Breastfeeding Problems: Causes, Solutions & When to Get Help

What Causes Breastfeeding Problems?

The most common cause of breastfeeding problems is incorrect latch, where the baby doesn't attach deeply enough to the breast. Other causes include tongue-tie in the baby, flat or inverted nipples, engorgement, and insufficient milk removal. Understanding the root cause is essential for finding the right solution.

Breastfeeding is a learned skill for both mother and baby, and it's completely normal to experience challenges in the beginning. Research shows that up to 92% of new mothers encounter at least one breastfeeding problem in the first week postpartum. However, this high rate of problems doesn't mean breastfeeding is inherently difficult—it means that most mothers need some guidance and support to get started successfully.

The fundamental mechanism of breastfeeding involves the baby drawing the nipple and a significant portion of the areola deep into their mouth. When this happens correctly, the baby's tongue creates a wave-like motion that compresses the breast tissue against the roof of their mouth, effectively extracting milk. When this mechanism is disrupted—whether by positioning issues, anatomical variations, or the baby's feeding technique—problems arise.

Understanding the underlying cause of your specific problem is crucial because different issues require different solutions. For example, sore nipples from a shallow latch need positioning correction, while sore nipples from a yeast infection need antifungal treatment. A healthcare provider or lactation consultant can help identify the root cause and recommend appropriate interventions.

Incorrect Latch

By far the most common cause of breastfeeding problems is an incorrect or "shallow" latch. When a baby latches only onto the nipple rather than taking in a large mouthful of breast tissue, several problems occur simultaneously. The nipple is compressed against the hard palate instead of reaching the soft palate, causing friction and damage. Milk removal is inefficient, leading to supply concerns and potential engorgement. The baby may become frustrated and feed for extended periods without getting enough milk.

Signs of a shallow latch include pain during nursing (especially pain that continues throughout the feed rather than improving after the first minute), clicking sounds while feeding, visible nipple damage such as cracking or bleeding, and a baby who seems unsatisfied despite long feeding sessions. When you look at your nipple after a feed, if it appears creased, flattened, or looks like a new lipstick that has been slanted, this indicates the latch wasn't deep enough.

Anatomical Factors

Sometimes anatomical variations in either the mother or baby can contribute to breastfeeding difficulties. Flat or inverted nipples can make it harder for the baby to latch initially, though with patience and proper technique, most mothers with these variations can breastfeed successfully. Nipple shields may be helpful as a temporary tool while the baby learns to latch.

In babies, tongue-tie (ankyloglossia) is a common anatomical issue where the tissue connecting the tongue to the floor of the mouth is too short or tight. This restricts the tongue's movement and can prevent effective milk removal. Symptoms include painful nursing despite good positioning, a baby who tires quickly at the breast, slow weight gain, and the mother hearing clicking sounds during feeds. A healthcare provider can assess for tongue-tie and, if significant, a simple procedure called frenotomy can release the restriction.

Why Do My Nipples Hurt When Breastfeeding?

Sore nipples during breastfeeding are usually caused by shallow latch, where the baby isn't taking enough breast tissue into their mouth. Other causes include thrush (yeast infection), bacterial infection, eczema, or nipple vasospasm. While mild discomfort in the first 1-2 weeks may be normal, persistent or severe pain always indicates a problem that can be resolved.

Nipple pain is the most frequently reported breastfeeding problem, affecting 80-90% of mothers to some degree. However, there's an important distinction between normal initial sensitivity and problematic pain. In the first week or two, some mothers experience mild discomfort at the beginning of feeds that quickly improves as the feed progresses—this can be part of the normal adjustment period. In contrast, pain that is severe, persists throughout the feed, or worsens over time is not normal and indicates an issue that needs addressing.

The most common cause of nipple pain is incorrect latch. When a baby doesn't open wide enough or isn't brought to the breast quickly when their mouth is open, they end up with just the nipple in their mouth instead of a good portion of the areola. This creates friction against the sensitive nipple tissue rather than the compression of breast tissue that should occur. The damage can progress from redness and tenderness to cracking, bleeding, and even blistering if not corrected.

Beyond latch issues, several other conditions can cause nipple pain. Thrush (a yeast infection caused by Candida) often causes burning, itching pain that continues between feeds. The nipples may appear pink or shiny, and the baby may have white patches in their mouth. Bacterial infections can occur when damaged nipples become infected, causing increasing pain, redness, and sometimes discharge. Nipple vasospasm, where blood vessels in the nipple constrict, causes blanching of the nipple followed by color changes (white to blue to red) and burning or throbbing pain, often triggered by cold or the end of a feed.

How to Heal Sore Nipples

The most important step in healing sore nipples is correcting the underlying cause—in most cases, this means improving the latch. Working with a lactation consultant to assess and correct positioning can make a dramatic difference, often providing relief within just a few feeds. Key principles include ensuring the baby's mouth is open very wide before bringing them to the breast, aiming the nipple toward the roof of their mouth, and ensuring more areola is visible above the baby's upper lip than below the lower lip.

While working on latch correction, several comfort measures can help the healing process. Letting nipples air dry after feeds allows natural healing and prevents moisture from causing further damage. Applying a small amount of expressed breast milk to the nipples after feeding takes advantage of breast milk's natural antibacterial and healing properties. Purified lanolin cream can create a moist wound healing environment that promotes faster recovery without needing to be wiped off before the next feed.

If pain is severe, you may need to temporarily modify your feeding approach. Starting feeds on the less sore side (since babies tend to suck more vigorously at the beginning when hungrier), using different breastfeeding positions to change the angle of pressure on the nipple, or briefly pumping and bottle-feeding while the most damaged tissue heals are all reasonable options. The goal is to maintain your milk supply while giving your nipples time to recover.

What Is Breast Engorgement and How Can I Relieve It?

Breast engorgement is swelling and hardening of the breasts caused by increased blood flow and milk production, typically peaking 3-5 days after birth when milk "comes in." Relief comes from frequent feeding or pumping, warm compresses before feeding, cold compresses after, gentle massage, and ensuring effective milk removal. Severe engorgement can make latching difficult, but expressing a small amount of milk first can soften the areola.

Breast engorgement is a common and usually temporary condition that occurs when the breasts become overly full with milk, fluid, and increased blood flow. For most mothers, this happens around days 3-5 postpartum as the mature milk "comes in" to replace the colostrum produced in the first days. The breasts can become swollen, hard, warm, and painful—sometimes dramatically so. In severe cases, the entire breast can feel like a rock, the skin may appear shiny and tight, and the swelling can extend into the armpits.

Understanding why engorgement happens helps in managing it effectively. After birth, hormonal changes trigger a significant increase in milk production. Simultaneously, blood flow to the breasts increases and the tissues swell with extra fluid. If milk isn't removed frequently enough during this transition period, the combination of excess milk and fluid buildup leads to engorgement. The key to both preventing and treating engorgement is frequent, effective milk removal.

Engorgement that isn't addressed can create a problematic cycle: the swollen areola becomes too firm for the baby to latch properly, which means milk isn't removed effectively, which worsens the engorgement. This is why it's so important to address engorgement promptly and thoroughly. Additionally, prolonged engorgement can lead to blocked milk ducts or mastitis, and if milk production isn't adequately stimulated during this critical period, it may affect long-term supply.

Relieving Engorgement

The primary treatment for engorgement is to remove milk frequently and effectively. Breastfeed your baby 8-12 times per 24 hours, ensuring they're latching well and actively swallowing. If your baby is struggling to latch due to breast firmness, hand express or pump just enough milk to soften the areola first—this is called "reverse pressure softening." Press your fingertips around the base of the areola for about a minute before attempting to latch.

Warm compresses or a warm shower before feeding can help milk flow more easily and provide some comfort. Gentle breast massage, stroking from the outer breast toward the nipple, can help move milk and fluid toward the nipple during and between feeds. However, be careful not to massage too aggressively, as this can worsen inflammation.

After feeding, cold compresses can reduce swelling and provide pain relief. Some mothers find that chilled cabbage leaves placed inside the bra are particularly soothing—while the evidence for any specific benefit of cabbage is limited, the cold and the shape of the leaves do provide comfort. Anti-inflammatory medications like ibuprofen can help with both pain and swelling and are generally safe while breastfeeding.

What Causes Blocked Milk Ducts?

Blocked milk ducts occur when milk backs up and forms a plug, usually due to incomplete breast emptying, pressure on the breast (from tight bras or sleeping positions), or infrequent feeding. Symptoms include a painful, tender lump in the breast that may feel warm. Treatment involves frequent nursing on the affected side, warm compresses, massage toward the nipple, and ensuring complete breast emptying.

A blocked or plugged milk duct occurs when milk flow in one area of the breast becomes obstructed, causing milk to back up and form a tender lump. The blockage might be caused by thickened milk, inflammation in the duct, or external pressure on the duct. Whatever the initial cause, the result is the same: milk can't flow freely, and the backed-up milk causes localized pain, swelling, and often a palpable lump.

Several factors increase the risk of developing blocked ducts. Inconsistent feeding schedules, going longer than usual between feeds or pumping sessions, can allow milk to accumulate. Pressure on the breast from tight bras, underwire bras, ill-fitting nursing bras, sleeping on your stomach, or a baby carrier strap can compress ducts and impede flow. Incomplete breast emptying—whether from a baby who doesn't finish feeds, poor latch, or rushing through pumping sessions—leaves milk in the breast that can become problematic. Stress, fatigue, and general immune suppression can also contribute.

Recognizing a blocked duct early is important because prompt treatment can prevent progression to mastitis. Symptoms typically include a localized area of tenderness, often with a palpable lump that feels like a firm marble or pea under the skin. The overlying skin may appear red or pink. Unlike mastitis, blocked ducts typically don't cause fever or flu-like symptoms—if you develop these, the blockage may have progressed to an infection.

Clearing a Blocked Duct

The goal of treating a blocked duct is to move the backed-up milk out of the affected area. The most effective approach combines heat, massage, and frequent nursing or pumping. Before feeding, apply a warm compress to the affected area for 10-15 minutes. This helps the milk become more liquid and encourages flow. Some mothers find that taking a warm shower and letting water run over the affected area while gently massaging is particularly effective.

When nursing or pumping, start on the affected side while milk is flowing well and the baby is hungry. Position your baby (or the pump flange) so that their chin or the suction is directed toward the blocked area—different breastfeeding positions can help accomplish this. During the feed, use gentle massage on the lump, stroking firmly but not painfully toward the nipple. The goal is to help push the milk plug out.

Continue to nurse frequently on the affected side until the lump resolves. Most blocked ducts clear within 24-48 hours with consistent treatment. If a blockage doesn't resolve within this timeframe, or if you develop fever, increasing redness, or feel unwell, contact your healthcare provider as these may indicate the development of mastitis.

What Is Mastitis and How Is It Treated?

Mastitis is inflammation of breast tissue, often involving bacterial infection, causing intense pain, redness, swelling, and flu-like symptoms including fever and body aches. Treatment involves continuing to breastfeed or pump frequently, rest, pain relievers like ibuprofen, plenty of fluids, and antibiotics if symptoms don't improve within 12-24 hours or are severe. It is safe and important to continue breastfeeding with mastitis.

Mastitis is a potentially serious condition that occurs when breast tissue becomes inflamed, often (but not always) involving a bacterial infection. It typically develops when milk stasis—milk staying in the breast too long—leads to inflammation. Bacteria can then enter through cracked nipples or simply multiply in the stagnant milk. The result is an acute inflammatory response that can make you feel quite ill.

Mastitis affects 10-33% of breastfeeding women, most commonly in the first six weeks postpartum, though it can occur at any time during lactation. Risk factors include a history of mastitis, cracked or damaged nipples (which provide an entry point for bacteria), incomplete breast emptying, engorgement, blocked ducts, fatigue, and stress. The condition often seems to strike when mothers are already depleted—during growth spurts when babies feed irregularly, during holidays when routines are disrupted, or when mothers return to work and pumping schedules change.

Symptoms typically develop rapidly and include a painful, red, warm area on the breast that may look wedge-shaped radiating from the nipple. Flu-like symptoms are characteristic: fever (often 38.5°C/101°F or higher), chills, body aches, fatigue, and general malaise. Many mothers describe feeling like they've been "hit by a truck." The onset is often sudden—you may feel fine one moment and then develop a high fever within hours.

Treatment for Mastitis

The cornerstone of mastitis treatment is continuing to breastfeed or pump frequently—this is crucial. Many mothers worry about feeding their baby from an infected breast, but it is both safe and therapeutic. The milk is safe for the baby (their digestive system handles any bacteria without problems), and removing milk from the affected breast is essential for recovery. In fact, stopping breastfeeding abruptly can worsen mastitis and potentially lead to abscess formation.

Supportive care is important and effective for many cases of mastitis. Rest as much as possible—go to bed with your baby if you can. Stay well hydrated. Take ibuprofen for pain relief and to reduce inflammation; it's safe while breastfeeding and more effective than acetaminophen/paracetamol for inflammatory conditions. Apply warm compresses before feeding to encourage milk flow, and cold compresses after feeding for comfort.

If symptoms don't significantly improve within 12-24 hours of conservative treatment, or if you have severe symptoms from the start, antibiotics are usually needed. Your healthcare provider will prescribe an antibiotic effective against the bacteria most commonly responsible for mastitis (typically Staphylococcus aureus). It's important to complete the full course of antibiotics even if you feel better quickly. Most antibiotics prescribed for mastitis are compatible with breastfeeding.

How Do I Know If I Have Low Milk Supply?

True low milk supply is less common than perceived low supply. Signs of adequate milk include 6+ wet diapers per day after day 4, regular bowel movements, audible swallowing during feeds, baby content after feeding, and appropriate weight gain. The most reliable indicator is your baby's weight gain. If concerned, consult a lactation specialist before assuming supply is insufficient.

Concerns about milk supply are extremely common among breastfeeding mothers, but true insufficient milk supply is actually quite rare—most mothers are capable of producing all the milk their baby needs. Studies suggest that fewer than 5% of women have a genuine physiological inability to produce adequate milk. However, perceived low supply is one of the most common reasons mothers supplement with formula or stop breastfeeding earlier than planned.

The disconnect between perception and reality often comes from misinterpreting normal infant behavior or normal breast changes. Babies naturally cluster feed at certain times (especially in the evening), which can feel like they're never satisfied. After the first few weeks, breasts typically stop feeling engorged even when supply is abundant—the "full" feeling disappears as supply regulates, but milk production continues. Babies go through frequent growth spurts where they feed more intensely for a few days, which is their way of signaling your body to increase production—this is the system working as designed, not a sign of inadequacy.

The most reliable way to assess whether your baby is getting enough milk is to monitor their output and weight gain. After day 4 (once milk has come in), a baby getting enough milk will have at least 6 wet diapers per day, with urine that is pale or colorless. Bowel movements should be regular in the first month (though frequency decreases after 4-6 weeks). During feeds, you should hear rhythmic swallowing. Your baby should seem satisfied after most feeds (though expect some fussy periods). Most importantly, weight gain should be appropriate—babies typically regain birth weight by 10-14 days and then gain about 150-200 grams per week in the first months.

Increasing Milk Supply

If you have concerns about milk supply, the first step should be consulting with a lactation professional who can assess whether there's actually a supply issue and identify any underlying causes. If supply does need boosting, the fundamental principle is simple: milk production works on supply and demand. The more milk removed from the breasts, the more milk they make. The less milk removed, the more production slows.

Practical strategies for increasing supply include breastfeeding more frequently—aim for at least 8-12 times per 24 hours, including at least once at night when prolactin levels are highest. Ensure each feed is as effective as possible by optimizing latch and keeping your baby actively nursing (switch sides if they're falling asleep, use breast compression to maintain flow). Consider adding pumping sessions after or between breastfeeds to provide additional breast stimulation and emptying.

General health factors also matter: stay well hydrated, eat enough calories, and try to rest when possible (though this is admittedly challenging with a newborn). Stress can temporarily inhibit the let-down reflex, so relaxation techniques before feeding may help. Some mothers explore galactagogues (substances believed to increase milk supply), such as certain herbs (fenugreek, blessed thistle) or prescription medications (domperidone, metoclopramide). However, these should be discussed with a healthcare provider and are not substitutes for the fundamental work of frequent and effective milk removal.

How Do I Get My Baby to Latch Correctly?

A correct latch involves the baby taking a large mouthful of breast tissue, not just the nipple. Position yourself comfortably, hold your baby tummy-to-tummy with nose at nipple level, wait for a wide-open mouth, then quickly bring baby to breast with chin first. Signs of good latch: lips flanged out, visible swallowing, no pain after initial seconds, more areola visible above than below.

Achieving a good latch is perhaps the single most important skill in successful breastfeeding, yet it's often the most challenging to master. A proper latch means the baby has taken a deep mouthful of breast tissue—not just the nipple—so that the nipple reaches far back into the baby's mouth against the soft palate. In this position, the baby's tongue can work effectively to compress milk sinuses in the areola and draw milk out efficiently.

The foundation of good latch begins with positioning. You should be comfortable—this is crucial because you'll be in this position for 20-40 minutes many times a day. Use pillows to support your back and arms as needed. Bring your baby to your breast rather than hunching over to bring your breast to your baby. Your baby's body should be facing yours completely (tummy to tummy), with their head and body in a straight line so they don't have to turn their head to feed.

Hold your baby with their nose at nipple level—this positioning means they'll naturally tip their head back slightly when latching, which allows for a deeper latch. Support your baby's neck and shoulders rather than pushing on the back of their head, which can cause them to resist and pull away. Touch your nipple to your baby's upper lip to stimulate the rooting reflex. Wait for them to open their mouth very wide, like a yawn—patience here is key. When their mouth is at maximum openness, quickly bring them to the breast, aiming your nipple toward the roof of their mouth. Their chin should touch your breast first.

Checking and Adjusting the Latch

Once your baby is latched, take a moment to assess whether it's a good latch. Their lips should be flanged outward (like fish lips), not tucked in. You should see more areola above their upper lip than below their lower lip—this asymmetry indicates they've taken more breast from below. Their chin should be pressed into your breast. You should hear rhythmic swallowing sounds as they feed, not just sucking or clicking.

Pay attention to how it feels. Brief discomfort at the very beginning of a feed can be normal initially, but this should ease quickly. If pain continues throughout the feed, or if you feel pinching, biting, or rubbing sensations, the latch isn't right. Don't just endure a painful latch—break the suction by sliding your finger into the corner of your baby's mouth, and try again. It's better to relatch multiple times than to persist with a damaging latch.

Different breastfeeding positions can help achieve a better latch depending on your and your baby's anatomy. The cradle hold is traditional but not always the easiest for beginners. Many lactation consultants recommend the "laid-back" position (biological nurturing) for early breastfeeding, where you recline comfortably and let gravity help position your baby. The football/clutch hold can be helpful for mothers with large breasts or after cesarean delivery. The side-lying position is excellent for night feeds once you're more confident. Experimenting with different positions may help you find what works best.

What Is Thrush and How Does It Affect Breastfeeding?

Thrush is a yeast infection (Candida) that can affect both mother's nipples and baby's mouth. Symptoms in the mother include intense burning, itching, or shooting pain in nipples that continues between feeds. Treatment typically involves antifungal medication for both mother and baby simultaneously, along with careful hygiene measures to prevent reinfection.

Thrush (candidiasis) is an overgrowth of the naturally occurring yeast Candida, which can infect both the mother's breasts and the baby's mouth. Yeast thrives in warm, moist environments—making the breastfeeding situation ideal when conditions allow overgrowth. Contributing factors include recent antibiotic use (which disrupts normal bacterial balance), damaged nipples (which provide an entry point), diabetes, use of breast pads that stay moist, and immune suppression.

In mothers, thrush typically causes nipple pain that is distinct from latch-related pain. The pain is often described as burning, itching, or shooting sensations that may radiate into the breast. Importantly, this pain often continues between feeds, which distinguishes it from latch problems that hurt mainly during nursing. The nipples may look pink, shiny, or flaky, or they may look completely normal despite significant pain.

In babies, thrush appears as white patches on the tongue, gums, or inside of the cheeks that don't wipe off easily (unlike milk residue, which does). Some babies with thrush are fussy during feeding or refuse to feed, while others show no obvious symptoms. Because mother and baby pass the yeast back and forth, both need to be treated simultaneously even if only one is showing symptoms.

Treating Thrush

Treatment for thrush involves antifungal medication. For babies, an oral antifungal suspension (typically nystatin or miconazole) is applied to the mouth after feeds. For mothers, antifungal creams or ointments are applied to the nipples after feeds and don't need to be wiped off before the next feed. In some cases, oral antifungal medication (fluconazole) may be prescribed for the mother, particularly if topical treatment isn't sufficient or if there's concern about ductal thrush (infection deeper in the breast).

Hygiene measures help prevent reinfection during treatment. Wash hands frequently, especially after diaper changes (yeast is often in the intestinal tract and can spread from the diaper area). Change breast pads frequently and let nipples air dry after feeds. If you're pumping, be meticulous about cleaning pump parts. Any pacifiers, bottle nipples, or teething toys should be boiled daily during treatment or replaced.

Treatment typically continues for at least one week after symptoms resolve to ensure the infection is fully cleared. Because thrush can be stubborn and recurring, maintaining good hygiene practices and addressing any underlying factors (like controlling blood sugar if diabetic) is important for long-term prevention.

When Should I Seek Help for Breastfeeding Problems?

Seek help promptly if: pain is severe or not improving with latch correction, you have symptoms of mastitis (fever, flu-like symptoms, red painful breast area), your baby isn't gaining weight appropriately, your baby has fewer than 6 wet diapers per day after day 4, or you're feeling overwhelmed. Early intervention prevents problems from worsening.

Knowing when to seek professional help can make the difference between successfully overcoming a breastfeeding challenge and struggling unnecessarily or giving up. In general, if something doesn't feel right or you're worried, it's worth seeking advice—lactation support providers would much rather help with a minor issue early than try to solve a major problem that has been building for weeks.

Certain situations warrant prompt attention. If you have signs of mastitis—fever, flu-like symptoms, and a red, painful area on your breast—contact your healthcare provider within 24 hours. If symptoms are severe or worsening rapidly, seek care sooner. If your baby isn't gaining weight appropriately (hasn't regained birth weight by 2 weeks, or isn't gaining as expected thereafter), this needs investigation. If your baby has fewer than 6 wet diapers per day after your milk has come in (after day 4 or so), this is concerning.

For pain that persists despite your attempts at improving latch, or damage that isn't healing, a lactation consultant can assess in person and identify issues you might not be able to see or feel. If you suspect thrush, a healthcare provider can confirm the diagnosis and prescribe appropriate treatment. If you're experiencing nipple vasospasm, there are treatments available that can help significantly.