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Common Breastfeeding Challenges

Breastfeeding can be challenging, especially in the early days. This information can help you overcome common issues.

This information is part of Virtua’s Breastfeeding resources collection. Please see our Breastfeeding Support Resources page to view the entire series.

Breastfeeding can be challenging at times, especially in the early days. But it’s important to remember that you’re not alone. This information can help you overcome common issues. A Virtua lactation consultant also is an excellent resource to help you with ANY of these challenges.

Inverted, flat, or very large nipples

Some women have nipples that turn inward instead of protruding outward or are flat and don’t protrude. Nipples also can flatten temporarily due to engorgementor swelling while breastfeeding.

If you have inverted or flat nipples, it can sometimes make it harder to breastfeed. But remember that for breastfeeding to work, your baby has to latch on to both the nipple and the breast, so you can still successfully feed your baby. Often, flat and inverted nipples will protrude more over time as the baby sucks more.

If you have large nipples, it can make it harder for your baby to get enough of the areola into their mouth to compress the milk ducts.

What you can do:

  • Talk to your doctor or a lactation consultant if you’re concerned about your nipples.
  • You can use your fingers to try to pull out your nipples. You can also use a special device to pull out inverted or temporarily flattened nipples.
  • If you have large nipples, your baby’s latch will improve with time. In some cases, it might take several weeks to get the baby to latch well. But if you have a good milk supply, your baby will get enough milk even if they’re not latching on well yet.

Low milk supply

You’re probably making plenty of milk for your baby, but it’s understandable if you’re not sure. Checking your baby's weight and growth is the best way to ensure they get enough milk. Let your doctor know if you’re concerned.

There may be times when you think your supply is low, but it’s just fine:

  • When your baby is around 6 weeks to 2 months old, your breasts may no longer feel full. This is normal. At the same time, your baby may nurse for only five minutes per feeding. This can mean that you and baby are adjusting to the breastfeeding process—and getting good at it!
  • Growth spurts may cause your baby to want to nurse longer and more often. These growth spurts can happen around 2 to 3 weeks, 6 weeks, and 3 months of age—or any time. Don't be alarmed that your supply is too low to satisfy your baby. Follow your baby’s lead, nursing more often to help you build up your milk supply to meet your baby’s needs. Once your supply increases, you’ll likely be back to your usual routine.

What you can do:

  • Make sure your baby is latched on and positioned well.
  • Breastfeed often and let your baby decide when to end the feeding.
  • Offer both breasts at each feeding. Have your baby stay at the first breast if they’re still sucking and swallowing. Offer the second breast when the baby slows down or stops.
  • Avoid giving your baby formula or cereal, which can decrease your milk supply. Your baby doesn't need solid foods until they’re 6 months old. If you need to supplement your baby's feedings, try using a spoon, cup, or dropper.

Let your pediatrician know if you don’t think your baby’s getting enough milk.

Oversupply of milk

You may be concerned about having an oversupply of milk. An overfull breast can make feedings stressful and uncomfortable for you and your baby.

What you can do:

  • Breastfeed on one side for each feeding. Continue to offer that same side for at least two hours until the next full feeding, gradually increasing the length of time per feeding.
  • If the other breast feels unbearably full before you’re ready to breastfeed, express your breastmilk for a minute to relieve some pressure. You also can reduce discomfort or swelling by placing a cold compress or washcloth on your breast.
  • Feed your baby before they become overly hungry to prevent aggressive sucking.
  • Try positioning your baby in the side-lying or football hold position to prevent the force of gravity from helping with milk ejection.
  • Burp your baby frequently if they’re gassy. 

Some women have a strong milk ejection reflex or let-down. This can happen along with an oversupply of milk. If you have a rush of milk, try the following:

  • To reduce the force of your milk ejection, lightly compress your milk ducts by holding your nipple between your forefinger and middle finger or with the side of your hand.
  • If your baby chokes or sputters, unlatch them and let the excess milk spray into a towel or cloth.
  • Let your baby come on and off the breast at will.

Plugged milk duct

It’s common to experience a plugged milk duct when breastfeeding. A plugged milk duct feels like a tender, sore lump in your breast, usually occurring in one breast at a time.

A plug occurs when a milk duct doesn’t properly drain and becomes inflamed. Pressure builds up behind the plug, and the surrounding breast tissue becomes inflamed. 

What you can do:

  • Breastfeed about every two hours on the affected side. This helps loosen the plug and keeps your milk moving freely.
  • Massage the area to loosen the plug, starting behind the sore spot. Press your fingers in a circular motion toward the nipples.
  • Place a cold compress on the sore area.
  • Get extra sleep or relax with your feet up to help speed healing. A plugged duct often is a sign that you’re doing too much.
  • Wear a well-fitting, supportive bra that’s not too tight, as this can constrict your milk ducts. Consider wearing a bra without an underwire.

A plugged duct can lead to a breast infection if it doesn't loosen up. If needed, see a lactation consultant for help.

Breast infection (mastitis)

Mastitis is soreness or a lump in the breast that’s often accompanied by a fever and flu-like symptoms, such as fatigue and body aches. Some women also experience nausea and vomiting.

A breast infection can occur when other family members have a cold or the flu. If you have a breast infection, you may have a yellowish discharge from the nipple that looks like colostrum. Or, your breasts may feel warm or hot to the touch and appear pink or red. Often, it only occurs in one breast.

It’s challenging to distinguish between a breast infection and a plugged duct because both have similar symptoms. If you experience these symptoms and they don’t improve within 24 to 48 hours, see your primary care provider for treatment. 

What you can do:

  • Breastfeed on the affected side, as often as every two hours. This keeps your milk moving freely and your breast from becoming overly full.
  • Massage the area, starting behind the sore spot. Press your fingers in a circular motion toward the nipple.
  • Apply heat to the sore area with a warm compress. Ice may help to relieve swelling.
  • Get extra sleep or relax with your feet up to help speed healing.
  • Wear a well-fitting, supportive bra that’s not too tight, as this can constrict your milk ducts.

Call your health care provider if you follow these tips and don’t feel better within 24 to 48 hours. You may need treatment if you have a fever, or your symptoms worsen.

See your doctor right away if:

  •  You have a breast infection in which both breasts look affected.
  • There’s pus or blood in your milk.
  • You have red streaks near the sore area on your breast.
  • Your symptoms came on severely and suddenly.

Even if you’re taking medicine, continue to breastfeed during treatment. This is best for both you and your baby.