Common Lactation Problems from A-Z: Cause, Prevention and Treatment

baby breastfeeding
  • Blebs: Also known as “Milk Blisters”: The most common cause of this issue is that baby is compressing the nipple (biting it with his/her gums) when latched. A milk duct at the tip of the nipple becomes kinked or blocked impeding milk to flow out. The milk somehow dries in the duct and skin grows over the dried, congealed milk fragment. As you try to nurse, more milk becomes back up which then becomes a chain of blockages along the length of the duct (almost like a piece of string cheese). This can be very painful at the tip of the nipple as the baby latches and suckles. It can also cause the same pain as plugged ducts and can lead to mastitis.  Treatment: Warm compresses for ten minutes to the tip of the nipple and a little warmed olive oil can help loosen the skin that has formed over the blocked nipple opening. Then latch the baby properly and/or pump that breast with a breast pump to try to remove the blockage. It is very important that the baby doesn’t continue to compress the nipple or the problem will persist.

  • Engorgement: Please read my article on engorgementReminders regarding treatment: Use Heat (before feed), then Ice (after feed). Hand express, pump, massage, and Reverse Pressure Softening. Add ibuprofen to help take the edge off of engorgement pain. 

  • Growth Spurts: Growth spurts occur frequently throughout your child’s life. Remember when you were a teenager and growing in epic proportions? Well, you probably found yourself at the refrigerator or pantry quite a bit during those times. Your baby will do the same. Trying to double his/her birth weight by six months and triple his/her weight by one year, you’ll feel, at times, that your baby is feeding constantly. The baby will display this behavior at these typical ages: 2-3 weeks, 6-8 weeks, 3 months, possibly 4 months, and 6 months. After you introduce solids at around 6 months old, you aren’t the only “pantry” baby feeds from, thus growth spurts become more manageable. 
    Treatment: Feed on Demand. A bottle will only derail what your baby is trying to accomplish; which is making your milk supply increase to his/her growing need. Skin to Skin with your baby. Have a baby-moon. Get in bed and let others take care of you if you have that luxury.

  • Plugged Ducts: The bleb is only one reason you may get plugged ducts. Other causes to plugged or blocked ducts are ill-fitting (too small/tight) bras, always sleeping on one side, holding your breast too hard when feeding. 
    Treatment: Massage the blockage toward the nipple then apply warm or hot compresses- or vice versa. Massage your breasts while in a hot/warm shower or bath. Drain your breasts by feeding or pumping- or both- in order to fully empty the breast. Make sure you are wearing a properly fitted nursing bra. Read our guide to Proper Nursing Bra Fit. You can also email if you have any questions about nursing bras and sizing.

  • Nipple Vasospasms: When baby is constantly compressing the nipple, he/she may be cutting the circulation off to the nipple tip due to compression of the capillaries. This is also known as Raynaud’s Phenomenon for people who have a common circulatory condition (most people know about it when their toes and finger tips have this burning sensation when it gets too cold) and the baby may be latching well without nipple compression. As baby lets go of the nipple, after the feeding, exposing your nipple to the cold air, you may notice your nipples turning, red, bluish-purple, and/or white (blanched). Then, after the feeding, your nipples begin to burn. It’s a cold burn like when you’re holding a piece of ice and it becomes uncomfortable. This is commonly misdiagnosed as Thrush because the burning sensation is similar, but unlike thrush, which is uncomfortable at all times, nipple vasospasms only burn AFTER the feed. This burning sensation can last up to 1 hour after the feed. 
    Treatment: Have a heating pad near you after the feed put the heating pad on until the saliva from your baby’s mouth dries. The cause of the capillaries constricting is because of the colder air hitting a wet, warm nipple (baby’s mouth is 86 degrees F), this is why the nipple will eventually turn white. Also, wool breast pads or a blanket can help warm the nipples before they get too shocked by the cold air. For some moms, they have to take a medication called Nifedipine (talk to your physician about this option) because warming techniques don’t help. Nifedipine is a calcium-channel blocker that is used with some heart patients. A homeopathic way of managing this is by taking 2000mg of magnesium and 1000mg of calcium. Primrose Oil applied to the nipple can also help, but please make sure to wipe it off prior to the feeding!

  • Mastitis: A blocked duct left untreated can lead to a breast infection called mastitis. It is usually bacterial (Staph bacteria is commonly to blame.) Another cause to mastitis is handling cracked nipples with unwashed hands. Applying salves to the nipple before washing your hands could lead to an entry for germs to cause mastitis when the skin tissue is already broken down. Common signs that indicate mastitis are: presence of a blocked duct, fever, chills, flu-like symptoms without a sore-throat or cough. Red area on the breast. Extremely hot to the touch at the site of the infection. Can even lead to an abscess.  
    Treatment: As with a plugged duct, Massage, Drain Breast, and Rest! Rx from Dr: You will most likely need a prescription for an antibiotic. The best antibiotic is one that is strong enough to kill Staph bacteria

  • Tender Nipples/Sore Nipples: applying breast milk, lanolin based creams or salves or nipple shields help sore nipples, however, the key to long-term relief from nipple soreness is a proper latch. Please read our article on Sore Nipples and/or seek the help of a board certified lactation consultant.

  • Thrush: This is a yeast infection of the nipple, and the baby’s mouth may also be affected. In mom, symptoms will appear as itchy, burning nipples- it’s the same itch and burn as that of a vaginal yeast infection. The skin surrounding the nipple may look flaky or scaly, like snake or lizard skin. Thrush can make the areola pink or reddish. And, it will be a persistent discomfort: upon the initial latch, during the feed, and afterward the feed.  In baby, his/her mouth will have cottony-white patches on the tongue that won’t rub off with a wet baby washcloth. It may even become red and angry when you attempt to rub it off. 
    Treatment: Keep the breasts dry. Yeast loves a moist and dark environment, and that’s exactly what a lactating breast is! A good tip is to blow-dry your breasts on a low setting after feedings and showers. Expose breasts to sun if possible, or take a trip to a tanning booth if you haven’t got a private place to sun your breasts. UV rays kill yeast, making it difficult for the Thrush to survive. Take live acidophilus or live probiotics to get your internal yeast in control. Rx from Dr: Nystatin, Diflucan. Treat Mom & Baby! Baby will probably need to have his/her mouth swabbed with oral Nystatin. Make sure to get all areas of the mouth, not just the area where you see the cotton patches.

 Written for Nursing Bra Express by Veronica Tingzon, IBCLC