Common Breastfeeding Complications
Common breastfeeding issues
Clogged/plugged ducts
- Breastmilk flows through a series of "pipes" called milk ducts inside your breasts and then out through pores in your nipples. Clogged ducts are just a blockage in these "pipes" which can cause hard lumps or nodules to form in a localized area of your breast.
- These can be painful and give you an achy sensation
- Usually do not cause a fever
- Most times unilateral, or only on one side
- Can lead to mastitis if no intervention, so contact IBCLC to be sure you have the correct treatment plan
- Typically can be resolved by
- Breastfeeding or pumping frequently, especially on affected breast
- Massage breast during feeding/pumping toward the nipple
- Warm compresses, warm gel packs, shower, etc.
- Sunflower lecithin - a supplement that helps make milk less "sticky" and can help prevent reoccurrence
- You can also use warm water with epsom salt in a haakaa with suction to gently pull the clog out
- Click here for a step-by-step guide on how to do this
Mastitis
- Mastitis is an infection in the breast tissue. It causes flu like symptoms (fever >101, chills, aches), along with localized pain, swelling and redness in the breast.
- May notice decreased milk supply or a fussy baby on the breast
- Contact your OBGYN if you suspect mastitis, as it MUST be treated with antibiotics.
- Other ways to help treat mastitis at home include:
- Expressing milk or breastfeeding about every two hours on the affected side
- It is safe to give your infant breastmilk when you have mastitis- you cannot pass a breast infection to your infant via the breastmilk
- Use NSAIDs for pain/fever management
- Use warm, moist compresses on the affected breast, warm showers and breast massage
- Wash hands often
- Rest and drink plenty of fluids
- Wear a supportive, but not tight/restrictive bra
- Expressing milk or breastfeeding about every two hours on the affected side
Fungal Infection (Thrush)
- New onset severe nipple pain while breastfeeding after previously breastfeeding without discomfort
- Typically described as itching, burning, shooting, stabbing pain that extends back to the chest wall
- Breasts can look shiny, inflamed, irritated, or even get small blisters
- Baby may also have symptoms such as thick, white spots or patches on their tongue, inner cheeks and upper palate, or a red, spotted, "angry" looking diaper rash.
- Contact IBCLC if you suspect a fungal infection because they can prescribe a treatment for you and baby.
- In the meantime, air dry the nipples as much as possible. Yeast thrives in a warm, moist environment.
- If you're using breast pads because of leakage, make sure you change them immediately once they become wet
- Wear 100% cotton bras and underwear that "breathe" and can be washed frequently
Nipple Vasospasm
- Caused by constriction in the arterioles of the breast which limits blood flow to the nipple causing intermittent, but severe pain and discoloration of the nipples
- This can feel like a deep shooting or stinging pain and typically occurs after baby comes off the breast
- Will notice a discoloration of the tip of the nipple - starts as white (blanching), then progresses to a deep purple/blue, then back to normal.
- To combat this, make sure that you have a warm towel or heat pack ready so that you can apply that to your breast immediately after baby un-latches from the breast
- You don't want the cold air to touch your nipples and make the constriction of blood worse
- Avoid cold temperatures in general
- Have warm towels ready for after showers
- Sometimes may need a prescription medication to help dilate the blood vessels
- Always contact IBCLC if you suspect this, because it can feel similar to a fungal infection
Milk Bleb/Blister
- These can occur on the nipple itself or on the areola, and are typically caused by plugged ducts.
- It happens when skin forms over the pores of the nipple which doesn't allow for milk to flow out as it normally should.
- You'll want to treat it similarly to a plugged duct by applying warm, moist compresses to the affected nipple, warm saline soaks, and extra pumping to help pull the milk through the thin layer of skin.
- Also try exfoliation with a dry or rough washcloth, a loofah or other material that can help rub that thin layer of skin off so the milk can flow.
- If these strategies don't work, the last resort is popping or lancing the bleb with a sterile needle. This can be done at home or with the help of an IBCLC or other trained professional.
- Click here for a nice article on how to treat these at home
Oversupply / Overproduction
- Sometimes your breasts will produce more milk than your baby needs.
- Mom's symptoms may include:
- Frequent clogged milk ducts or mastitis, pumping >2 oz per hour in addition to breastfeeding, excessive leakage of milk, painful fullness of breasts even after breastfeeding.
- Baby's symptoms may include:
- Gagging or choking frequently during feedings, requiring them to unlatch
- Spray of milk coming from breasts whenever baby pulls off
- Frequent spit up, or reflux-like symptoms
- Gassy, fussy, restless at the breast, or having explosive green, frothy stools (although we don't recommend basing too much on baby's poop!)
- You can try to manage this supply issue by fully emptying the breasts once a day using a double pump, then restricting breastfeeding at one breast for a set number of feedings or a set amount of hours (aka- "block feeding").
- Empty breasts = signal to the body to make more milk. Full breasts = NO signal to make more milk
- For example: fully empty breasts by pumping both breasts once in the morning. Then offer ONLY left breast for 2 feedings in a row (or 4 hours), then switch and ONLY offer right breast for the following 2 feedings in a row.
- You can increase the time/feeding interval as needed based on severity of oversupply, but do not exceed 12 hour blocks.
- Try not to pump the other breast unless it's extremely painful
- If you need to pump, express just enough to reduce the pain (typically 15-30 ml.
- Milk stasis in the breast can lead to plugged ducts or mastitis, so always contact IBCLC with questions or concerns about supply.
Nipple Pain
- There are a number of reasons for nipple pain so it's always helpful to speak with an IBCLC if you're experiencing symptoms.
- It is important to note that nipple tenderness without any trauma to the nipple (cracks, blisters, bleeding) is normal in the first week of breastfeeding.
- Nipples will toughen up naturally over time.
- If you're having nipple soreness, there's a few things you can do at home to try and help
- Try to change baby's position or switch your hold during a feeding
- Saline nipple soaks - dissolve 1 tsp of table salt in 8 oz of warm water in a bowl, then "dip the nip" for a few minutes in the salt water.
- Use a balm like lanolin or motherlove nipple cream after nursing.
- Can also hand express a little breastmilk and rub it on the nipple and let it air dry after a feeding to help with soreness.