Engorgement is when the breasts become noticeably larger and feel "full". There typically isn't any pain associated with the fullness, it is completely normal, and it usually will not prevent a baby from nursing well. When a mother's breasts are engorged it can sometimes be difficult for her baby to latch on. In this case you should pump or hand express just enough milk to soften the breast, then your baby should be able to latch and nurse much more easily.

It is not unusual for your breasts to become very engorged within three to five days after the birth of your child, this is simply a sign that your milk has come in.  After a few days of nursing your baby will help your breasts to regulate the supply of milk and they will no longer feel so swollen unless you have gone longer than you usually do between feedings, or if your baby is experiencing a growth spurt and has encouraged a greater milk supply. Eventually, the breasts will settle into a pattern of making milk based on the infant's needs based on how much he takes from them.

Engorged breasts are temporary and the problem can usually be resolved fairly quickly, or even prevented in the first place!

A yeast infection can also cause nipple soreness and often just appears suddenly.  See our section below on thrush for more information on yeast infections.

Teething

If a clogged duct has not resolved itself with 48 hours, or becomes very painful and red, you should contact your health care provider for assistance.

Breast Infection

Mastitis is a bacterial infection of the breast that can occur in breastfeeding mothers. It differs from a clogged duct because mastitis usually requires treatment with antibiotics. A clogged duct is similar to mastitis as they both appear as a painful, swollen, firm mass in the breast, often with red skin in the area, however mastitis is usually much more intense and is typically associated with a fever. It is not always easy to differentiate between mastitis and a clogged duct, and a clogged duct can lead to mastitis if untreated.

For a diagnosis of mastitis, there must be an area of hardness, pain, redness and swelling in the breast. Flu-like symptoms or fever alone are not enough to make the diagnosis of mastitis. If there is not an area of hardness and pain then you do not have mastitis. Shooting pains in the breast without an area of hardness are not indicative of mastitis. These are more likely caused by a yeast infection and should not be treated with antibiotics.

As with most breastfeeding problems, a poor latch or poor draining of the breast promotes a situation where mastitis can occur.

Thrush is a common yeast infection that affects the mucous membranes and can affect the breasts. Occasionally, a nursing mother will experience sore nipples after a period of pain-free breastfeeding. If this occurs and other causes such as improper positioning and inadequate latch-on have been ruled out, thrush should be considered.

Yeast is normally present in the body in harmless amounts, but an imbalance can occur under certain circumstances. Although thrush is not generally considered a serious condition and breastfeeding can and should continue, a yeast infection in a premature or low birth-weight infant can be life-threatening, as can a yeast infection in an individual whose immune system is impaired by other illness or infection.

Symptoms of thrush in the mother can include itchy, burning nipples, shooting pains during or after a feeding, bright pink nipples extending into the areola and flaky skin in the nipple area. Symptoms of yeast infection in the infant can include a sudden onset of fussiness at the breast, gassiness or colic symptoms, and white spots or a film inside the mouth, on the gums or on the tongue that does not wipe off.

A baby with thrush may also have a diaper rash with raised, red patchy areas or a shiny appearance. Keep in mind that it is possible for thrush to be present even without any visible symptoms in the mother or baby. If either mom or baby has yeast symptoms, both need to be treated simultaneously to prevent reinfection.

Women who are susceptible to vaginal yeast infections, have recently used antibiotics or have a history of diabetes are more likely to get thrush. A history of anemia, use of steroid medications such as those used to suppress pre-term labor, use of antidepressant medications or the use of oral contraceptives can also contribute to the possibility of a yeast infection. Physical factors that can also contribute to yeast infections include a humid environment and clothing that retains moisture, such as a wet bathing suit, panty hose, tight jeans or a wet bra and nursing pads.

Your healthcare provider will need to diagnose and treat you for thrush. Treatment options should be based on the severity of infection and pain. A topical antifungal is usually prescribed for the nipples and for the baby’s diaper area, along with simultaneous treatment of the baby’s mouth with a liquid oral antifungal medication. Research has shown that very little of these types of medication enters the breast milk and any that does reach the baby is destroyed in the gastrointestinal tract.

Women who experience frequent yeast infections are often advised to change towels after each bath or shower, wash clothing in very hot water, cut down on their intake of sugary foods, wheat, cheeses and fermented food products. The addition of dietary supplements such as vitamin C, zinc and B complex vitamins may be helpful, as is adding garlic and yogurt with live cultures to the diet.