Breastfeeding Problems: Latch, Low Supply, Engorgement

Most breastfeeding problems are common and can be fixed, especially when help comes early. Sore nipples are usually a latch problem, engorgement settles with frequent feeding, and most mothers make enough milk even when they fear they do not.

This guide covers the main problems, what you can try at home, the signs of mastitis, and when to ask a doctor or breastfeeding specialist for help.

Why breastfeeding can feel hard at first

The NHS describes breastfeeding as a skill that you and your baby learn together. MedlinePlus says problems are common and that getting help early from a lactation consultant or nurse can prevent many of them. Having difficulty does not mean you are doing something wrong or that your body cannot make milk.

Poor latch and sore or cracked nipples

Sore nipples are usually caused by poor positioning or attachment, according to the NHS. Painful feeds, or a baby who still seems hungry afterwards, can mean the latch is not right. Pain that you simply put up with can get worse, so ask for help early.

• Ask someone trained to check your baby’s position and attachment at the breast.
• To take the baby off, gently slip a clean finger into the corner of the mouth to break the suction.
• After a feed, MedlinePlus says expressed milk, olive oil or lanolin ointment can soothe dry or cracked nipples. Ask your doctor what is safe for you.
• Avoid harsh soaps and tight synthetic bras that trap moisture.

Tip: Ask a midwife, nurse or lactation counsellor to watch a whole feed. Seeing the position in real life is more useful than reading about it.

The NHS also lists tongue-tie, where a short strip of skin under the tongue limits movement, as a cause of feeding trouble. It is easily treated, so mention it if feeds stay painful.

Worry about low milk supply

Many mothers worry about not having enough milk, especially in the first days. MedlinePlus says most women make enough milk, and supply adjusts to the baby’s demand. The NHS suggests these steps to help supply:

• Feed as often and as long as your baby wants.
• Offer both breasts at each feed and alternate which breast you start with.
• Use skin-to-skin contact, which also helps you spot early hunger cues.
• Ask someone to watch a feed to check positioning and attachment.
• Once feeding is going well, expressing a little milk after feeds can help build supply.

The NHS lists several things that can reduce supply: poor attachment, infrequent feeding, alcohol, smoking, some medicines, illness, anxiety, stress, depression and tongue-tie. MedlinePlus cautions that adding formula can reduce supply, so talk to your doctor before supplementing if you are worried about your baby’s growth.

To judge whether your baby is getting enough, look at nappies, swallowing and weight gain. Our guide to newborn feeding schedule and hunger cues lists the signs. The CDC also notes that fewer than 8 feeds in 24 hours most days, or continued weight loss after day 5, can mean the baby is not getting enough.

Engorgement: very full, hard breasts

Engorgement means the breasts become overly full, hard, tight and painful. It is most common when the milk first comes in, and can also happen when feeds are missed or when a baby begins to feed less often. MedlinePlus suggests:

• Feed often, about 8 or more times a day, for at least 15 minutes each time, to prevent it.
• Relax, reduce distractions and use gentle massage before feeding.
• Alternate warm showers with cold compresses for comfort.
• Do not skip feeds to “rest” your breasts. This tends to make it worse.

Blocked milk ducts

A blocked duct feels like a small tender lump. The NHS explains that it can be caused by engorgement, skipped or delayed feeds, or pressure from a tight bra, bag strap or clothes. MedlinePlus lists a tender, red, warm area near a lump. Feeding frequently from the affected breast, gentle massage and pressure often help it clear. Wear a comfortable, supportive bra and avoid tight straps.

Mastitis: signs and what to do

Mastitis is breast inflammation that can develop if a blocked duct is not relieved. The NHS describes a hot, painful breast and flu-like symptoms. MedlinePlus adds fever and a red, hot, tender area on one breast.

• Keep breastfeeding. Milk from the affected breast is safe for your baby and feeding helps healing. Start with the tender breast, as the NHS suggests.
• If feeding is too painful, express milk and start on the other side.
• Rest, drink fluids and use warm compresses.
• Antibiotics are often needed. Your doctor will choose what is suitable while you are breastfeeding.

When to be cautious: If a hot, red, painful area does not improve in 12 to 24 hours, or you develop a high fever, feel very unwell, or a lump that does not go away, see a doctor the same day. Mastitis that is not treated can lead to a breast abscess, which may need draining, as the NHS explains.

Thrush and other infections

Breast or nipple pain can also be caused by bacteria, viruses or fungus. MedlinePlus says thrush, a yeast infection, can pass between mother and baby. Signs in a mother include tender, deep pink nipples. In a baby they include white patches in the mouth, nappy rash and fussiness. Both of you will need treatment, so do not self-medicate.

When to see a doctor

• Pain that does not go away after correcting the latch
• Cracked nipples that are bleeding, itchy or look different
• A red, hot, swollen area with fever or flu-like illness
• Mastitis that is no better in 12 to 24 hours, or is getting worse
• A lump that stays after feeds
• Signs of thrush in you or your baby
• Worry that your baby is not gaining weight or has too few wet and dirty nappies

You can call your doctor even if you are unsure, and breastfeeding can usually continue during an illness or fever. Our postnatal and newborn care speciality includes breastfeeding support for new mothers. If you are also very low, anxious or overwhelmed, read about postpartum depression; stress itself can make feeding harder.

Support and encouragement

Learning to breastfeed takes patience. Read our article on breastfeeding benefits for mother and baby for encouragement, and postpartum recovery for your own healing. If breastfeeding does not work out despite help, you have not failed. A fed, loved baby with a healthy mother is the goal.

Talk to a doctor

If you have questions about breastfeeding, you are welcome to book an appointment or call +91 944 103 0587. Chaitanya Hospital is in Kadapa, near RTC Bus Stand, Simhapuri Colony, and teleconsultation is also available. This article is for general awareness and is not a substitute for a doctor's advice.