Breastfeeding: Best for baby. Best for mom.

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Related information Frequently Asked Questions on Breastfeeding

Call the National Breastfeeding Helpline at 1-800-994-9662 to talk to a trained peer counselor in English or Spanish for answers to common breastfeeding concerns.

Common Concerns

Home > Breastfeeding Home > Common Concerns

• Sore Nipples
• Engorgement
• Plugged Ducts
• Breast Infection
• Fungal Infections
• Nursing "Strike"
• Inverted, Flat, or Very Large Nipples
• Feeding a Sleepy Baby
• Milk Supply Concerns
• Health Problems in Baby and Breastfeeding
• Special Situations and Breastfeeding
• Additional Resources

Most breastfeeding concerns can be prevented. And if an issue arises, there are many ways to treat it right away by calling on a lactation consultant or other health care provider. Getting plenty of rest and fluids, reducing stress, and eating healthy foods will also help you feel better and be able to cope with any early challenges you might face after your baby is born.

This list of concerns is for informational purposes only. Only a lactation consultant and/or your doctor can diagnose and treat you.

Sore Nipples

Many moms report that breastfeeding can be tender at first until both they and their baby find comfortable breastfeeding positions and a good latch. Once you have done this, breastfeeding should be comfortable. But it is possible to still have pain from an existing abrasion. Make sure to treat the wound so that it doesn't get worse. Other problems can cause pain, including engorgement, infections, and Raynaud's. Raynaud's (Ray-NIHDS) phenomenon is a rare disorder of the blood vessels that can affect the nipples, causing painful breastfeeding in some women. You may also have pain if your baby is sucking on only the nipple. Gently break your baby's suction to your breast by placing a clean finger in the corner of your baby's mouth and try again. Your nipple also should not look flat or compressed when it comes out of your baby's mouth. It should look round and long, or the same shape as it was before the feeding. If your baby is latched on correctly and sucking effectively, he or she should be able to nurse as long as he or she likes without causing any pain. See the section on Learning to Breastfeed for more information.

Engorgement

It is normal for your breasts to become larger, heavier, and a little tender when they begin making greater quantities of milk on the 2nd to 6th day after birth. Sometimes this fullness may turn into engorgement, when your breasts feel very hard and painful. You also may have breast swelling, tenderness, warmth, redness, throbbing, and flattening of the nipple. Engorgement sometimes also causes a low-grade fever and can be confused with a breast infection. Engorgement is the result of the milk building up, and usually happens during the third to fifth day after birth. This slows circulation, and when blood and lymph move through the breasts, fluid from the blood vessels can seep into the breast tissues.

All of the following can cause engorgement:

• poor latch-on or positioning
• trying to limit feeding times or infrequent feedings
• giving supplementary bottles of water, juice, formula, or breast milk
• overusing a pacifier
• changing the breastfeeding schedule to return to work or school
• baby changing the breastfeeding pattern by beginning to sleep through the night or breastfeed more often during one part of the day and less often at other times
• having a baby that has a weak suck who is not able to breastfeed effectively
• fatigue, stress, or anemia in the mother
• an overabundant milk supply
• nipple damage
• breast abnormalities

Engorgement can lead to plugged ducts or a breast infection, so it is important to try to prevent it before this happens. If treated properly, engorgement should only usually last for one to two days.

Plugged Ducts

It is common for many women to have a plugged duct in the breast at some point if she breastfeeds. A plugged milk duct feels like a tender and sore lump in the breast. It is not accompanied by a fever or other symptoms. It happens when a milk duct does not properly drain and becomes inflamed. Then, pressure builds up behind the plug, and surrounding tissue becomes inflamed. A plugged duct usually only occurs in one breast at a time.

Breast Infection

A breast infection, also called mastitis, is soreness or a lump in the breast that can be accompanied by a fever and/or flu-like symptoms, such as feeling run down or very achy. Some women with a breast infection also have nausea and vomiting. You also may have yellowish discharge from the nipple that looks like colostrum or the breasts may feel warm or hot to the touch and appear pink or red. A breast infection can occur when other family members have a cold or the flu, and like a plugged duct, it usually only occurs in one breast. It is not always easy to tell the difference between a breast infection and a plugged duct because both have similar symptoms and can improve within 24 to 48 hours. Most breast infections that do not improve on their own within this time period need to be treated with an antibiotic. Learn more about medicines and breastfeeding.

Fungal Infections

A fungal infection, also called a yeast infection or thrush, can form on your nipples or in your breast because it thrives on milk. The infection forms from an overgrowth of the candida organism. Candida usually exists in our bodies and is kept at healthy levels by the natural bacteria in our bodies. When the natural balance of bacteria is upset, candida can overgrow, causing an infection. A key sign of a fungal infection on your nipples or in the breast is if you develop sore nipples that last more than a few days even after you make sure your baby has a good latch and positioning, or you suddenly get sore nipples after several weeks of unpainful breastfeeding. Some other signs of a fungal infection include pink, flaky, shiny, itchy or cracked nipples, or deep pink and blistered nipples. You also could have shooting pains deep in the breast during or after feedings, or achy breasts.

Some of the things that can cause thrush include: having an overly moist environment on your skin or nipples that are sore or cracked; taking antibiotics, birth control pills or steroids; having a diet that contains large amounts of sugar or foods with yeast; or having a chronic illness like HIV infection, diabetes, or anemia.

The infection also can form in your baby's mouth from having contact with your nipples, and appear as little white spots on the inside of the cheeks, gums, or tongue. This is called thrush. Many babies with thrush refuse to nurse, or are gassy or cranky. A baby's fungal infection can also appear as a diaper rash that looks like small red dots around a rash. This rash will not go away by using regular diaper rash ointments.

Ask for help if you have or your baby has these symptoms. You also should contact both your doctor and your baby's doctor so you can be correctly diagnosed and receive treatment at the same time to prevent passing the infection to each other. Fungal infection may put you at risk for another kind of breast infection so it is important to get help. Your doctors will decide the best course of treatment for both of you.

Nursing "Strike"

A nursing "strike" is when your baby has been breastfeeding well for months, then suddenly loses interest in breastfeeding and begins to refuse the breast. A nursing strike can mean several things are happening with your baby and that she or he is trying to communicate with you to let you know that something is wrong. Not all babies will react the same to different situations that can cause a nursing strike. Some will continue to breastfeed without a problem, others may just become fussy at the breast, and others will refuse the breast entirely. Some of the major causes of a nursing strike include:

• mouth pain from teething, or from a fungal infection like thrush, or a cold sore
• an ear infection, which causes pain while sucking
• pain from a certain breastfeeding position, either from an injury on the baby's body or from soreness from an immunization
• being upset about a long separation from the mother or a major change in routine
• being distracted while breastfeeding — becoming interested in other things around him or her
• a cold or stuffy nose that makes breathing while breastfeeding difficult
• reduced milk supply from supplementing with bottles or overuse of a pacifier
• responding to the mother's strong reaction if the baby has bitten her
• being upset about hearing arguing or people talking in a harsh voice with other family members while breastfeeding
• reacting to stress, overstimulation, or having been repeatedly put off when wanting to breastfeed

If your baby is on a nursing strike, it is normal to feel frustrated and upset, especially if your baby is unhappy. It is important not to feel guilty or that you have done something wrong. Your breasts also may become uncomfortable as the milk builds up.

Inverted, Flat, or Very Large Nipples

Some women have nipples that naturally are inverted, or that turn inward instead of protruding, or that are flat and do not protrude. Nipples can sometimes be flattened temporarily due to engorgement or swelling while breastfeeding. Inverted or flat nipples can sometimes make it harder to breastfeed because your baby can have a harder time latching on. But remember that for breastfeeding to work, your baby has to latch on to both the nipple and the breast, so even inverted nipples can work just fine. Very large nipples can make it hard for the baby to get enough of the areola into his or her mouth to compress the milk ducts and get enough milk.

Inverted Nipple

Flat Nipple

Normal Nipple

Feeding a Sleepy Baby

In the early weeks after birth, you should wake your baby to breastfeed if four hours have passed since the beginning of the last feeding. You can:

• remove any blankets
• change your baby's diaper
• place your baby skin-to-skin
• massage your baby's back, abdomen, arms and legs

If you find that your baby tends to fall asleep at the breast in the middle of the feeding, you might want to try the technique of breast compression, made popular by pediatrician and breastfeeding expert, Dr. Jack Newman. It can help a baby get more milk at each feeding by keeping him or her feeding actively for a longer time and to "finish" the first breast offered. This technique does not raise your risk of getting plugged ducts.

When the baby is drinking milk, you do not need to use any breast compression, but once the baby is no longer drinking and is just nibbling, you can start the technique. See the diagrams below. Click on the "Next" button for a demonstration or view the text only version.

Once your baby has finished the first breast and still wants more milk, you can offer the other breast. Signs that your baby has finished with the first breast are falling asleep at the breast and doing no more opening wide, pausing, then sucking. If the compression does not work at first, it does not mean that you have to switch breasts right away. If your baby comes off the breast by him or herself, you might want to try offering the first breast again to see if he or she will drink more. If not, or if your baby is getting fussy or sleepy because the milk flow is slow, you can change your baby over to the other breast. You can experiment with this technique and do a variation of it that works best for you.

Ask for help if you have questions or concerns about your baby falling asleep during most feedings and getting enough milk.

Milk Supply Concerns

Although most mothers can make plenty of milk for their babies, many are concerned about having enough milk. Some women are concerned about having an oversupply of milk in which the rush of milk from an overfull breast can make feedings stressful and uncomfortable for both mother and baby.

If you are concerned about your milk supply, see a lactation consultant to get to the root of the problem. Checking your baby's weight and growth often is the best way to make sure he or she is getting enough milk. If you have concerns about your baby's weight gain, talk with his or her doctor.

Health Problems in Baby and Breastfeeding

There are some health problems that can affect babies, making it more challenging to breastfeed. You can stay firm with your choice to breastfeed and get help from a lactation consultant. Breast milk and early breastfeeding are still best for both the health of you and your baby, and even more so if your baby is premature or sick. Even if your baby cannot breastfeed directly from you, it's best to express or pump your milk and give it to your baby with a cup or bottle. Be sure to continue lots of skin-to-skin contact with your baby.

Some of the most common health problems in babies that can make breastfeeding more difficult include:

Jaundice

Jaundice is a condition that is common in many newborns. It appears as a yellowing of the skin and eyes and is caused by an excess of bilirubin, a yellow pigment that is a product in the blood. All babies are born with extra red blood cells that undergo a process of being broken down and eliminated from the body. Bilirubin levels in the blood can be high because of higher production of it in a newborn, an increased ability of the newborn intestine to absorb it, and a limited ability of the newborn liver to handle large amounts of it. Many cases of jaundice do not need to be treated — your baby's doctor will carefully monitor your baby's bilirubin levels. Sometimes infants have to be temporarily separated from their mothers to receive special treatment with phototherapy. In these cases, breastfeeding may be discouraged and supplements or other fluids may be given to the baby. But, the American Academy of Pediatrics discourages against stopping breastfeeding in jaundiced babies and suggests continuing frequent breastfeeding, even during treatment.

If your baby is jaundiced or develops jaundice, discuss with your baby's doctor all possible treatment options and say that you do not want to interrupt breastfeeding if this is at all possible.

Reflux Disease

Some babies have a condition called gastroesophageal (GASS-troh-uh-SOF-uh-JEE-uhl) reflux disease (GERD), which occurs when the muscle at the opening of the stomach opens at the wrong times, allowing milk and food to come back up into the esophagus, the tube in the throat. Symptoms of GERD can include:

• severe spitting up, or spitting up after every feeding or hours after eating
• projectile vomiting, where the milk shoots out of the mouth
• inconsolable crying as if in discomfort
• arching of the back as if in severe pain
• refusal to eat or pulling away from the breast during feeding
• waking up frequently at night
• slow weight gain
• problems swallowing
• gagging or choking
• frequent red or sore throat
• frequent hiccupping or burping
• signs of asthma, bronchitis, wheezing, problems breathing, pneumonia, or apnea

Many healthy babies might have some of these symptoms and do not have GERD. But there are babies who might only have a few of these symptoms and have a severe case of GERD. Not all babies with GERD spit up or vomit.

Some babies with GERD do not have a serious medical problem, but caring for them can be hard since they tend to be very fussy and wake up frequently at night. More severe cases of GERD may need to be treated with medication if the baby, in addition to spitting up, also refuses to nurse, gains weight poorly or is losing weight, or has periods of gagging or choking.

See your baby's doctor if he or she spits up after every feeding and has any of the other symptoms mentioned above. If your baby has GERD, it is important to continue breastfeeding since breast milk is more easily digested than infant formula.

Cleft Palate and Cleft Lip

Cleft palate and cleft lip are some of the most common birth defects that happen as a baby is developing in the womb. A cleft, or opening, in either the palate or lip can happen together or separately and both can be corrected through surgery. Both conditions can prevent babies from breastfeeding because a baby cannot form a good seal around the nipple and areola with his or her mouth, or effectively remove milk from the breast.

Cleft palate can happen on one or both sides of a baby's mouth and be partial or complete. Right after birth, a mother whose baby has a cleft palate can try to breastfeed her baby, and she can start expressing her milk right away to keep up her supply. Even if her baby can't latch on well to her breast, the baby can be fed breast milk by cup. In some hospitals, babies with cleft palate are fitted with a mouthpiece called an obturator that fits into the cleft and seals it for easier feeding. The baby should be able to exclusively breastfeed after his or her surgery.

Cleft lip can happen on one or both sides of a baby's lip, but a mother can try different breastfeeding positions and use her thumb or breast to help fill in the opening left by the lip to form a seal around the breast. With cleft lip repair, breastfeeding may only have to be stopped for a few hours.

If your baby is born with a cleft palate or cleft lip, talk with a lactation consultant in the hospital for assistance as soon as possible. Breast milk and early breastfeeding are still best for your baby's health.

Special Situations and Breastfeeding

Twins or Multiples

Mothers of twins or multiples might feel overwhelmed with the idea of breastfeeding more than one baby at a time. The benefits of human milk to both these mothers and babies are the same as for all mothers and babies.

Breastfeeding early and often for a mother of multiples is important to keep up her milk supply. A good latch-on for each baby is important to avoid sore nipples. Many mothers find that it is easier to nurse the babies together rather than separately, and that it gets easier as the babies get older. There are many breastfeeding holds that make it easier to nurse more than one baby at a time.

If you have multiples, talk with a lactation consultant about more ways you can successfully breastfeed your baby.

Breastfeeding During Pregnancy

Breastfeeding during your next pregnancy is not a risk to either the breastfeeding toddler or to the new developing baby. If you are having some problems in your pregnancy such as uterine pain or bleeding, a history of preterm labor or problems gaining weight during pregnancy, your doctor may advise you to wean. Some women also choose to wean at this time because they have nipple soreness caused by pregnancy hormones, are nauseous, or find that their growing stomachs make breastfeeding uncomfortable. Your toddler also may decide to wean on his own because of changes in the amount and flavor of your milk. He or she will need additional food and drink because you will likely make less milk during pregnancy.

If you keep nursing your toddler after your baby is born, you can feed your newborn first to ensure he or she gets the colostrum. Once your milk production increases a few days after birth you can decide how to best meet everyone's needs, especially the new baby's needs for you and your milk. You may want to ask your partner to help you by taking care of one child while you are breastfeeding. Also, you will have a need for more fluids, healthy foods, and rest because you are taking care of yourself and two small children.

Breastfeeding after Breast Surgery

How much milk you can produce depends on how your surgery was done and where your incisions are, and the reasons for your surgery. Women who have had incisions in the fold under the breasts are less likely to have problems making milk than women who have had incisions around or across the areola, which can cut into milk ducts and nerves. Women who have had breast implants usually breastfeed successfully. If you ever had surgery on your breasts for any reason, talk with a lactation consultant. If you are planning breast surgery, talk with your surgeon about ways he or she can preserve as much of the breast tissue and milk ducts as possible.

Adoption and Inducing Lactation

Many mothers who adopt want to breastfeed their babies and can do it successfully with some help. Many will need to supplement their breast milk with donated breast milk or infant formula, but some adoptive mothers can breastfeed exclusively, especially if they have been pregnant before. Lactation is a hormonal response to a physical action, and so the stimulation of the baby nursing causes the body to see a need for and produce milk. The more the baby nurses, the more a woman's body will produce milk.

If you are adopting and want to breastfeed, talk with both your doctor and a lactation consultant. They can help you decide the best way to try to establish a milk supply for your new baby. You might be able to prepare by pumping every three hours around the clock for two to three weeks before your baby arrives, or you can wait until the baby arrives and start to breastfeed then. Devices such as a supplemental nursing system (SNS) or a lactation aid can help ensure that your baby gets enough nutrition and that your breasts are stimulated to produce milk at the same time.

Additional Resources

Publications

1.   Breastfeeding and Travel — This fact sheet provides general information about travel for women who are breastfeeding.

   http://wwwn.cdc.gov/travel/yellowBookCh8-Breastfeeding.aspx.aspx

2.   Coping with Breastfeeding Challenges — This Internet site explains how to deal with several common breastfeeding challenges and lists resources for more information.

   http://www.womenshealth.gov/breastfeeding/index.cfm?page=229

3.   LactMed: Drugs and Lactation Database — The Drugs and Lactation Database (LactMed) is a peer-reviewed and fully referenced database of drugs to which breastfeeding mothers may be exposed. Among the data included are maternal and infant levels of drugs, possible effects on breastfed infants and on lactation, and alternate drugs to consider.

   http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT

4.   Overcoming Breastfeeding Problems — This publication contains information on common breastfeeding problems, including nipple soreness, engorgement, let-down reflex problems, inadequate milk supply, plugged milk duct, breast infection, and thrush.

   http://www.nlm.nih.gov/medlineplus/ency/article/002452.htm

5. Breastfeeding a Cleft Lip-Palate Baby (Copyright © SMILES) — This fact sheet provides helpful information on the possible uncertainties associated with breastfeeding and caring for a child with a cleft lip, palate, or both a cleft lip and palate.

   http://www.cleft.org/breastfeeding.htm

6.   Breastfeeding after a Natural Disaster (Copyright © OTIS) — This fact sheet contains questions and answers about what things a mother could be exposed to during a natural disaster that might be passed to her baby in breast milk. It explains how to keep your breast milk as safe as possible and what to do if you have to use formula.

   http://otispregnancy.org/pdf/breastfeeding.pdf

7. Breastfeeding and Returning to Work (Copyright © AAFP) — Going back to work and keeping up with breastfeeding can be a challenge for many new mothers. This publication answers some commonly asked questions about how to transition back to work after having a child and still maintain a breastfeeding schedule.

   http://familydoctor.org/827.xml

8. Breastfeeding During Pregnancy (Copyright © LLLI) — This publication has information on the benefits and risks of continuing to breastfeed if you become pregnant. It also outlines what to expect with regards to your milk supply and changes that may occur to your body during pregnancy.

   http://www.lalecheleague.org/FAQ/bfpregnant.html

9. Breastfeeding the High-Risk Newborn (Copyright © UUHSC) — This on-line resource offers information on the benefits of breastfeeding high risk newborns including how to overcome difficulties in breastfeeding, how to express breast milk, and how to maintain milk production.

   http://www.uuhsc.utah.edu/healthinfo/pediatric/Hrnewborn/bresthub.htm

10. Can I Breastfeed My Adopted Baby? (Copyright © La Leche League International) — This publication discusses options for breastfeeding-adopted babies. It explains induced lactation and links to articles from mothers who have breastfed their adopted children.

    http://www.lalecheleague.org/FAQ/adopt.html

11. Extended Breastfeeding and the Law (Copyright © LLLI) — This publication discusses the evidence in favor of extended breastfeeding and how mothers can cope with reports of abuse or neglect from people who think extended breastfeeding is abnormal or wrong.

    http://www.lalecheleague.org/Law/LawExtended.html

12. FAQ on Breastfeeding Twins (Copyright © LLLI) — This publication provides information on breastfeeding twins. It includes positioning techniques, feeding plans, and ways to care for oneself.

    http://www.llli.org/FAQ/twins.html

13. FAQ: How Do I Prevent Sore Nipples? (Copyright © LLLI) — This publication contains information on what you can do to help heal or prevent sore nipples after breastfeeding. It gives suggestions on how to properly position the baby at the breast in easy-to-follow steps.

    http://www.lalecheleague.org/FAQ/sore.html

14. How Can I Deal with My Leaking Breasts (Copyright © LLLI) — This publication discusses nursing pads, patterned clothing, and frequent breastfeeding as ways to deal with leaking breasts.

    http://www.lalecheleague.org/FAQ/leak.html

15. If Breastfeeding is so Natural, Why Doesn't it Seem to Come Naturally? (Copyright © LLLI) — This publication encourages mothers to not give up on breastfeeding when they face challenges.

    http://www.llli.org/FAQ/natural.html

16. Is Thrush Causing My Sore Nipples? (Copyright © LLLI) — This publication contains information on what thrush is, what causes it, and how to relieve it.

    http://www.lalecheleague.org/FAQ/thrush.html

17. My Breast Hurts. What Can I Do? (Copyright © LLLI) — This fact sheet explains the causes and treatments for sore breasts.

    http://www.lalecheleague.org/FAQ/mastitis.html

18. Special Challenges to Breastfeeding (Copyright © AAP) — This publication contains information on obstacles that may create special challenges in breastfeeding, including maternal illness, plastic surgery, mastitis, and cracked nipples.

    http://www.medem.com/search/article_display.cfm?path=n:&mstr=/ZZZHCCBXQ7C.html&soc=AAP&srch_typ...

19. What are the Benefits of Breastfeeding my Toddler? (Copyright © La Leche League International) — This publication describes how breastfeeding your toddler can help their ability to mature and their understanding of discipline as well as provide protection from illness and allergies.

    http://www.lalecheleague.org/FAQ/advantagetoddler.html

20. Will the Breast Surgery I had in the Past Prevent Me From Being Able to Breastfeed My Baby? (Copyright © LLLI) — This publication explains some of the complications that a mother who has had breast surgery may experience. It also provides a list of signs that the baby is not getting enough milk.

    http://www.lalecheleague.org/FAQ/surgery.html

21. Would Weaning Make My Life Easier? (Copyright © LLLI) — This publication encourages mothers to look at the reasons why they feel weaning will be easier than continuing to breastfeed. It also offers suggestions on dealing with the barriers to breastfeeding that they may be experiencing.

    http://www.lalecheleague.org/FAQ/wean.html

Organizations

1.   Centers for Disease Control and Prevention, HHS
2.   Maternal and Child Health Bureau, HRSA, HHS
3.   Special Supplemental Nutrition Program for Women, Infants and Children, (WIC) USDA
4.   Womenshealth.gov, OWH, HHS
5. American College of Nurse-Midwives
6. Breastfeeding After Reduction (BFAR)
7. Human Milk Banking Association of North America
8. International Lactation Consultant Association (ILCA)
9. La Leche League International
10. National Healthy Mothers, Healthy Babies Coalition
11. Smiles
12. World Alliance For Breastfeeding Action

= Indicates Federal Resources

Content last updated February 27, 2009.