How to manage breastfeeding pain and issues

Breastfeeding may be biologically natural, but that doesn’t mean that it comes naturally to all women. It’s a learned skill, and sometimes problems (painful ones) can pop up along the way.

Even if things are going along smoothly now, it’s a good idea to ask your maternal and child health nurse and/or lactation consultant to check your baby’s latch and positioning. It could help you to avoid breastfeeding pain and issues later on.

How to manage breastfeeding pain and common issues

Here are some of the more common breastfeeding issues and causes of pain, plus some helpful tips for managing them. Recognising any problems as they emerge, and getting the necessary help and support, is the best way to avoid some of the more serious problems.

Sore and cracked nipples

Can be caused by poor attachment, poor-fitting or rigorous pumping equipment, an ill-fitting nursing bra, or one of the following conditions below, such as a yeast infection or mastitis.

Management and treatment

  • Hand-express some milk to soften the areola and lubricate the nipples before and after feeds.
  • Offer the less sore nipple first when your baby is showing hunger signs.
  • Wash breasts daily in the shower with warm water to avoid infection.
  • Use cooling and soothing compresses on sore nipples between feeds.
  • Contact a lactation consultant, or speak to an Australian Breastfeeding Association breastfeeding counsellor

Breast and nipple thrush

Can cause strong pain in the nipple and breast. The pain may be severe enough to lead a mother to wean early if it’s not treated. Read about the signs to look for oral thrush in newborns.

Management and treatment

  • Breast or nipple thrush is treated with antifungal tablets or creams. You’ll also need to treat any fungal infections in the rest of the family. Thrush in your baby’s mouth is treated using an oral gel or drops.
  • Keep your nipples dry by frequently changing breast pads.
  • Clean teats and dummies regularly, and boil for 5 minutes.
  • Wash your hands thoroughly after nappy changes to prevent spreading the infection.
  • Wash towels, bras, breast pads etc in hot soapy water, and line dry if possible.

Nipple vasospasm

Cccurs when blood vessels constrict (or tighten). It can be very painful and is usually worse when it’s cold. Read more about it here.

Management and treatment

  • Avoid or reduce exposure to poor attachment (seek support from a lactation consultant), nipple damage or infection, exposing your nipples to cold air.
  • Try to keep your nipples warm (a warm pack or ‘breast warmers’ can help), wear an extra layer of clothing, and warm your bathroom before undressing for showers.
  • If pain continues, you might consider taking supplements or medication (on advice from your healthcare professional), such as fish oil capsules, magnesium tablets, or prescription medication.

Mastitis

An inflammation of the breast that can lead to infection. It can feel like you have the flu, and you may feel hot and have body aches and pains. Read more on what it is here.

Management and treatment

  • Continue to breastfeed or express from the affected breast.
  • Placing a warm pack or cloth on the sore area before feeding can help with any issues with milk flow.
  • Gently massage any lumps towards the nipple when feeding or expressing, or in the bath or shower.
  • A cool pack on the breasts after feeds may help to reduce the discomfort.
  • Drink plenty of water throughout the day.
  • Rest as much as possible.
  • If you don’t feel better after a few hours, speak to your GP or other healthcare professional immediately. They might suggest paracetamol or ibuprofen for the pain, which are safe to take while breastfeeding. They might also prescribe you antibiotics.

Flat or inverted nipples

May make it difficult for your baby to attach to your breast.

Management and treatment

  • It’s still possible to breastfeed using nipple shields. Nipple shields are thin silicone covers that can be placed over the nipples.
  • Nipple shields should not be used until milk is in and flowing well. They also shouldn’t be used when nipples are damaged or breasts are engorged.
  • See your breastfeeding counsellor or lactation consultant to ensure that you’re using the right size and using them correctly.
  • It’s recommended that baby eventually feeds directly from the breast after a week or two. Again, seek support from a lactation consultant to wean from the nipple shield.

Low milk supply

When not enough breast milk is being produced to meet your baby’s growth needs.

Management and treatment

  • A low milk supply is generally a temporary situation and can be improved with appropriate support from your lactation consultant or MCHN.
  • Practice regular Kangaroo Care.
  • Breastfeed frequently, two to three hourly (you may need to wake your baby for some feeds).
  • Ask your lactation consultant to check your baby’s attachment, and that they’re sucking and swallowing.
  • Express after breastfeeds to provide further stimulation to your breasts, and to ensure they’re well drained.
  • Here are some more tips for increasing your supply plus what affects supply.

Tongue-tie

A condition in which a thin piece of skin under the baby’s tongue (the lingual frenulum) is abnormally short and may restrict the movement of the tongue, making breastfeeding difficult. It occurs in about 3% of babies, and can run in families.

Management and treatment

  • Read our article, Tongue-tie – Your Questions Answered for more details.
  • A tongue-tie is assessed by a lactation consultant or experienced clinician, who will determine if a release is required.
  • If the frenulum is thin and your baby is under 4 months, the tongue-tie can be released as an outpatient procedure without any anesthesia. It’s released with a small pair of sterile scissors.
  • If you have any concerns about the procedure, speak to your lactation consultant, MCHN, paediatrician, or GP.

Engorgement

When a mother’s breasts become hard, swollen, or tender, and her nipples may become taut and flattened. It’s caused by a build-up of milk, blood, and other fluids in the breast tissue.

Management and treatment

  • Take your bra off completely before breastfeeds, and gently massage your breasts or use warmth for a few minutes to help trigger your let-down reflex.
  • If your baby has trouble attaching to the breast, you may need to express some milk (by hand or pump) first.
  • Massage your breasts gently while you breastfeed, and feed your baby frequently.
  • You may need to express after feeds for comfort.
  • Using a cooling compress, cold packs or cool cloths after a feed can reduce inflammation.
  • Ask your healthcare professional about taking anti-inflammatory medication or pain relief if necessary.
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