Breast still hard after feeding

What is breast engorgement? | Engorged breasts

Some new mums experience breast engorgement when their milk starts ‘coming in’ a few days after the birth. It’s usually temporary and easily treated – read on to find out how

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Sioned Hilton, health visitor, neonatal nurse and lactation consultant:
Mum-of-three Sioned has been supporting families with babies and young children for more than 30 years. As well working with breastfeeding and expressing mothers, both in hospitals and the community, she contributes to parenting magazines and conferences, and delivers workshops for healthcare professionals.

When you first start breastfeeding your baby, your breasts produce colostrum in small amounts that gradually increase over the first few days. But after around two to four days they start making much larger quantities of milk – a change known as your breast milk ‘coming in’. ¹

One of the signs milk is coming in is your breasts become fuller and firmer. This swelling is not just caused by the greater quantity of milk, but also by increased blood flow and extra lymph fluids in your breast tissue.²

For most new mums, if their baby is feeding well and frequently, these feelings of heaviness pass without problems. But some produce almost more milk than their breasts can hold, which makes them feel rock hard and uncomfortably full – a condition called engorgement. While this is usually only temporary, the 24 to 48 hours it typically lasts for can be painful.

What do engorged breasts feel like?

Engorgement can happen in one or both breasts. It may cause throbbing and swelling, sometimes extending as far as your armpit, and could make your breasts feel fairly hot or lumpy – this is because of all the activity going on inside. You may notice other breast engorgement symptoms, including the skin of your breasts looking shiny and feeling stretched, and your nipples becoming hard and flat. Engorgement may even cause your body temperature to rise to around 37.5 to 38.3 °C (99 to 101 °F).³

As well as being painful, breast engorgement can cause breastfeeding difficulties – which can, in turn, worsen the problem. Your baby might struggle to latch if your nipples are flatter and your breast tissue is harder, which can cause sore nipples. In addition, if your baby’s latch is poor she’s less likely to drain the breast well. This means that, if left untreated, engorgement can lead to blocked ducts, mastitis and reduced milk production.

What causes breast engorgement?

Engorgement usually occurs because a baby is not feeding frequently enough (at least eight times every 24 hours). It can happen to any new mum, but is more common in women who’ve had previous breast augmentation or other breast surgery.² Pressure from a badly fitting bra or tight clothing can make the discomfort worse, and may lead to blocked ducts and possibly mastitis.

Breast engorgement can happen to women who don’t or can’t breastfeed, as well as those who do. The hormonal changes that follow delivery of the baby and placenta, which cause an increase in milk production, occur whether you breastfeed or not. Engorgement can also happen if you suddenly cut breastfeeds, perhaps because your baby is sick, sleeping longer, starting solids, or going into childcare.

How can I treat engorged breasts?

The most effective breast engorgement treatment is a hungry baby! You should try to empty your breasts as much and as often as possible to help keep milk flowing – so feed on demand, between eight and 12 times every 24 hours.

Keep your baby in skin-to-skin contact with your chest for as long as possible throughout the day, and when you’re awake at night. This way she can smell the tempting aroma of your milk, has easy access to your breasts, and you’re more likely to spot her early hunger cues so you can ensure she feeds frequently. Let her take as much milk as she wants from one breast before offering the other.

It’s also well worth getting your baby’s latch and positioning checked by a lactation consultant or breastfeeding specialist, to make sure she’s feeding effectively and draining your breasts properly. The tips below may also help relieve symptoms.

Tips for engorgement relief²

• Ensure you’re breastfeeding a minimum of eight times every 24 hours.
• Check that your baby has a good breastfeeding latch.
• Try breastfeeding in different positions.
• Massage your breasts gently while feeding to help the milk drain effectively.
• Express a little milk, either by hand or with a breast pump before breastfeeding to help soften your nipple so it’s easier to latch on to.
• If your breasts are still very firm and full after a feed, express again until you feel comfortable.
• If your baby is unable to breastfeed, replace the feeds with expressions. Pump your breasts until they feel much softer – a minimum of eight times every 24 hours.
• Try ‘reverse pressure softening’, a technique that can move excess fluid from the breast. A lactation consultant or breastfeeding specialist can show you how to do this.
• If your breasts are leaking milk, try a warm shower or applying a warm, wet flannel just before breastfeeding or expressing to soothe them and help milk flow. Don’t do this for more than a couple of minutes, as too much heat may worsen swelling.
• If your breasts aren’t leaking, apply a cold compress, chilled gel pad, or even frozen peas wrapped in a cloth, to your breasts for ten minutes after a feed to reduce swelling and relieve pain. 
• Tuck clean cabbage leaves inside your bra. Yes, really! Many mums find they help reduce swelling and discomfort, and there’s scientific evidence to back this up.⁴
• Take anti-inflammatory painkillers. Paracetamol and ibuprofen can be used while breastfeeding, although ibuprofen has contraindications for asthmatic mums. Always consult a healthcare professional and follow the manufacturer’s and pharmacist’s guidance. It’s generally best to avoid aspirin – for more on which medicines you can take while breastfeeding, read Breastfeeding while sick.
• Wear a properly fitted nursing bra and avoid underwires, or you may prefer not to wear a bra.
• Don’t skip feeds or stop breastfeeding suddenly as you could make the engorgement worse.

Seek medical advice if you develop a fever⁵ of around 38 °C (101°F) or above, or if your baby is unable to breastfeed because of the engorgement.

Finally, try to be patient. Your body is still getting used to making milk and feeding your baby. The engorgement should soon subside as you both get used to breastfeeding.

References

1 Pang WW, Hartmann PE. Initiation of human lactation: secretory differentiation and secretory activation. J Mammary Gland Biol Neoplasia. 2007;12(4):211-221.

2 Berens P, Brodribb W. ABM Clinical Protocol# 20: Engorgement, Revised 2016. Breastfeed Med. 2016;11(4):159-163.

3 Affronti M et al. Low-grade fever: how to distinguish organic from non-organic forms. Int J Clin Pract. 2010;64(3):316-321.

4 Boi B et al. The effectiveness of cabbage leaf application (treatment) on pain and hardness in breast engorgement and its effect on the duration of breastfeeding. JBI Libr Syst Rev. 2012;10(20):1185-1213.

5 NHS Choices. How do I take someone’s temperature? [Internet]. UK: NHS Choices; updated 2016 June 29. Available from: www.nhs.uk/chq/pages/1065.aspx?categoryid=72 

Breast pain and breastfeeding - NHS

There are a number of reasons why you may experience breast pain while you're breastfeeding.

Always ask for help from your midwife, health visitor or breastfeeding specialist if you're having problems breastfeeding.

Here's how to deal with some of the most common causes.

Breast engorgement

Breast engorgement is when, for whatever reason, your breasts become overly full. They may feel hard, tight and painful.

In the early days, engorgement can be due to your milk coming in. Newborns need feeding little and often. It can take a few days for your milk supply to match your baby's needs.

If your baby is not well attached to the breast, it may be hard for them to take your milk when your breast is engorged.

The nipple can become a little overstretched and flattened, and possibly painful.

Ask your midwife, health visitor or a breastfeeding specialist for advice immediately to help your baby relieve the engorgement and prevent it happening again.

Find out more about positioning and attachment

Engorgement can still happen once you have learnt the skill of positioning and attachment, usually when your baby has not fed for a while.

Your baby usually knows when they need a feed, for how long and from which breast.

Early signs (cues) that your baby is ready to feed can include:

• moving their eyes rapidly
• putting their fingers into their mouth
• rooting (turning to 1 side with their mouth open as if seeking the breast)
• becoming restless

Crying is the very last sign that your baby needs feeding. Feeding them before they cry often leads to a much calmer feed.

Keeping your baby close so you can watch and learn their early feeding cues will help.

How to ease breast engorgement

To ease the discomfort of engorgement, apart from your baby feeding, you could try expressing a little breast milk by hand. Only express enough to relieve the discomfort because expressing more will make you produce more milk.

Ask your midwife, health visitor or breastfeeding specialist to show you how.

Find out more about expressing breast milk

You may also find it helps to:

• wear a well-fitting breastfeeding bra that does not restrict your breasts
• put warm flannels on your breasts just before hand expressing if they're leaking
• take some paracetamol or ibuprofen at the recommended dose to ease the pain (these are safe to take while you're breastfeeding)

Too much breast milk

Occasionally women make too much breast milk and their babies struggle to cope.

It's best to get your midwife, health visitor or breastfeeding specialist to watch a feed to see if they can spot why this is happening.

They can also suggest ways to decrease your supply.

Blocked breast milk ducts

The milk-making glands in your breasts are divided up into segments, rather like an orange.

Narrow tubes called ducts carry the milk from each segment to your nipple.

If one of the segments is not drained properly during a feed (perhaps because your baby is not attached properly), this can lead to a blocked duct.

You may feel a small, tender lump in your breast.

Avoid wearing tight clothes or bras so your milk can flow freely from every part of your breast.

Other things that may help include:

• frequent feeding from the affected breast
• warm flannels or a warm shower to encourage the flow
• gently massaging the lump towards your nipple while your baby feeds

It's important to deal with a blocked duct quickly as, if left, it could lead to mastitis.

Mastitis 

Mastitis (inflammation in the breast) happens when a blocked duct is not relieved.

It makes the breast feel painful and inflamed, and can make you feel very unwell with flu-like symptoms.

If you do not deal with the early signs of mastitis, it can turn into an infection and you'll need to take antibiotics.

Symptoms of mastitis include:

• a breast that feels hot and tender
• a red patch of skin that's painful to touch
• a general feeling of illness, as if you have flu
• feeling achy, tired and tearful
• a high temperature

If you think you're developing a blocked duct or mastitis, try the following:

• Carry on breastfeeding.
• Check your baby's positioning and attachment. Ask your midwife, health visitor or a breastfeeding specialist to watch a feed.
• Let your baby feed on the tender breast first.
• If the affected breast still feels full after a feed, or your baby cannot feed for some reason, express your milk by hand.
• Warmth can help the milk flow, so a warm flannel, or a warm bath or shower, can help.
• Get as much rest as you can. Go to bed if you can.
• Take paracetamol or ibuprofen to relieve the pain.

Contact your GP or NHS 111 if you feel worse at any time, or if you're no better within 12 to 24 hours.

You may need antibiotics, which will be fine to take while breastfeeding.

Stopping breastfeeding will make your symptoms worse, and may lead to a breast abscess.

Breast abscess

If a mastitis infection is not treated, it can lead to a breast abscess, which may need an operation to drain it.

This can also develop if the mastitis does not respond to frequent feeding plus a course of antibiotics.

You can carry on breastfeeding after an abscess has been drained.

Find out more about breast abscesses

Thrush

If you experience pain in both breasts, often after a period of pain-free breastfeeding, and the pain lasts for up to an hour after a feed, you may have developed thrush.

Find out more about thrush and breastfeeding

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Chat to the Start4Life Breastfeeding Friend on Amazon Alexa, Facebook Messenger or Google Home for fast, friendly, trusted NHS advice any time, day or night.

What is breast swelling? | Breast swelling

Some mothers experience breast swelling when milk begins to flow in the first days after childbirth. Usually this phenomenon is temporary and easily eliminated. Read our article to find out how to help yourself.

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Sioned Hilton, health visitor, neonatal nurse and lactation consultant:
Schoned, a mother of three, has been supporting families with newborns and young children for over 30 years. She provides advice on breastfeeding and pumping, both in clinics and at home. In addition, Schoned writes articles for parenting magazines, attends conferences, and conducts seminars for attending physicians.

When you start breastfeeding, you first produce a small amount of colostrum, which gradually increases over the first few days. After about two to four days, production increases significantly. This phenomenon is called the "arrival" of milk. ¹

One of the signs that milk is starting to come in is a change in the breast - it fills up and becomes firmer. This is due not only to an increase in the amount of milk, but also to increased blood flow and additional lymphatic fluid to the breast tissues. ²

If the child eats well and often, then for most mothers this feeling of heaviness disappears over time without any complications. However, some women produce so much milk that their breasts fill up and become painful and very hard. This condition is called breast swelling. And although everything usually passes in a day or two, this period can be quite painful.

How does breast swelling manifest itself?

Swelling may affect one or both breasts. It can cause swelling, sometimes down to the armpits, and a throbbing sensation. The chest becomes quite hot, sometimes lumps are felt in it. All this is due to the fact that a huge number of processes take place inside. You may also notice other symptoms, such as the skin on your breasts becoming shiny and tight, and your nipples becoming hard and flat. Swelling of the mammary glands can even cause a temperature to rise to 37.5–38.3°C (99–101°F). ³

In addition to painful sensations, breast swelling is also dangerous because it can make breastfeeding difficult, and this, in turn, will worsen the situation even more. If the baby finds it difficult to latch on because the nipples have become flat and the breast tissue is firmer, nipples may become inflamed. In addition, in the event of a poor grip, he will not be able to completely empty the chest. Thus, if left untreated, swelling of the mammary glands can lead to blockage of the milk ducts, mastitis, and reduced milk production.

What causes breast swelling?

Usually breast swelling is due to the fact that the child does not feed often enough (less than eight times a day). In principle, this can happen to any mother, but women who have undergone various breast surgeries, including breast augmentation, are more prone to swelling of the mammary glands. ² Wearing a bra that is the wrong size or that is too tight can increase discomfort and lead to clogged milk ducts and even mastitis.

Breast swelling can occur in both breastfeeding mothers and mothers who are not or cannot breastfeed. The hormonal changes that occur after the birth of a baby and the release of the placenta and increase milk production are independent of whether you are breastfeeding or not. Swelling can also occur if the number of feedings is drastically reduced, for example, if the child becomes ill, sleeps longer, starts eating solid foods, or goes to nursery.

How to treat breast swelling?

The best cure for swollen breasts is a hungry baby! Try to empty your breasts as much and as often as possible to facilitate the release of milk. To do this, feed your baby on demand, preferably eight to twelve times a day.

Maintain skin-to-skin contact with your baby, cuddling as often as possible during the day and at night when you are awake. This will allow him to smell the attractive smell of your milk and have easy access to the breast, and you will be able to better monitor signs that he is hungry and, accordingly, feed more often. Let the baby eat enough from one breast before offering the second.

It's a good idea to see a lactation consultant or specialist to check if your baby is properly grasped and positioned. It depends on how well he will eat and empty his chest. The tips below will also help you relieve the symptoms of breast swelling.

Tips for relief of breast swelling ²

• Breastfeed at least eight times a day.
• Make sure your baby is latching on well.
• Try other feeding positions.
• Gently massage your breasts during feeding to improve the flow of milk.
• Express some milk by hand or with a breast pump before feeding to soften the nipple and make it easier for your baby to latch on.
• If your breasts are still firm and full after a feed, pump more until you feel better.
• If your baby cannot breastfeed, express milk for him. Pumping must be continued until the breast becomes softer, and do this at least eight times a day.
• Try the areola pressure softening technique. This helps to remove excess fluid from the breast. A lactation consultant or specialist will show you how to do this.
• If milk leaks, try taking warm showers or applying warm flannel to your breasts just before feeding or pumping to soften your breasts and make it easier for your milk to flow. You should not, however, warm the chest for more than two minutes, as this can only increase swelling.
• If your milk isn't leaking, try applying cold compresses, chilled gel pads, or even frozen green peas wrapped in a towel for ten minutes after feeding to reduce swelling and relieve pain.
• Put clean cabbage leaves in your bra. Yes Yes! For many moms, it really helps reduce swelling and discomfort, and there are scientific explanations for this. ⁴
• Take an anti-inflammatory pain reliever. While breastfeeding, you can take some medications, in consultation with your doctor. Always consult your doctor, follow the drug manufacturer's instructions and the pharmacist's recommendations. To learn more about medications and breastfeeding, read our article on breastfeeding when sick.
• Wear an appropriately sized and comfortable nursing bra, avoid underwire or no bra at all.
• Do not skip feedings or stop breastfeeding abruptly as this may increase breast swelling.

Seek medical advice if your ⁵ temperature rises above 38 °C or if your baby is unable to suckle due to breast swelling.

And in any case, try to remain calm. Your body is just getting used to producing milk and feeding your baby. Breast swelling should go away on its own soon after you both get comfortable with breastfeeding.

Literature

1 Pang WW, Hartmann PE. Initiation of human lactation: secretory differentiation and secretory activation. J Mammary Gland Biol Neoplasia. 2007;12(4):211-221. - Pang, W.W., Hartmann, P.I., "Lactation initiation in the lactating mother: secretory differentiation and secretory activation." G Mammary Gland Biol Neoplasia. 2007;12(4):211-221.

2 Berens P, Brodribb W. ABM Clinical Protocol# 20: Engorgement, Revised 2016. Breastfeed Med . 2016;11(4):159-163. - Behrens P, Brodrhibb W, "AVM Clinical Protocol #20: Engorgement, 2016 edition". Brestfeed Med (Breastfeeding Medicine). 2016;11(4):159-163.

3 Affronti M Low-grade fever: how to distinguish organic from non-organic forms. Int J Clin Pract. 2010;64(3):316-321. - Affronti M. et al., "Subfebrile temperature: how to distinguish organic from non-organic cases." Int Zh Klin Prakt. 2010;64(3):316-321.

4 Boi B et al. The effectiveness of cabbage leaf application (treatment) on pain and hardness in breast engorgement and its effect on the duration of breastfeeding. JBI Libr Syst Rev . 2012;10(20):1185-1213. - Boys B. et al., "Effectiveness of cabbage leaf (as a drug) for breast pain and engorgement, and its effect on the duration of breastfeeding." JBAi Libr Sist Rev. 2012;10(20):1185-1213.

5 NHS Choices. How do I take someone's temperature? [Internet]. UK: NHS Choices; updated 2016 June 29. Available from : www.nhs.uk/chq/pages/1065.aspx?categoryid=72 - NHS Choice. "How to measure the temperature?" [Internet]. United Kingdom: NHS Choice, 29 June 2016 edition Article linked: www.nhs.uk/chq/pages/1065.aspx?categoryid=72

Solving nine breastfeeding problems in the first month

Expert advice on solving major breastfeeding problems in the first month.

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Cathy Garbin, child health nurse, midwife and lactation consultant:
Cathy, a mother of two, was a research fellow at the renowned Human Lactation Research Institute, founded by Peter Hartmann, for seven years, providing support to breastfeeding mothers in clinics and at home. Today, she still works as a family counselor, and also conducts seminars for attending physicians and speaks at international conferences.

Breastfeeding is as much a skill as driving a car, and in the first month mother and baby may encounter some obstacles along the way. It takes time and experience to make it familiar to both of you. Solving breastfeeding problems in the first month helps to establish good milk production and increase the duration of breastfeeding in the future. Below you will find tips on how to overcome the main breastfeeding challenges that mothers often face from the end of the first week to the end of the first month after giving birth.

Problem #1. A painful lump appeared in the breast

Lumps and bumps in the breast of a nursing woman can appear for various reasons. One of the most common is blockage of the milk ducts, which results in a hard and painful lump that can become inflamed.

Solutions ^1–3

• Massage the inflamed area, especially while breastfeeding or expressing, to clear the blockage.
• Gently place warm flannel on your breast or take a warm shower before feeding to relieve discomfort.
• Continue breastfeeding as usual to avoid milk accumulation that can cause mastitis.
• Try to express milk from the inflamed breast after feeding to ensure that it is completely emptied. This will help to remove the blockage and restore the patency of the duct. See what breast pumps* Medela has to offer and choose the right one for you.
• Try ultrasound therapy. If you have repeated blocked ducts, your lactation consultant or healthcare professional may suggest this procedure to help restore milk flow. The procedure is performed by a physiotherapist.
• Call your healthcare provider, if you notice signs of infection (breast redness and tenderness or flu-like symptoms such as fever, aches, malaise and headache), or if you think the lump is not related to breastfeeding .

Problem #2. The breast is red and sore

If one or both mammary glands are red and sore, and this is not due to blockage of the ducts, mastitis, that is, inflammation of the breast tissue, is not excluded. Mastitis is characterized by redness, burning, and soreness of the breasts, combined with flu-like symptoms: You feel hot and cold, your joints ache, and your temperature rises above 38.5 °C (101.3 °F). Seek medical attention immediately if you experience these symptoms. Mastitis needs to be treated as soon as possible, as your condition can worsen in just a few hours. ³

Mastitis can be caused by the following causes:

• no treatment for blocked ducts,
• Bacteria entering the breast through cracked and damaged nipples,
• improper attachment of the child to the breast,
• long periods between feedings,
• breasts too full,
• wearing a bra that is too tight or that cuts into the skin,
• Abrupt weaning,
• excess milk.

Solutions ³
In addition to seeking medical attention:

• Continue to breastfeed or express milk frequently. Your milk is still safe for your baby. Its release will help eliminate blockage of the ducts and prevent painful accumulation of milk. Sudden cessation of feeding or pumping may exacerbate symptoms. After feeding, it is advisable to express any remaining milk.
• Give the child the inflamed breast first. This way the child can empty it completely. If it hurts too much, start feeding on the healthy breast, and when milk begins to flow, go back to the first one.
• Have a good rest, drink and eat. You need to get enough fluids and good nutrition.
• Massage the sore area under a warm shower or apply a warm flannel or warm pack to clear the blockage and relieve symptoms before breastfeeding or pumping.
• Apply a cooling pack after feeding, , to reduce inflammation.

Problem #3. My strength is running out

Breastfeeding in the first weeks can be very tiring and seem endless. The baby will ask for a breast every few hours, day and night, and you have not yet grown stronger after giving birth.

Solutions

• Take care of yourself. This may be easier said than done when you have a newborn in your arms, but still try to get as much rest as possible, eat healthy and regular meals, and drink plenty of water. Do not refuse the help of your partner, relatives and friends, or even hire an assistant if you can afford it.
• Feed lying down. This will allow you to relax and reduce stress on sore spots, stitches or c-section scars.
• Do not skip feedings. Your partner may offer to bottle feed your baby while you are resting. However, despite this temptation, it should be remembered that milk production is best established in the first four weeks through breastfeeding. When breastfeeding is well established, you can give your baby expressed milk, but before that, ask family or friends to help you with other things so you can fully focus on breastfeeding.

Problem #4. How can I increase breast milk production?

It's easy to question whether your breastmilk supply is adequate, especially when your baby has developmental spikes between the third and fourth weeks. It may seem to you that the child asks for breasts more often because he does not have enough milk. However, if the number of wet and soiled diapers doesn't change—see Breastfeeding: What to Expect in the First Month—the baby is likely to breastfeed more often to calm down. The baby is surrounded by many new sounds and images that are easy to get tired of, and at the breast he feels safe. ⁴

Solutions ^4.5

• Do not try to supplement your baby with formula, unless doctors are worried about weight gain or fluid loss. Continue breastfeeding your baby. This will help naturally increase breast milk production.
• Do not feed on a schedule. Feed your baby on demand. Thus, the production of breast milk will adapt to his needs.
• Use the breast pump, , to help increase breast milk production while continuing to breastfeed.

Problem #5. I have too much milk

Hyperlactation, or too much milk, can also be difficult for you and your baby. You may experience discomfort from swollen and leaking breasts, and your baby may have difficulty latch-on, choke on the milk flowing too fast, and be unable to empty the breast properly. ⁶

Solutions

• Express some breast milk at the start of a feed to reduce the force of the flush. Don't pump too much as this can aggravate the situation - pump only as much as needed to ease the discomfort. Try hand pumping or use a breast pump (check out the Medela* breast pump range and choose the right one for you).
• Use the towel or pad to soak up excess milk, or place the milk collection pad** on the other breast while you breastfeed first.
• The child must feel supported. Hold him firmly (this gives a sense of security) and in a comfortable position so that he can turn his head. Talk to the baby during the first rapid flush, then he will not be frightened by surprise and will not push the breast.
• Contact a lactation consultant or health care professional who will monitor you and suggest single-sided feedings or hourly breast changes (“breast duty”) to normalize your milk supply.
• Be patient . Problems with milk production usually go away after a few weeks.

Problem #6. I have different breasts!

You have noticed that the baby has a preference for one breast, or that one breast produces more milk than the other, and as a result, the mammary glands have acquired different sizes and shapes. This happens quite often and does not pose any problems for breastfeeding. If this does not bother you or your baby, you can leave everything as it is. If this makes you uncomfortable, try the following tricks.

Solutions

• Offer less demanded breasts first during feeding as babies usually suckle more vigorously at the beginning of a feed.
• Use the breast pump to increase breast milk production in the smaller breast.
• Don't give up on bigger breasts. Breastfeeding should continue with fuller breasts to avoid blocked ducts and mastitis.
• See a doctor. Sometimes an ear infection is the reason for a baby to latch on only one side. However, some positions may cause him discomfort, so try to keep the child more upright. In addition, a breast infection can change the taste of milk and cause milk to be rejected as well.

Problem #7. A blister has appeared on the nipple

With frequent feeding, sometimes painful friction occurs, and a blood bubble may appear on the breast,
nipple or areola. ⁷

Solutions

• Ask a lactation consultant or specialist to check the baby's latch on. A shallow grip can cause blistering of the nipples and areolas.
• Talk to your doctor about what medicine you can take to relieve pain if needed.
• Try other feeding positions to avoid pressure on the painful area.
• Lubricate inflammation with pure lanolin.
• Use Breast Pads** to avoid rubbing your blister with clothing and help it heal faster with air circulation, or try cooling hydrogel pads** to help relieve pain and promote healing.
• Try expressing milk. Using a breast pump can be an alternative way to get breast milk without bladder irritation. Choose the correct funnel size so that the nipple can move freely and the bubble does not rub against the walls of the tunnel.
• Do not pierce the vial as this may lead to infection.
• Seek medical attention, if the problem persists and causes you pain.

Problem #8. Painful white spot on nipple

When the opening of the milk duct is blocked by milk or a thin layer of skin grows over it, a small white or yellowish spot may appear on the tip of the nipple. For some, these blocked ducts, sometimes called milk vesicles or blisters, cause pinpoint pain, especially during feeding or pumping. Others do not experience any discomfort. White blisters may persist for several days or weeks until the skin breaks and hardened milk comes out. ⁸

Solutions

• Follow the tips above to solve friction bubble problems.
• Remove the blockage, if you see that the milk cork is starting to bulge. Try to squeeze it out very gently with clean nails.
• Continue breastfeeding or pumping, to clear the milk duct. If the milk duct clears during feeding, it will not harm the baby in any way.
• Apply hot wet flannel to the vial just before feeding or pumping. This will help open the blocked duct. You can also try rubbing the area quickly with a clean, damp cloth.
• Manually express some milk before feeding, trying to push out hardened milk clots. If this does not help, feed the baby or express milk as usual. Repeat several times a day.
• Soak a cotton swab with olive oil and place it in the bra, pressing it against the bubble nipple. This will help soften the skin.
• Seek medical attention, if problem persists. Your doctor may remove the plug with a sterile needle. This should be done immediately after feeding, when the bubble is as inflated as possible.

Issue #9. My nipples hurt while breastfeeding

At the start of breastfeeding, my nipples may become more tender, sore, and even inflamed, but this usually goes away after a few days. If your baby's latch is checked by a specialist and the inflammation persists or the nipples hurt with every feeding, you may need medical attention to resolve this problem. ^2.7

The following symptoms and signs that appear on one or both breasts during or after feeding may indicate a bacterial infection or thrush:

• burning, itching or moderate to severe pain in the nipples
• pain in nipples aggravated by contact with clothing,
• nipple pain persists despite attempts to attach baby differently,
• nipples hurt to touch,
• stitching, shooting, burning or deep aching pain,
• chest pain during feeding and almost an hour after,
• hot pink nipples,
• discoloration and texture of the areola (hot pink color, darkening, dryness or peeling),
• white rash on chest or areola.

Also check if your child has any of the following symptoms and signs:

• thick white patches or coating on the tongue
• white indelible spots on the cheeks,
• bright red spotted rash on buttocks not helped by diaper rash creams.

Solutions ⁷

• Seek medical attention. He will most likely suggest testing for infections to make a diagnosis. Bacterial and fungal (yeast) infections are treated differently, so appropriate treatment should be started as soon as possible. There are other reasons that can cause similar nipple pain, such as eczema, psoriasis or vasospasm (narrowing of the blood vessels) in the mother and problems with latch or tongue frenulum in the child. Therefore, it is very important to make an accurate diagnosis.
• Strict hygiene. Wash hands before and after feeding and applying any medication, and after changing diapers. Change bra pads regularly, wash bras, tank tops and towels in high temperature water, thoroughly wash breast cups and anything your baby puts in her mouth, such as nipples.
• Let the nipples dry after feeding, as all infections love a warm and humid environment.
• See your doctor again if there is no improvement after a few days. Do not let the problem run its course, otherwise the situation may worsen.

Materials on the topic. Breastfeeding: what to expect in the first month

Breastfeeding: what to expect after the first month

Breastfeeding problems after the first month

Literature

1 Academy of Breastfeeding Medicine Protocol Committee. ABM clinical protocol # 20: Engorgement. Breastfeed Med. 2009;4(2):111-113.- Breastfeeding Academy Protocol Committee, "AVM Clinical Protocol #20: Breast engorgement". Brestfeed Med (Breastfeeding Medicine). 2009;4(2):111-113.

2 Jacobs A et al. S3-guidelines for the treatment of inflammatory breast disease during the lactation period. Geburtshilfe and Frauenheilkunde . 2013;73(12):1202-1208. - Jacobs A. et al., "Recommendations S -3 for the treatment of inflammatory diseases of the breast during breastfeeding. Geburtskhilfe und Frauenheilkünde. ABM Clinical Protocol# 4: Mastitis , Revized 2014. Breastfe 9009 H., Academy of Breastfeeding Protocol Committee, AVM Clinical Protocol #4: Mastitis, March 2014 edition of Brestfeed Med (Breastfeeding Medicine). 2014;9(5):239-243.