Breastfeeding Problems and Solutions: Nipple Cracks, Mastitis, Tongue-Tie, and More
Dra. Paula Andrade
CRM-SP 204778 | RQE 131771 | Título SBP 2024
Licensed in Brazil — Itaim Bibi, São Paulo
Although breast milk is the ideal food for babies, breastfeeding can present challenges that lead many mothers to stop before the recommended time. The good news is that most problems have solutions when identified early and treated properly. If you are in your first days of breastfeeding, this guide will help you prevent and solve the most common difficulties. For expat families in Sao Paulo, know that specialized breastfeeding support is readily available in English.
You Are Not Alone
Studies show that over 60% of mothers face some difficulty with breastfeeding. Pain, nipple cracks, low supply, and latch problems are extremely common and, in the vast majority of cases, reversible. Asking for help is not weakness — it is wisdom.
1. Nipple Cracks and Fissures
Nipple cracks are the number one complaint in pediatric offices. They are painful splits in the nipple that can bleed and make breastfeeding agonizing. The main cause is an incorrect latch.
Warning Signs
- • Intense pain throughout the entire feed
- • Deformed nipple after feeding (flattened or with marks)
- • Bleeding from the nipple
- • Crusting or blisters forming
How to Treat
- • Correct the latch (root cause)
- • Apply your own breast milk to the nipple
- • Use pure lanolin after each feed
- • Let nipples air-dry
- • Silicone breast shells protect between feeds
When to Seek Immediate Help
If cracks do not improve within 48-72 hours with the measures above, if there are signs of infection (pus, intense redness, fever), or if the pain is unbearable, see your pediatrician or an IBCLC lactation consultant.
2. Mastitis: Breast Infection
Mastitis is an inflammation of breast tissue that can progress to infection. It affects up to 10% of breastfeeding women and usually occurs in the first weeks, but can appear at any time.
Symptoms of Mastitis
- • Red, warm, and painful area on the breast
- • Fever above 38.5 C (101.3 F) with chills
- • General malaise, flu-like symptoms
- • Milk may appear different (thicker, yellowish)
Treatment
- Continue breastfeeding! The milk is safe for the baby and emptying the breast is essential for recovery
- Warm compresses before nursing to help milk flow
- Cold compresses after nursing to reduce inflammation
- Antibiotics if prescribed by the doctor (breastfeeding-compatible options are available)
- Rest, hydration, and pain medication as directed
Suspect mastitis or breastfeeding pain?
Do not wait for it to worsen. Dr. Paula evaluates and provides appropriate treatment, maintaining breastfeeding whenever possible.
Talk to the Pediatrician3. Breast Engorgement
Engorgement occurs when the breasts become overly full, painful, and hard. It is most common in the first days when the milk “comes in,” but can also happen when baby skips feeds or the mother is returning to work.
How to Relieve Engorgement
- Nurse more frequently (on demand)
- Gentle circular massage before nursing
- Warm compresses for 3-5 minutes before breastfeeding
- Hand-express a little before nursing to soften the areola
- Cold compresses between feeds (a chilled cabbage leaf works!)
4. Low Milk Supply
Concern about “weak milk” or “not enough milk” is the leading cause of early weaning. However, true milk insufficiency is rare (less than 5% of mothers). In most cases, supply is adequate, but the mother does not realize it. Tracking your baby's weight gain is the best way to assess.
Myths About “Low Supply”
- • “My breasts feel soft, I have no milk” — soft breasts mean supply has regulated
- • “Baby cries a lot, must be hungry” — babies cry for many reasons, including colic
- • “Baby wants to nurse all the time” — on-demand feeding is normal, especially during growth spurts
How to Increase Supply
- • Nurse more frequently (supply and demand principle)
- • Offer both breasts at each feed
- • Ensure correct latch and effective emptying
- • Stay well hydrated and nourished
- • Rest whenever possible
- • Avoid bottles and pacifiers in the first weeks
5. Tongue-Tie (Ankyloglossia)
Tongue-tie is a condition where the membrane connecting the tongue to the floor of the mouth is shorter or tighter than normal, limiting tongue movement. This can significantly impair breastfeeding.
Signs That Suggest Tongue-Tie
In the baby:
- • Difficulty opening mouth wide
- • Heart-shaped tongue when crying
- • Clicking sounds during feeds
- • Long and inefficient feeding sessions
- • Inadequate weight gain
In the mother:
- • Persistent pain despite latch correction
- • Non-healing nipple cracks
- • Deformed nipple after feeds
- • Frequent engorgement
- • Declining milk supply
Diagnosis should be made by a pediatrician or specialized speech therapist. When indicated, a frenotomy(release of the tie) is a quick and safe procedure that significantly improves breastfeeding in most cases. In Brazil, this can be done at the pediatrician's office or at specialized clinics.
6. Incorrect Latch and Persistent Pain
An incorrect latch is at the root of most breastfeeding problems. A good latch should look like this:
- Baby should take in the entire areola, not just the nipple
- Lower lip turned outward(like a “fish mouth”)
- Baby's chin touching the breast, nose free
- You should hear baby swallowing rhythmically
- After feeding, the nipple comes out rounded (not flattened)
7. Breast Thrush (Candidiasis)
A fungal infection (Candida) can affect the nipple and milk ducts, causing intense stinging or burning pain during and after feeds. The baby usually shows white patches in the mouth (oral thrush).
Signs of Thrush
- • Burning or stinging pain in the nipple
- • Red, shiny, or peeling nipple
- • Pain that worsens after feeds
- • White patches in baby's mouth
Treatment
- • Mother and baby are treated together (even without symptoms)
- • Topical antifungal as prescribed by the doctor
- • Sterilize all nipples, pacifiers, and mouth toys
- • Keep nipples dry and aired
- • Change breast pads frequently
8. When to Seek Professional Help
Certain signs indicate it is time to seek specialized support. Do not hesitate to contact your pediatrician or an IBCLC lactation consultant:
Seek Help If:
- • Intense pain that does not improve within 48 hours
- • Nipple cracks with bleeding or pus
- • Fever above 38.5 C (101.3 F)
- • Baby is not gaining weight or is losing weight
- • Fewer than 6 wet diapers per day (after day 5 of life)
- • Baby is excessively sleepy or refuses the breast
- • You are thinking about giving up breastfeeding
Struggling with breastfeeding?
Dr. Paula evaluates the latch, identifies problems, and offers practical solutions so breastfeeding works for you and your baby.
Talk to the PediatricianPrevention: The Best Medicine
Most problems can be prevented with a few simple steps. Tracking your baby's weight gain is essential for early detection:
- Ensure correct latch from birth — ask for help at the hospital
- Breastfeed on demand (no rigid schedules)
- Avoid artificial nipples and pacifiers in the first weeks
- Keep nipples dry and aired
- Schedule the first appointment in the first week of life for breastfeeding assessment
- Do not be afraid to ask for help — the sooner, the better
“Breastfeeding should not be a sacrifice. With adequate support, the vast majority of problems are resolved and breastfeeding becomes lighter and more enjoyable for both mother and baby.”
— Dr. Paula Andrade, Pediatrician
Struggling with Breastfeeding?
Schedule a consultation for latch evaluation and specialized breastfeeding support in Itaim Bibi, Sao Paulo.
Consultório no Itaim Bibi, São Paulo | CRM-SP 204778 | RQE 131771
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