Engorgement, mastitis + thrush: What they are and how to treat them

We all have unique breastfeeding journeys and unexpected problems can pop up along the way.

breastfeeding complications

We all have unique breastfeeding journeys and unexpected problems can pop up along the way. Some problems, like engorgement, may occur in the first few days after giving birth, while others, like mastitis, can happen much later on.

Any time that you experience pain while nursing or pumping, whether it be your first time breastfeeding or your 300th time, it's important to be seen by a lactation professional as soon as possible. They can help you get a prompt diagnosis and start a treatment plan.


Here are common breastfeeding-related problems that can come on as a surprise include engorgement, plugged milk ducts, mastitis and thrush.

What is engorgement?

Engorgement is when your breasts are overly full of milk.

Swollen breasts due to engorgement can cause pain and interfere with your baby's ability to latch. Engorgement is common during the first few days after giving birth when one's milk "comes in," but can also occur later on if a feeding or pumping session is skipped, as well as during the process of weaning.

How to treat engorgement

One of the best treatments for engorgement within the first week after giving birth is to empty your breasts by nursing or pumping frequently. Applying heat with warm compresses and massaging your breasts prior to breastfeeding can also be helpful.

Other tricks to help with engorgement include applying cold packs to your breasts for 15 to 20 minutes after each feeding, wearing a comfortable bra, and spending as much time as you can flat on your back (a good excuse to be able to get extra rest!).

Untreated engorgement can lead to additional problems, including plugged milk ducts and mastitis. So, if you try these techniques and are still struggling, reach out to your provider or a lactation professional for help.

What is a plugged milk duct?

A plugged (or clogged) milk duct occurs when drainage from a milk duct is blocked. Plugged milk ducts can develop if your breasts are not totally emptied after a nursing or pumping session. Localized pain, tenderness and swelling, or a lumpy feeling in the area of the blockage occur. Pain associated with a blocked duct typically worsens while breastfeeding and resolves afterward. Your baby may also be fussier than normal while feeding if you have a plugged duct due to slow milk flow from the affected breast.

How to treat plugged milk ducts

Treatments for plugged ducts include frequent feeding on the affected side, pumping after feeding to promote total emptying of the breast, and trying out different nursing positions that may help clear the blockage.

Other treatments are similar to the remedies for engorgement: wear a comfortable bra, apply heat and massage your breast prior to feeding, and cold packs and rest after feeding to help to decrease pain and inflammation.

What is mastitis?

Mastitis is an inflammation of breast tissue that causes pain, swelling, warmth and redness. Fever, chills, and flu-like symptoms are also common.

The two main causes of mastitis are plugged milk ducts and nipple cracks or abrasions that can cause bacteria to enter the breast. Other risk factors for mastitis include poor breastfeeding technique or latch, wearing a bra that is too tight and having previously had mastitis in the past (though some mothers develop mastitis in the absence of any of these risk factors).

All possible cases of mastitis should be evaluated by a lactation or medical professional as soon as possible.

How to treat mastitis

You will likely be encouraged to continue to breastfeed from the affected side, making sure that one's breasts are fully emptied out after each feeding. Using warm compresses and breast massage prior to feeding can also help.

Over-the-counter pain relievers, such as ibuprofen, are commonly used for mastitis-associated pain and discomfort. Other tips for moms with mastitis include focusing on getting rest between feeding and pumping sessions, increasing fluid intake, starting each breastfeeding session on the affected side, and applying cold packs to the affected area between feedings.

If a mother with mastitis gets very ill or has a significant worsening of symptoms over a 12 to 24-hour period, antibiotics may be needed to clear a bacterial infection.

What is thrush?

Thrush is a fungal (yeast) infection of the nipple area that can cause significant pain and discomfort. Symptoms of thrush include a sudden onset of intense nipple pain while nursing (does not improve with changing latch or technique), an itching or burning sensation of the nipples, or a pink or red, flaky rash around the nipples.

Symptoms of thrush in a baby include white patches visible in the mouth or on the tongue, feeding refusal or pain while eating, and a diaper rash that does not respond to the application of common diaper rash creams or ointments. Some babies with thrush have no symptoms at all.

Risk factors for thrush include nipple cracks and abrasions, leaving damp nursing pads on for too long, antibiotic use during pregnancy or labor, having a recent vaginal yeast infection, and diabetes.

How to treat thrush

Treatment for nipple thrush includes treating both mother and baby at the same time. Oral nystatin is the most common treatment for babies with thrush, while moms are usually treated with topical antifungal creams. Severe cases of thrush may require treatment with an oral antifungal, such as Diflucan (fluconazole).

Alternative treatments for mothers with breast thrush include probiotics and grapefruit seed extract. However, these should be taken under the guidance of a medical professional.

Moms with thrush should continue breastfeeding and pumping during treatment to prevent a decrease in milk supply. Mothers and babies should be treated for at least one week after all symptoms resolve to avoid reinfection.

Other ways to prevent reinfection include frequent hand washing, changing nursing pads as soon as they become damp, rinsing your nipples after every breastfeeding and letting them dry before applying antifungal cream, and making sure that all pump parts, bottle nipples, and pacifiers are boiled after every use to kill any remaining yeast.


You've got this, mama!

Although the breastfeeding complications discussed above can cause some discomfort, they are relatively common, treatable and should not interfere with your ability to breastfeed your baby long term. If concerning symptoms pop up, it's essential not to ignore them and to seek help and guidance as soon as possible. Most importantly, please remember that you can (and should) continue to breastfeed while being treated for any of these conditions.