Breastfeeding: Solving early problems

Breastfeeding should not hurt. Pain is usually a sign that your baby is not breastfeeding effectively. Pain may interfere with breastfeeding your baby. We want to do every thing possible to help you and your baby have a comfortable breastfeeding experience.

Normal Types of Discomfort

You may have brief pain (10-15 seconds) at the beginning of each breastfeeding while the collagen fibers in your nipples stretch. You may have slight tenderness of the nipple.

Some women may have an uncomfortable sensation when their milk releases or "lets down" which may feel like tingling or "pins and needles." Other women have no sensation when their milk releases.

Pain that Needs Attention

If breastfeeding hurts after the first minute, or if your nipples and/or breast hurt between breastfeeding, ask for help from your baby's nurse or from a lactation consultant. Contact a Lactation Consultant if your nipples hurt when chilled and turn white, red and/or purple.

General Breast Care

• Always wash your hands before touching your breasts.
• Wash your breasts with water only, once per day. This will help you to prevent excessive drying of the skin on the breast and nipple. Pat your breasts dry with a clean cloth.
• You may let your breast milk dry on your breasts after pumping.
• Change breast pads when moist.
• Empty your breasts 8-12 times/day by helping your baby to breastfeed.
• If your baby isn't breastfeeding effectively, empty your breasts by pumping.

Engorgement

Engorgement is an over fullness that occurs when the breasts have not emptied regularly and frequently. Engorgement may happen when the milk volumes increase; it may happen if the baby's latch does not effectively empty the breast. It can occur 2 to 5 days after delivery or anytime when breastfeeding or pumping patterns change. Breastfeeding and/or pumping can prevent engorgement (8 to 12 times in 24 hours).

Symptoms of breast engorgement include:

• Swollen, firm and painful breasts.
• Severely engorged breasts are swollen, hard, shiny, and warm.
• You may also have plugged ducts (lumps) during engorgement.
• Your nipples may flatten and your areolas may be hard.
• You may have a slightly elevated temperature (less than 100° Fahrenheit)

To treat engorgement:

• If your breasts are painful, cold packs will be the most helpful. A bag filled with crushed ice or a bag of frozen vegetables such as peas will mold around your breasts. Apply these cold packs over a layer of clothing for up to 20 minutes. Repeat as needed.
• If your breasts are mildly engorged, you may apply moist heat for 5 minutes, using warm packs. (In tub, cover breasts with a warm, wet towel.) Or take warm showers, letting water flow over upper back and shoulders. Or soak (dangle) breasts in a basin at waist level; massage them while bending over the basin.
• Massage the breast gently before and during breastfeeding, until the tissue begins to soften.
• If your baby is unable to latch because your areola is too firm, you may press your fingertips downward in a ring around the base of your nipple (or use the length of two index fingers on each side of your nipple, shifting their locations as needed). You may find that this area softens as fluids shift farther back in your breast. Your nipple will stand out and your milk may begin to leak. This is called Reverse Pressure Softening. http://www.health-e-learning.com/articles/RPS_JCotterman_ver2005.htm
• Over-the-counter pain medications such as ibuprofen (Motrin) or Tylenol may help reduce your pain. Take as directed by your doctor or by the directions on the bottle. These medications are safe for the breastfeeding mother to use.
• If baby still cannot latch on or the nipple is flattened, use a breast pump or hand expression to soften the areola, stimulate milk flow, and help make the nipple stand out.

Plugged Ducts

The glands inside your breasts that produce milk look like tiny bunches of grapes and the stems resemble the ducts that move the milk out to the nipple. Small plugs in the ducts can cause the milk glands to become over distended with milk.

Symptoms

• A firm or hard lump in the breast is most likely a plugged duct. It may occur anywhere in the breasts including in the underarm area.
• The lumps may be single or multiple, pea-sized or may be as large as 2-3 inches across.
• You may feel pain with plugged ducts and may also notice that your breasts do not empty very well.

Plugged ducts may also be seen during engorgement and mastitis.

Prevention

Check your breasts after every breastfeeding. If you find your plugged ducts soon after they form, you will be able to resolve the plugged area more rapidly. Tight bras also may cause plugged ducts.

Treatment

Plugged ducts will release if you massage your breasts before breastfeeding. It is most helpful to find the plugged areas and massage the area between the plug and the nipple. Sometimes the plug is in the nipple and it helps to roll your nipple between your thumb and pointer finger.

You can also provide some steady pressure on the side of the plug that is farthest from your nipple while breastfeeding.

Mastitis

Mastitis is a breast infection that may be from damaged nipples or even persistent plugged ducts.

Symptoms include a reddened area on the breast and flu-like symptoms, which include an elevated temperature (101° F or greater), chills, headache, aching body, nausea and vomiting.

Prevention

• Use good hand washing before touching breasts.
• Help your baby attach deeply to your breast, which will help prevent nipple injury.
• Empty your breasts completely.

Treatment

• If emptying your breasts and resting do not quickly relieve the symptoms, you should contact your obstetrician or family doctor.
• Your doctor may prescribe antibiotics. It is very important to take all of the antibiotics as prescribed by your doctor. If you do not feel better after 2 days of treatment, contact your doctor again.
• Please continue to empty your breasts by breastfeeding or pumping.
• Rest is also very important to your recovery.
• You may also see a dip in your milk supply. This reduction may be temporary or permanent.

Questions?

This sheet is not specific to your child but provides general information. If you have any questions, please call

Children's – Minneapolis: 612-813-6100
Children's – St. Paul: 651-220-6000
Children's West: 952-930-8600

Children's Hospitals and Clinics of Minnesota
Patient/Family Education
2525 Chicago Avenue South
Minneapolis, MN 55404
Last reviewed 8/2015 ©Copyright

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