Hesperian Health Guides

Common difficulties while breastfeeding

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HealthWiki > A Book for Midwives > Chapter 16: Breastfeeding > Common difficulties while breastfeeding

Fear of not having enough milk

Some women are afraid that they do not have enough breast milk. Health workers or family members may even tell them they do not have enough. Assure the mother that this is almost never true. The more a baby suckles, the more milk a mother's breasts will make.

If the baby does not seem satisfied, do not give solid food or a bottle. Help him breastfeed more!
a woman holding a crying baby.
a bottle with the word NO! on it.
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a clothesline with 6 diapers pinned to it.

At times the baby may suddenly want more milk than before. Assure the mother that this is normal. It means the baby is growing and so is his hunger. The baby does not need anything else to eat or drink — just let him breastfeed more often and for as long as he wants. After about 2 days of extra breastfeeding, the mother's milk supply will have grown to meet the baby's needs.
The baby is getting enough breast milk if he gains weight and urinates more than 6 times a day.

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long nipple flat nipple

Flat or inverted nipples

Some women's nipples are flat or inverted (sink into the breast). Even so, the baby can usually breastfeed without a problem. But the mother and baby may need some help in the first few days.

Breastfeeding with flat nipples
  • Start breastfeeding right after birth — before the breasts become full.
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  • If the breasts are very full, remove some milk by hand to make them softer.
  • Gently roll the nipple to make it stand out.
  • Cup a hand around the breast and pull back. The nipple will pop out.

Take the breast like this: and pull back towards the chest. The nipple will stand up.
a hand on a woman's breast, just behind the nipple.
the hand pressing toward the chest.
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Engorged (swollen) breasts

Sometimes a mother's breasts get very full and hard, especially during the first few days after the birth. This can be painful for the mother and also makes her more likely to develop a breast infection. It can also make it hard for the baby to suck the breast. If the mother begins breastfeeding the baby very soon after the birth, and feeds often, she may avoid this problem.

But if a mother's breasts do get swollen, she can try the following:

  • Breastfeed the baby more often, both day and night (every 1 or 2 hours, and on both breasts).
  • Place hot, wet cloths on the breasts for 15 to 20 minutes before each feeding.
  • Put ice, cool cloths, or fresh cabbage leaves on the breasts between feedings. Let the milk leak freely and support the breasts with a bra or cloth.
  • If the baby has trouble getting onto the breast because it is swollen, remove a little milk by hand until the breast is soft enough for the baby to take.

Encourage the mother and remind her that this problem will go away soon.

Painful lump in the breast (abscess)

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If a painful lump forms in the breast, the milk is probably getting stuck in one part of the breast. If the lump is not treated, the breast can easily become infected.

If a mother has a painful lump, she should:

  • breastfeed frequently (every 1 or 2 hours), giving the baby the sore breast first. If for some reason the mother cannot breastfeed, she must remove the milk by hand.
  • stay in bed and keep the baby with her so he can feed often.
  • drink lots of liquid.
  • place hot, wet cloths on the sore breast for 15 to 20 minutes before each feeding.
  • use ice or cold cloths between feedings to lessen the pain.
  • gently massage the lump as the baby feeds.

Some women have gotten rid of an abscess by drinking 1 tablespoon of vinegar in a cup of water every hour. Putting cabbage leaves on the abscess also might help.

Breast infection (mastitis)

Infection inside the breast can occur if the mother has sore, cracked nipples or full, engorged breasts, if she wears a very tight bra or binding clothing, or if she is very tired or in poor health. Preventing these situations will help prevent breast infection.

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Signs of breast infection:
  • abscess (painful lump in the breast)
  • hot, red, sore area on the breast
  • body aches and pains
  • fever of 38°C (100.4°F) or higher

For breast infection
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  • give 500 mg dicloxicillin
by mouth, 4 times a day for 7 days
If you cannot find this medicine, or if the woman is allergic to penicillin
  • give 500 mg erythromycin
by mouth, 4 times a day for 7 days
For fever and pain
  • give 500 to 1000 mg paracetamol
by mouth, every 4 hours, until the
pain goes away

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If a breast infection is not treated early, it will get worse. If an abscess develops and antibiotics do not make it go away, the woman should see a health worker who has been trained to drain an abscess using sterile equipment.

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Sore or cracked nipples

If a woman feels pain in her nipples while breastfeeding, the baby is probably not in a good position. If the baby keeps breastfeeding in a bad position, the mother's nipples may crack. Cracked nipples can become infected.

To treat sore or cracked nipples:
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Offer the whole breast (not just the nipple) so the baby can get a good mouthful.
  • Help the mother hold the baby in a position that allows the baby to get a large mouthful of breast.
  • The mother can rub breast milk into her nipple. This will prevent infection in the cracks and keep the nipples soft so they will not crack more.
  • Encourage the mother to leave her breasts open to air and sunlight when she is not breastfeeding.
  • Encourage the mother to keep feeding from both breasts — but she can start with the less sore breast and switch to the cracked one once the milk starts flowing.
  • If the pain is too great to breastfeed, the mother can remove her milk by hand and feed the baby with a cup and spoon for a few days.


If a baby is in a good position while suckling and the mother still has pain in the nipples that lasts for more than a week, it may be caused by thrush (a yeast infection on the nipple or in the baby's mouth). The mother may feel an itch on her nipples or a stabbing burning pain. The baby may have white spots or redness in her mouth.

How to treat thrush

Mix gentian violet and water to make a 0.25% strength. For example, if you have a solution of 1% gentian violet, mix 1 teaspoon with 3 teaspoons of water.

Use a clean cloth or a finger to paint the nipples and white spots in the baby's mouth once a day for 5 days. Gentian violet will stain clothing and will turn the baby's mouth and the mother's nipples purple — this is normal. The mother should keep breastfeeding. If the thrush does not get better in 3 days, stop using gentian violet and get medical advice.

The baby has gas pains (colic)

If a baby starts to cry and pull his legs up soon after he starts to suck, he may have gas — too much air in the belly. Some babies swallow air when they breastfeed. It may help to let the baby burp.

Lay the baby on your shoulder and rub or pat his back.
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or Lay the baby across your knees and rub or pat his back.
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or Sit the baby up leaning forward and rub or pat his back.
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Sometimes a baby seems to get gas pains when the mother eats a certain food or spice. The mother can try eating food without spices, or stop eating a food that may be causing gas for 2 or 3 days (if she is getting enough nutrition from other foods). There is no particular food that should be avoided, because each baby is different.

Gas pains usually stop when the baby is about 4 months old.

This page was updated:11 Sep 2019