increase milk supply is simply to breast-feed more often (or pump the breasts manually). 

Less commonly, an inadequate milk supply may be due to other complications, such as a problem with the baby’s sucking or a physical problem with the mother.  Mothers who continue to have inadequate milk supplies even if they have tried emptying their breasts often should consult a physician or certified lactation consultant.

Blocked Milk Duct

If the breasts are not emptied often, the milk ducts may become blocked or plugged.   A tender breast lump or spot may occur when a milk duct becomes blocked.  To treat a blocked milk duct, experts recommend breast-feeding often and changing positions to help drain the milk from all parts of the breast.  Applying warm heat, massaging the breast before nursing to increase the flow of milk, and getting plenty of rest are also helpful. 

Blocked milk ducts can lead to breast engorgement (swelling) and mastitis (infection).   See below for an explanation of these conditions.

Breast Engorgement

Breast engorgement (swelling) occurs when the breasts produce more milk than the amount that is being expelled by breast-feeding, pumping, or manual (hand) expression.  The milk overflows from the glands and engorges the breasts.   Breast engorgement is common during the first two to five days after childbirth when breast-feeding begins but can also develop any time the baby’s demand for breast milk decreases or stops or the mother is unable to empty her breasts.  

When breast engorgement occurs, the entire breast, nipple, and areola (pigmented region surrounding the nipple) swell and usually cause discomfort or pain.  The baby may suck from the nipples but will not receive much milk.  However, the baby's sucking will cause the breasts to produce more milk, further overfilling the milk glands and increasing engorgement.

Other symptoms of breast engorgement include:

• Hard, warm, throbbing, or slightly lumps breasts
• Flattened nipples (difficult for the baby to latch on)
• A slight increase in body temperature (around 100 degrees Fahrenheit or 37.78 degrees Celsius)
• Slightly swollen axillary (underarm) lymph nodes

Severe breast engorgement should not last more than 12 to 48 hours.  The best way to prevent breast engorgement is to breast-feeding, pump, or manually (hand) express milk often.  The treatment of breast engorgement usually focuses on relieving symptoms.  Click here to learn more about breast engorgement and other treatment suggestions.

Breast Mastitis

Mastitis is a benign (non-cancerous) infection that can usually be treated successfully with antibiotics.   Signs of mastitis include red, hot, painful, or inflamed breasts and other flu-like symptoms such as headache, nausea, temperature (101 degrees Fahrenheit, 38.4 degrees Celsius or greater), or chills.  Women with symptoms of mastitis should see a physician.  Breast-feeding with mastitis is generally not harmful to the baby and may actually help speed up recovery.    

Mastitis during breast-feeding can be caused by:

• Breast engorgement (swelling)
• Blocked milk duct/s
• Cracked or damaged skin or tissue around the nipple

Approximately 10% of women with mastitis develop pus-filled abscesses in the affected breast area.  An abscess is benign (non-cancerous) and will usually need to be drained with a needle by a physician.   A particularly large abscess may need to be cut open by a physician to drain.  Usually, the area is numbed with a local anesthesia and covered with gauze after the procedure.  Click here to learn more about breast mastitis and other treatment suggestions.    

Nipple Discharge 

It is fairly common for the breasts to discharge small amounts of blood during pregnancy and lactation.  During pregnancy and lactation, breast tissue grows rapidly.  Rapid tissue growth can lead to irritation of the breast ducts, causing bloody nipple discharge.  This discharge should not interfere with breast-feeding.  If the discharge persists after breast-feeding has stopped or is particularly bothersome, it should be further evaluated by a physician.  Click here to learn more about nipple discharge.  

Nipple Confusion 

Nipple confusion can occur during the first few weeks after childbirth.  The baby becomes “confused” between the mother’s nipple and an artificial nipple of a bottle.  Babies with nipple confusion will not latch on to the mother’s nipple and become fussy when a mother tries to breast-feed.  The best way to avoid and treat nipple confusion is to delay the introduction of bottles until a few weeks after childbirth. 

Breast Pain 

While 80% of women experience mild breast pain during the first few days of breast-feeding, pain usually subsides within a few weeks. Chronic breast pain during nursing should be reported to a physician or certified lactation consultant for clinical evaluation.

Persistent breast pain while nursing may result from:

• Improper positioning.  Leaning over the baby can lead to breast and back pain.
• Engorgement.
• Strong milk ejection reflexes. The actual process of expelling milk from the breast is called milk-ejection reflex (or let-down).  Milk is ejected from the breast into the baby’s mouth.  Normally, women feel a mild tingling sensation during milk ejection.  However, some women have strong milk ejection reflexes and experience a painful tingling or stinging sensation during breast-feeding.  This usually subsides after the first few weeks of nursing.
• Nipple blanching (also called vasospasm). The nipples turn white during and often in between breast-feeding. Many women report burning sensations in the nipples. Nipple blanching may be relieved with warm compresses and better breast support.
• Mastitis (breast infection). 

Nipple Soreness 

Nipple soreness is common during the first few days of breast-feeding but usually subsides soon thereafter.  If a woman is experiencing persistent nipple pain, she should consult a physician or certified lactation consultant.

Sore nipples are usually not related to how often or how long a woman breast-feeds her child.  Rather, sore nipples are most commonly caused by improper positioning.  The baby needs to take in approximately one inch of the areola (pigmented region surrounding the nipple) when feeding on the mother’s nipple.             

Techniques that may help reduce sore nipples include:

• Changing positions at each feeding.
• Breast-feed often for shorter intervals.
• Ask a physician about taking over the counter acetaminophens such as Tylenol to relieve discomfort.

Sore nipples may also result from a problem with the baby’s mouth such as thrush.  Thrush is a yeast infection.  See the section below on thrush for more information.

Rarely, a baby’s receding chin or a short frenulum in the baby’s mouth causes sore nipples.  The frenulum is the small band of tissue that connects the underside of the tongue to the floor of the mouth.  If the frenulum is too short, the baby is not able to grab the nipple properly with his mouth.  He or she will grab the nipple with the tongue, causing soreness.  If this is the case, some physicians will clip the baby’s frenulum to loosen the tongue.  The procedure is quick and does not cause much pain to the baby. Other physicians feel this procedure is not necessary.  If the baby has a receding chin, sore nipples can usually be avoided if the baby is nursed in alternate breast-feeding positions.     

Inverted or Flat Nipples

Many women have inverted or flat nipples and do not know it because the nipples will only turn inwards or flatten in the baby’s mouth.  To determine whether a woman has inverted or flat nipples, she can cup her hand under her breast and press the breast together at the areola tissue (the pigmented region surrounding the nipple).  If the nipple turns inward or flattens, the nipples are inverted or flattened. 

The most common way to “correct” inverted or flat nipples is to use breast shells before or in between feedings.  Plastic shells are worn directly on the breasts, and the nipple shows through a hole.  Shells help control the tissue around the nipple and cause the nipple to push forward instead of inward.  Women should talk to their physicians before using breast shells.     

Thrush

Thrush is a yeast infection that develops in the baby’s mouth and is characterized by white patches on the baby’s tongue, gums, and cheeks inside the mouth.  Thrush may also appear as a red rash or dots on the baby’s behind.  Thrush most commonly results from antibiotics taken by the mother or baby.   Thrush can be treated by over the counter medications such as nystatin ointment.  Mothers should talk to their physicians on how best to threat thrush.

If the baby has thrush, everything that enters the baby’s mouth (except the breast) must be sterilized, including pacifiers, breast pump parts, or toys the baby may chew on. 

Jaundice

Jaundice is an accumulation of bilirubin, a yellowish pigment, in the baby’s blood.   The skin of a baby with jaundice may be slightly yellow in color.  Jaundice is common and is usually not serious.  Babies are usually treated under bilirubin lights immediately after birth if they have jaundice.  Another type of jaundice called late-onset or breast milk jaundice may occur several days after birth.     

New research has shown that breast-feeding may not need to be stopped while a baby has jaundice.  Babies who are being treated with bilirubin lights can usually be feed bottled breast milk during treatment. 

Additional Resources and References

• So That's What They're For: Breastfeeding Basics by Janet Tamaro (1998) provides extensive information on breast-feeding in an easy-to-read, comprehensive, and humorous format.  Click here for pricing and ordering information.
• For additional resources, please visit the breast-feeding section of the Imaginis.com Breast Health Bookstore at http://www.imaginis.com/bookstore/breasthealth/nursing.asp

Updated: August 15, 2007

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