Although there is some degree of tenderness of the nipple and breast associated with learning to breastfeed, it is abnormal to have consistent pain during a feeding. Many breastfeeding problems – including those attributed to “too much milk” or “not enough milk” – are resolved with more frequent nursing.

Plugged ducts happen when the milk duct has become inflamed because the milk is unable to flow through easily. The mother may notice redness, or feel a tender spot or a sore lump. It is important that the mother try and lie down for a while and nurse her baby. She should nurse frequently on the affected side. Changing a baby’s position (so that the baby’s nose or chin points directly towards the plugged duct) may also help. Nursing or expressing milk is the only way that the blockage will be cleared and that the milk will flow freely again.

The mother should be encouraged to apply heat by taking a warm shower, or applying a heating pad or hot water bottle. Gently massaging the area while it is still warm and then nursing her baby or hand expressing some milk immediately afterward will help to clear the blockage. The mother’s bra may be a cause of the problem. Changing the baby’s position may also help.

Mastitis happens when the plugged duct doesn’t clear and gets infected; however, it can occur without a plugged duct. Symptoms of mastitis include:

  • fever of greater than 100.6°F (38.1°C);
  • red/painful/swollen breast(s);
  • chills;
  • “flu-like” symptoms;
  • baby is unable to latch on to her breast; and
  • baby is not having enough wet and dirty diapers.

Example Case of Thrush

A 3 week old exclusively breastfed girl presents with white spots in her mouth. The mother has tried to wipe them away, but they are persistent. The mother too has been experiencing pain after breastfeeding, and has developed itchy and flaky nipples. She tried to ignore these symptoms, but lately her baby is more fussy than usual and is refusing to breastfeed. This example illustrates a common and painful problem that can appear during breastfeeding. The mother should talk to her doctor about medicine for her and the baby. She should take extra care to sanitize her baby’s toys and pacifier regularly.

It is perfectly safe for the mother to nurse her baby while experiencing mastitis. Antibodies in her milk will protect her baby from any infection and do not present a contraindication to nursing. Frequent nursing will help the infection clear up more quickly. Weaning from the infected side may make matters worse.

Persistent nipple pain in the early weeks of breastfeeding, or nipple pain that appears after several weeks or months of pain-free nursing, may be caused by thrush. Thrush is the term we use to describe an overgrowth of yeast. This yeast, called candida, normally lives within our mouth, intestines, and genital area. It thrives in moist, warm environments. Occasionally this yeast can overgrow. It is important to know that thrush is difficult to diagnose and sometimes misdiagnosed because other conditions may present similarly. Many cases of breast pain initially diagnosed as thrush end up being identified as bacterial infections and/or vasospasms. Additionally, Reynaud’s phenomenon, which affects up to 20% of women within childbearing age, is often mistaken for thrush and subsequently treated as such before an accurate diagnosis is made.36, 43

Additional symptoms of thrush can include:

  • itchy or burning nipples, even when not feeding baby;
  • nipples that appear pink or red, and puffy, dry, or flaky;
  • shooting pains in the breast during or after feedings;
  • intense nipple or breast pain that is not improved with better latch-on and positioning; and/or deep breast pain.

The infant may also present with white spots on the tongue, gums and/or inside lining of the mouth. Both mother and baby should be treated for thrush, even if baby is asymptomatic. After treatment for thrush begins, the symptoms may appear to get worse for a couple of days before improving. While the pain continues, the baby should be offered short, frequent feedings, beginning on the least painful side.