Dr. Kim Foster: Wicked Health


Solutions To Common Breastfeeding Dilemmas

from painful nipples to breast infections

Breastfeeding is a wonderful, healthy, beautiful thing...but don't ever let anyone tell you it's easy. When I had my first baby, even though I had several years of medical training behind me, I was shocked to discover that breastfeeding didn't come perfectly naturally. I actually had to work at it. I had to think about it. A lot. I had to read, experiment, and eventually see a lactation consultant who helped me figure the whole thing out.

Of course everyone's experience is different, and many women (and their babies) take to breastfeeding right from day one. But if you're having trouble...trust me, you're not alone. 

In this post I'm going to talk about some specific breastfeeding challenges. It's important to know that if any of these issues come up for you, there are solutions.  

Sore Nipples

Cracked, sore nipples are very common, particularly in the early postpartum phase when both you and your baby are getting used to breastfeeding.  Here are some things you can do to relieve this painful problem:

  • Make sure the latch is right—see this for help.
  • Soothe the skin with pure lanolin cream, or breastmilk itself.
  • Continue breastfeeding and/or pumping your milk. If your nipples are bleeding you may see a little blood in the milk and that is okay—it's not harmful to your baby.


When the breasts painfully overfill with milk, it’s called engorgement. This is usually caused by a mismatch between milk production and milk extraction. It's more likely to happen at these times:

  • When your milk first starts to come in a few days after delivery
  • If your baby has a very irregular feeding routine
  • If his appetite drops due to illness, or starting on solid foods

Engorged breasts can be firm, hard, and painful. Engorgement can cause the nipple to flatten out and the areola to become hard, which makes it difficult for your baby to latch on.

Here are some solutions:

  • Manual expression of small amounts of milk just before feeding to soften the areola and help latching
  • The use of a breast pump just before feeding to soften the breast—but be careful because overuse will stimulate milk production and can worsen engorgement
  • Cold compresses after or between feedings to decrease swelling and pain
  • Warm compresses or a warm shower to enhance let-down and improve breastfeeding or pumping or manual expression
  • Try applying cold cabbage leaves to the breasts to relieve engorgement—it's an old folk remedy that has some evidence backing it up
  • pain relievers like ibuprofen and acetominophen are considered safe while breastfeeding.

Blocked Ducts

A plugged, or blocked, milk duct—which feels like a tender lump in the breast—can be very painful. Typically there’s no redness of the breast tissue or fever (distinguishing it from mastitis--see below).

Here are some of the ways to manage a blocked duct:

  • Optimize feeding technique
  • Do not stop breastfeeding!
  • Facilitate drainage via warm showers, warm compresses, manual expression
  • Pain relievers like ibuprofen/acetaminophen

If a blocked duct doesn’t resolve in about 48 hours using the above methods, see your doctor.


Mastitis is an inflammation of the breast—typically caused by an infection—that results in fever, pain, redness, and general symptoms of fatigue and achiness. All the above conditions (cracked nipples, engorgement, blocked ducts) can lead to mastitis.

If you have any of the following, see your doctor:

  • Fever over 38.5 C
  • A firm, red, tender area of the breast
  • Muscle aches and pains

If your doctor decides you do indeed have an infection, you will likely be put on antibiotics.

Here's how to deal with mastitis:

  • Continue breastfeeding and keep working on your technique to make sure your breasts empty well
  • Take your antibiotics as directed. If you don't start to feel better within 2-3 days, contact your doctor
  • Try acetaminophen or ibuprofen for pain
  • Apply cold compresses

If you found this helpful, see some of my other pregnancy and postpartum posts:

photo credit: Wikimedia commons