From spotting symptoms of thrush and mastitis to getting help if your baby has a tongue-tie, this guide explains the causes and solutions to common breastfeeding issues.
It’s very common to experience difficulties when you start to breastfeed, which can be both painful and exhausting when looking after a newborn baby. The good news is that most problems can be overcome with the right help and breastfeeding support.
Painful or sore nipples
Breastfeeding can be a strange sensation at first, and it’s completely normal to feel a tingling or uncomfortable feeling when your milk lets down. However, breastfeeding should never be painful. If you are in pain, it can be a sign that your baby’s latch needs to be improved or that you have an infection.
Signs that the latch is less than ideal include:
- pain in your nipples when breastfeeding
- nipples that look white or the shape of a lipstick after feeds
- nipples that crack or bleed.
What should I do if my nipples are painful or sore?
Get in touch with your midwife or another breastfeeding support worker for help. You may be able to improve the latch by simply holding your baby another way or breastfeeding in a different position. In case there is a problem that needs treatment, for example tongue-tie or thrush, you can be advised on what to do next.
While you wait to be seen, a nipple shield can be effective at reducing pain and discomfort – but it’s important that this is only a short-term solution. Nipple shields can affect how much milk your baby can get, and so have an impact on your breastfeeding experience. You should always talk to an expert who can observe a feed and give you tailored advice.
If your baby has a tongue-tie, it means that the membrane under their tongue (the frenulum) is too short or too tight for the tongue to move freely. This can make breastfeeding painful for you, as your baby may not be able to get a good latch or move their tongue around the breast in the right way. It can also make it difficult for your baby to get enough milk.
Tongue-tie is quite a common problem: around one baby in ten is born with a tongue-tie to some degree and around half of those find feeding difficult.
Symptoms that your baby may have tongue-tie include:
- your baby has problems latching on, or staying latched on
- your baby seems hungry and unsettled all the time
- your baby’s not gaining weight as quickly as they should
- your baby makes a ‘clicking’ sound as they feed
- you have sore or cracked nipples, develop mastitis or have a low milk supply.
What should I do if my baby has a tongue-tie?
If you suspect that your baby has a tongue-tie, you should get professional help to assess your baby. It’s very important that the person who takes a look at your baby is trained in tongue-ties, as it can be difficult to see if a baby has a tie, and how severe it is.
If your baby has a tie and has problems feeding, a tongue-tie division might be necessary. This is a procedure where a specially trained nurse or doctor snips the membrane under your baby’s tongue to release the tongue. Although it may sound scary, it’s a very quick procedure which doesn’t seem to be painful for babies – in fact, most babies can start feeding immediately afterwards.
Talk to your health visitor, midwife or GP about how to get your baby assessed where you live, or find an NHS or private tongue-tie practitioner in your area.
If your baby doesn’t drain your breasts of milk, for example by going longer than usual between feeds, or if you end up feeding on only one side for a whole night, you may end up uncomfortably full. If this happens, your breasts will feel warm, large and hard, possibly even painful. It happens more often in the early weeks after the birth, before your milk supply has adjusted.
What should I do if I’m engorged?
The best thing to do if you’re engorged is to get your baby to breastfeed as soon as possible – you’ll probably feel instant relief. There’s normally no need for you to seek medical help.
Sometimes, your breasts may be so engorged that your baby struggles to latch on. If that happens, try to express a bit of milk first, either by hand or with a breast pump, just enough for your breast to go softer so your baby can latch on.
Blocked milk ducts
When your baby feeds, milk flows from the milk ducts positioned all around your breast to the nipple. If the flow of milk is disrupted in some way either during or between feeds, for example if you’re wearing a bra that presses on your breast, you’re engorged for a long time or your baby skips feeds, your milk ducts can become blocked with old milk.
If you have a blocked duct, your breast will probably be warm, sore or painful, and if you look in a mirror, you may notice that the area of the blocked duct has become red.
To help avoid blocked ducts, make sure your bras aren’t tight or ill-fitting. Read our tips on nursing bras and other breastfeeding essentials.
What should I do if I have a blocked milk duct?
The best thing to do if you have a blocked duct is to get your baby to feed from the blocked breast as often as possible – aim to feed every two hours at least.
Before each feed, try to heat up your breast to make it more likely that the blocked duct will clear as your baby feeds. For example, you can try:
- massaging the area of the breast gently with your hands
- using the shower head to stream warm water over the breast
- putting a warm compress (or a clean nappy full of warm water) on the breast.
To make the feeding as efficient as possible, position your baby with their chin towards the lump or red area of your breast to drain that part of the breast. If that’s tricky, you can try placing your baby on the floor and feed them by dangling your breast over their mouth.
Most blocked ducts clear up without medical help, but if your duct is blocked for too long it can turn into mastitis, so it is important that you try to unblock the milk duct as soon as possible.
Mastitis means that, in addition to a blocked duct, your body has also developed an inflammation. This can happen if your milk flow is restricted in the same way as with a blocked duct. Mastitis usually comes on very suddenly and is most common when your baby is less than three months old.
Symptoms of mastitis include:
- the breast being tender and warm, more so than with blocked ducts
- the area of red skin on your breast may be extra hot and painful, possibly with red streaks extending outwards
- you have a fever (over 38°C) or chills
What should I do if I have mastitis?
If you think you have mastitis, it’s important that you contact your GP. While mastitis can clear up by itself, it often requires antibiotic treatment. Untreated and sustained mastitis could see you admitted to hospital with a breast abscess, so it’s really important that you get help as soon as possible.
Before you get seen by your GP, treat mastitis in the same way you would a blocked duct: breastfeed as frequently as possible and try to keep the breast warm and avoid pressure from tight-fitting clothes.
If at all possible, take your baby to bed with you and have them breastfeed as often as possible while you keep warm and rest (a ‘nurse-in’). Try to get help from your partner or another family member or friend if you have older children that you look after – you’re ill and need to rest as much as possible.
Pain in your nipples and breasts can be caused by a fungal infection. This is especially common if you or your baby have had a course of antibiotics (which changes the natural balance of bacteria), or if you’ve had cracked or bleeding nipples.
Symptoms of thrush include:
- breast or nipple pain in both breasts which lasts for up to an hour after feeds
- your baby has white spots in their mouth that can’t be wiped off
- your baby is unsettled when feeding.
What should I do if my baby or I have thrush?
Thrush can be extremely painful for you, and it can also make your baby more reluctant to feed if they have it in their mouth, so it’s important that you seek help as soon as possible.
Your GP, midwife or health visitor can arrange for swabs to be taken from you and your baby to confirm the diagnosis. Both you and your baby will need treatment if either of you have the fungal infection, as it spreads easily between the two of you.
- For your baby, treatment means spreading an anti-fungal gel or liquid in their mouth. It’s completely safe for your baby.
- For you, treatment means putting a prescribed cream on your nipples after feeds.
As well as using the anti-fungal gels and creams, it’s also important that you wash your breastfeeding bras at a high temperature and change breastpads frequently, as well as making sure you wash your hands as often as possible to kill the bacteria.
Low milk supply
If you have low milk supply, your baby’s not getting enough milk to put on as much weight as they should and might even lose weight.
Sometimes, well-meaning people around you may suggest that you have a low milk supply when your baby’s just exhibiting normal newborn behaviour, for example suddenly wanting to feed a lot more frequently (probably a growth spurt).
There are many possible causes of true low milk supply, and it’s important that you get expert help to find solutions that work for you and your baby. The good news is that it’s very rare for women to be physiologically unable to produce enough milk, and most causes of low milk supply can be overcome with the right help and support.
Some things that can cause or contribute to a low milk supply include:
- physical problems with your baby (for example, tongue-tie or jaundice)
- health problems with you (for example, if you have PCOS or you have retained placenta after the birth)
- scheduled feedings or cutting breastfeeding sessions short (breastfeeding works best on cue, as a breastfed baby can never eat too much).
What should I do if I have low milk supply?
If your baby has problems putting on weight, it’s often noticed at your postnatal midwife appointments or when you take them to your health visitor to be weighed.
Your midwife or health visitor can talk to you about your baby’s weight and what might be causing the problem, and refer you on to the hospital or a lactation consultant for further help. Alternatively, you can always contact a lactation consultant yourself for advice.
If you want or need to boost your milk supply, the best thing to do is to remove milk from the breast as often as possible. Milk works on a supply and demand basis, and the more milk you remove, the more is made.
- If you’re sure that your baby’s latch and positioning is good, try having your baby feed as often as possible. Consider having a nurse-in where you just spend a couple of days skin-to-skin with your baby in the bed and feed at every opportunity.
- If your baby’s not able to remove milk efficiently yet, still keep them skin-to-skin with you to help boost your breastfeeding hormones, express milk using a pump and feed your baby using a cup.
- If you have to supplement breastfeeds with formula, make sure your healthcare professionals work out a plan with you for how you’ll get back to breastfeeding after your baby’s weight has picked up. If in doubt, speak to a certified lactation consultant (lcgb.org/find-an-ibclc) for more advice.
Oversupply of milk
Having too much milk, or milk that flows too fast (a forceful let-down), can be very distressing for you and your baby. Many mums first notice that they have an oversupply when their baby’s around a month old.
You may have too much milk if:
- your baby gags, chokes or coughs while nursing
- your baby is fussy at the breast and pulls away often
- your baby spits up a lot of milk or is very windy.
What should I do if I have a forceful letdown or oversupply of milk?
Try to speak to your health visitor or midwife in the first instance, they can give you tips on positioning and latching and rule out that there are underlying problems causing your baby’s symptoms.
There are two main solutions to a forceful let-down:
- Help your baby deal with the fast flow: One of the best ways is to try different nursing positions, for example laid back positioning so your baby is on top of you and the milk has to flow against gravity, or side-lying position so any extra milk that comes out can dribble out your baby’s mouth. You can also try burping your baby often and hand express into the sink at the start of feeds before latching your baby on when the milk flow has slowed down.
- Adjust your supply to your baby’s needs: Only try to reduce supply once breastfeeding is well established (after the first six weeks) and only if your baby is gaining weight well. To reduce your supply you can try block feeding, where you only use one breast per feeding rather than both. Also avoid any unnecessary breast stimulation, like pumping, as that will encourage your breasts to produce more milk.
More from Which?
- Postnatal care: What happens after you’ve given birth? Understand how your place of birth can affect the first hours with your baby.
- Your postnatal appointments: Find out what help you can expect in the early weeks with your newborn.
- NHS vs NCT antenatal classes: Discover the differences between NHS and NCT classes and how they help to prepare you for parenthood.