Breastfeeding problems and getting help

Pain that makes you dread the next feed is a reason to ask for help. Sore nipples often relate to how your baby is positioned and attached at the breast, and putting up with the pain can make things worse. A feeding specialist can help you work out what is happening.

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. Describe when the pain happens and what makes you stop a feed. Ask them to explain each adjustment and watch you try it, so you can practise during the appointment.

If your baby is struggling to attach, changing position may help. If you are worried about milk supply, ask for a feeding review. Your baby’s weight and growth are part of checking that they are getting enough milk.

Breast or nipple pain that does not 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, rather than trying to name the cause from the appearance 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 may 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 difficult.

A small, tender lump may be described as a blocked milk duct. Skipped or delayed feeds and pressure from tight clothing can contribute. Discuss a lump if it persists or feeding advice is not helping. Avoid assuming 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, including shivering or a fever. Redness can be harder to see on black or brown skin, so pay attention to pain, heat and how you feel too.

NHS advice is to continue breastfeeding in response to your baby. If feeding is too painful, hand expressing enough milk for your baby is an option. A cold compress may soothe the breast. Avoid firm pressure, tight clothing and expressing more milk than your baby needs. Do not stop breastfeeding suddenly.

Tongue-tie needs a feeding assessment

Tongue-tie is a shorter strip of tissue attaching the tongue to the floor of the mouth. Some babies feed without difficulty; for others, restricted tongue movement makes breastfeeding harder. Ask your feeding professional to assess what your baby can do during a feed before discussing treatment. How it looks alone cannot tell you what treatment is needed.

Ask about medicines while breastfeeding

Tell your pharmacist or doctor that you are breastfeeding before discussing medicines, including products bought without a prescription. Also mention if your baby was premature or had jaundice at birth. Small amounts of medicines may pass into milk, but very few medicines are unsafe during breastfeeding. Your pharmacist or doctor can advise about the medicine you take; do not 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 develop blue, pale or blotchy skin while unwell. Do not wait for home care to help with these symptoms.

Call 999 now (UK) or 911 (US), or your local emergency number, if your baby is difficult 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 drowsy or has a sunken soft spot on their head. Do not 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 worsen or you have a fever or feel unwell. Seek help if there is no improvement within 12 to 24 hours of home care. A clinician may prescribe antibiotics if needed.

Arrange a feeding appointment for continuing nipple pain, cracked nipples or concerns about supply. Tell the clinician if mastitis keeps coming back: attachment problems may contribute. Ask how to feed your baby while you are uncomfortable.