Breastfeeding problems
Management:
(Note: Very common. Ensure you always involve the breastfeeding team, where available, for support)
Engorgement:
Wear non-restrictive bra
Heat packs or warm shower before feeding/expressing to stimulate milk let down
Use chilled cabbage leaves/cold gel packs to relieve swelling post-feeding/expressing
Blocked duct:
Encourage feeding from the affected breast
Wear loose comfortable and well-fitted bra/clothes to prevent further pressure
Warm compress/shower if relieves pain
Consider the following if simple measures do not work
Massage breast towards the nipple
If there is a white spot on the nipple remove by bathing and then rub with a damp towel
Duct infection:
May cause deep breast pain
Check attachment and feeding
If candidal infection suspected consider fluconazole 150-300 mg stat then 50-100 mg bd for 10-14 days (off label)
If a bacterial infection (crusting etc.) evident consider Flucloxacillin 500 mg qds for 10-14 days, or if penicillin-allergic erythromycin 250-500 mg QDS or clarithromycin 500 mg BD 10-14 days
Mastitis and breast abscess:
See Breast infections chapter
Nipple damage:
Check attachment using breastfeeding experts where possible and continue feeding if possible
Stop nipple shields/breast shells as these can contribute to incorrect positioning
If nipple does not heal consider infection:
- If bacterial infection suspected consider fusidic acid cream 2% after every breastfeed for 2 weeks
- If candidal infection suspected treat woman and infant at the same time; for mother miconazole cream 2% after every breastfeed for 2 weeks; if nipples red and inflamed add 1% hydrocortisone cream
Poor milk supply (infant losing/failing to gain weight etc.):
Encourage frequent feeds, offer both breasts at each feed, increase skin-to-skin contact, consider supplementary feeds or expressing in between to stimulate supply
Resource(s):
Information for patient/carer(s):
The Association of Breastfeeding Mothers: breastfeeding counsellor telephone helpline (0300 330 5453)
The Breastfeeding Network: national breastfeeding helpline (0300 100 0212)
The National Childbirth Trust: telephone helpline including breastfeeding support (0300 330 0700)