Complications Related to Breastfeeding

Breastfeeding can be a beautiful thing; however, there can sometimes be associated complications. Here are some of the most common complications below.

If you are experiencing feeding complications, call to make an appointment with one of our Annapolis Pediatrics Lactation Consultants.

If you are experiencing pain and discomfort, we also recommend contacting your OBGYN.

Engorgement

Engorgement is caused by the onset of copious milk production that exceeds the infant’s ability to extract milk. Engorgement typically begins 30-72 hours after delivery of the placenta when milk production and volume of milk exceed the storage capacity of the alveoli causing fullness of the breast.  This can be problematic if milk removal is compromised. Causes of ineffective milk removal that can lead to engorgement include a shallow latch, flat nipples, nipple anomalies, prematurity, and jaundice. Engorgement results in breast fullness and enlargement, mild tenderness, and tight skin.

To prevent engorgement:

• Breastfeed early and often
• Breastfeed on demand
• Allow baby to finish the first breast before switching to the opposite breast
• Ensure correct latch
• Avoid pumping unless the baby is not nursing well
• Hand express

To treat engorgement:

• Encourage early and frequent stimulation
• Apply moist heat prior to feeding for a limited time as needed. Note: this can lead to increased production and engorgement so use cautiously
• Cold compress after feeding
• Gently massage and compress the breast during feedings
• Reverse pressure softening

Severe engorgement can lead to breast tissue damage and decreased supply. Please contact your lactation consultant or provider if you are experiencing extreme breast tightness, taut or shiny skin, painful or hot breasts, lumps or hard areas in the breast, or poor milk drainage.

Mastitis

Mastitis is an inflammatory condition that sometimes results in infection.  It may result in significant redness and warmth of the breast, intense breast pain, fever, chills, or flu-like symptoms.  

To prevent mastitis:

• Relieve engorgement by breastfeeding on demand
• Wear a supportive bra
• Avoid excessive pumping/over stimulating breasts
• Avoid nipple shield use
• Treat hyperlactation (over supply)

To treat mastitis:

• Continue to breastfeed on demand
• Cold compress after breastfeeding
• Lymphatic massage/gentle massage when breastfeeding
• Discuss with mother’s physician if anti-inflammatory may be appropriate to help reduce inflammation
• Increase fluid intake

If your symptoms are not improving in 12-24 hours or you are acutely ill, contact your provider immediately.  

Plugged Ducts

 “Plugging” occurs due to ductal narrowing from surrounding breast inflammation, lymphatic congestion and alveolar edema.  Plugged ducts may feel like localized, tender, pea-sized lumps that are sometimes warm to touch. Fever is not associated with plugged ducts. Plugged ducts may occur with ineffective or poor latch, dysfunctional suck, jaundice, prematurity, hyperlactation, tight bra/clothing, and fibrocystic breasts.

To treat plugged ducts:

• Continue breastfeeding on demand
• Apply cold compress after feeding to help reduce inflammation
• Gently massage the breast
• Try different breastfeeding positions to help relieve congested areas
• Talk to mother’s physician about oral lecithin, like sunflower lecithin, to help reduce inflammation and emulsify milk

Bleb

A bleb appears as a white dot on the tip of the nipple. Caused by ductal inflammatory cells forming at the surface and lodging which obstructs milk flow from the nipple. Symptoms may include extreme pinpoint pain at the site of the bleb. 

To treat a bleb:

• Apply moist heat prior to feeds if this feels good / cold compress after feeding to help reduce inflammation
• Warm soaks to help release milk
• Talk to mother’s physician about oral lecithin, like sunflower lecithin, to help reduce inflammation and emulsify milk
• Talk to mother’s physician about steroid cream to reduce inflammation
• Treat hyperlactation (high supply)
• Avoid popping/unroofing as may cause nipple trauma

(Academy of Breastfeeding Medicine Protocol #36, The Mastitis Spectrum)