Breastfeeding problems and getting help

If you dread the next feed because of pain, ask for help. Sore nipples are often linked to how your baby is positioned and attached at the breast. Putting up with the pain can make things worse. A feeding specialist can help you work out what’s going on.

Have someone watch a feed

Ask your midwife, health visitor or breastfeeding specialist to watch your baby feed. In the US, this may be a lactation consultant. Say when the pain happens and what makes you stop a feed. Ask them to explain each change and to watch you try it, so you can practise during the appointment.

If your baby is struggling to attach, a different position may help. If you’re worried about your milk supply, ask for a feeding review. Checking your baby’s weight and growth is part of making sure they’re getting enough milk.

Pain in the breast or nipple that doesn’t go away also needs checking. An infection can sometimes cause pain, itching or a change in how the nipple or breast looks. Contact your midwife or GP in the UK, or your doctor elsewhere. Don’t try to work out the cause from how it looks alone.

When breasts feel hard and full

Engorgement means the breasts have become too full of milk. They can feel tight, hard and painful. It can happen in the early days as you get used to feeding, or later when feeds become less frequent. Ask for help with attachment if fullness is making feeding hard.

A small, tender lump may be called a blocked milk duct. Missed or late feeds and tight clothing pressing on the breast can play a part. Ask about a lump if it doesn’t go away or feeding advice isn’t helping. Don’t assume every breast symptom has the same cause.

Recognise mastitis and avoid forceful massage

Mastitis is inflammation of the breast. It can cause a hot, swollen, painful area and flu-like symptoms, such as shivering or a fever. Redness can be harder to see on black or brown skin, so notice pain, heat and how you feel too.

NHS advice is to keep breastfeeding whenever your baby wants to feed. If feeding is too painful, you can hand express enough milk for your baby instead. A cold compress may soothe the breast. Avoid pressing hard, tight clothing and expressing more milk than your baby needs. Don’t stop breastfeeding suddenly.

Tongue-tie needs a feeding assessment

Tongue-tie is when the strip of skin joining the tongue to the floor of the mouth is shorter than usual. Some babies with tongue-tie feed without any trouble. For others, the tongue can’t move freely, which makes breastfeeding harder. Ask your feeding professional to check what your baby can do during a feed before you talk about treatment. How it looks alone can’t tell you what treatment is needed.

Ask about medicines while breastfeeding

Before talking about medicines, tell your pharmacist or doctor you’re breastfeeding. This includes things you buy without a prescription. Mention too if your baby was born early or had jaundice at birth. Small amounts of medicines may pass into breast milk, but very few medicines are unsafe while breastfeeding. Your pharmacist or doctor can advise about your medicine. Don’t stop a prescribed medicine without talking to your doctor.

When to contact a clinician

Call 999 now (UK) or 911 (US), or your local emergency number, if you become confused, have slurred speech, breathe very fast, or your skin turns blue, pale or blotchy while you’re unwell. Don’t wait to see if home care helps with these symptoms.

Call 999 now (UK) or 911 (US), or your local emergency number, if your baby is hard to wake or has difficulty breathing.

Contact your baby’s doctor urgently today (UK, US and elsewhere), or call NHS 111 in the UK, if your baby has fewer wet nappies than usual, seems unusually sleepy or has a sunken soft spot on their head. Don’t wait for a routine feeding appointment for these symptoms.

Contact your GP or NHS 111 today in the UK, or your doctor or urgent care service in the US and elsewhere, if breast symptoms get worse or you have a fever or feel unwell. Get help if things are no better within 12 to 24 hours of looking after yourself at home. A clinician may prescribe antibiotics if needed.

Book a feeding appointment if your nipples stay painful or cracked, or you’re worried about your supply. Tell the clinician if mastitis keeps coming back, as problems with attachment may play a part. Ask how to feed your baby while you’re sore.