Key Takeaways

• Most breastfeeding problems, engorgement, clogged ducts, and perceived low supply, are common, temporary, and manageable with the right technique and timing.

• A shallow or poor latch, not low milk production, is the most common cause of feeding problems in the early weeks.

• True low milk supply is rare. It is often perceived, driven by exhaustion, comparison with other mothers, and misinformation.

• Distinguishing a blocked duct from mastitis is important: mastitis involves fever and systemic symptoms and sometimes needs antibiotics.

• Certain medical conditions and medications, including thyroid disorders, PCOS, and some contraceptive or cold medications, can genuinely reduce supply.

• Fever with breast pain, spreading redness, or a baby with reduced wet nappies and poor weight gain are red flags that need prompt medical attention.

Sore nipples. Rock-hard breasts. A crying baby who seems hungry all the time. These are some of the most common reasons new mothers worry that breastfeeding is "going wrong." In reality, most breastfeeding problems are temporary and often have simple solutions if recognised early.

Breastfeeding is a learned skill for both mother and baby. During the first few weeks after birth, challenges such as nipple pain, breast engorgement, concerns about milk supply, and feeding difficulties are common, even among healthy mothers and infants.

Concerns about engorgement, painful lumps, low milk supply, and infections such as mastitis are extremely common in the first few weeks after delivery.

While most of these problems are temporary and respond well to early recognition and the right support, a few genuinely need urgent medical attention.

Observed every year from August 1 to 7, World Breastfeeding Week is a global campaign led by the World Alliance for Breastfeeding Action (WABA) with support from the World Health Organization (WHO) and UNICEF. The week aims to raise awareness about the health benefits of breastfeeding, encourage support for breastfeeding mothers, and promote practices that help infants get the best possible start in life. Against this backdrop, understanding common breastfeeding challenges and knowing when to seek help becomes especially important for new families.

MedBound Times reached out to Dr. Preeti SD, a Consultant Pediatrician and Advanced Certified Lactation Professional at Bubbles Kids Clinic, Chennai, and Dr. Priyanka Bagdi, an OB-GYN at Cloudnine, T. Nagar, on how to tell the difference between a normal adjustment phase of breastfeeding and something that needs treatment.

Why Do Nipples Hurt or Crack During Breastfeeding?

Some tenderness or mild discomfort is common during the first few days as both mother and baby learn to breastfeed. However, persistent or severe pain during an entire feed is not considered normal and most often points to a poor latch rather than a problem with the nipple itself.

Persistent pain almost always points to a shallow latch rather than something inherently wrong with the nipple.

Dr. Preethi S.D, Consultant Pediatrician and Advanced Certified Lactation Professional, looks for a specific set of signs, in the baby as well as the mother, to confirm this.

Signs of a Poor Latch While Breastfeeding

• A clicking sound while feeding

• Dimpling of the cheeks while sucking, instead of full, rounded cheeks

• A visible gap between the baby's chin and the breast

• Fewer than 6 wet nappies a day, or yellow-coloured urine, suggesting milk transfer hasn't happened effectively

• Weight gain below the expected 25 to 30 grams a day after the baby has regained birth weight, as assessed during routine paediatric follow-up

• Mother's nipple post feed may look like a lipstick, wedge-shaped, if there is a poor latch. Normally it should be round and retain the same shape as before feeding.

On the mother's side, feeding should feel like a rhythmic pulling rather than a chomping action, and there shouldn't be pain during the feed. A lingering heaviness in the breast after feeding, or a nipple that looks flattened or wedge-shaped like a tube of lipstick right after a feed, instead of staying round, both point to an attachment problem during feeding. These signs should be considered alongside the baby's feeding pattern and weight gain rather than in isolation.

How To Fix a Poor Latch? Signs and Positioning Tips

Dr. Preethi S.D describes a useful way to think about positioning: the mother and baby should fit together like a jigsaw puzzle, with the baby's tummy fully against the mother's abdomen and no gap between them. Getting this alignment right makes latching noticeably easier.

The second key technique is sometimes called the “sniffing dog” position. Many mothers instinctively try to push the nipple into the baby's mouth, which tends to produce only a shallow latch.

How to get the "sniffing dog" position while breastfeeding?

• Keep the nipple at the level of the baby's nose, not pointed straight into the mouth

• Gently tease the baby's upper lip and philtrum with the nipple until the mouth opens wide

• Once the mouth is wide open, swiftly bring the baby onto the breast rather than moving the nipple toward the baby

If it is done correctly, the baby's chin should touch the breast with no gap, the cheeks should look full rather than dimpled, and the mother shouldn't feel pain through the feed.

What Is Breast Engorgement and How Long Does It Last?

Engorgement typically appears between the second and fifth day after delivery, when the body shifts from producing colostrum to mature milk, a process called lactogenesis II (when full milk production kicks in).

Engorgement can make the breasts feel:

• Full and heavy

• Warm

• Tight or swollen

• Tender to touch

For most women, this phase lasts 24 to 48 hours and improves as milk is removed regularly.

Relief from engorgement usually comes from:

• Feeding 8 to 12 times in 24 hours

• Ensuring a deep latch

• Avoiding skipped feeds

• Using reverse pressure softening (gently pressing the fingertips in a ring around the base of the nipple for a minute or two, to push fluid back and soften the areola)

• If the breasts are too firm for the baby to latch, reverse pressure softening before feeds and cold compresses after feeds may help.

Is Your Breast Milk Supply Really Low?

"True low milk supply is far less common than most mothers believe.", says Dr. Preethi S.D.

Exhaustion, unsolicited opinions from relatives and friends, and a steady stream of comparison on social media all push mothers toward assuming their supply is inadequate when it usually isn't.

How to Tell if Your Baby Is Getting Enough Breast Milk

• More than 6 wet nappies a day, and clear urine

• The baby sleeps for at least 1 to 2 hours at a stretch

• Weight gain is adequate at pediatrician check-ups

• The baby otherwise looks like it's thriving

If these are all present, the supply is almost certainly adequate and the concern is perceived rather than real. That said, Dr. Priyanka Bagdi notes genuine medical causes of low supply do exist and are worth ruling out when problems persist despite good technique:

Previous breast reduction or extensive breast surgery

• Significant postpartum haemorrhage, including rare Sheehan syndrome

• Retained placental tissue

• Hypothyroidism or poorly controlled diabetes

• Polycystic ovary syndrome (PCOS)

• Insufficient glandular breast tissue

• Obesity, which may delay the onset of mature milk production

Certain medications can also reduce supply, including combined oral contraceptive pills started soon after birth, oestrogen-containing medications, pseudoephedrine-containing cold medications, and dopamine agonists such as bromocriptine and cabergoline. Smoking and excessive alcohol intake may further reduce production.

Why Do Mothers Think They Don't Have Enough Milk in the First Weeks?

The single most common misconception, according to Dr. Preethi S.D, is that a crying baby means insufficient milk, especially in the first two weeks.

In the earliest days, mothers produce only small amounts of colostrum, gradually increasing to a fuller supply from around day three.

A newborn's stomach is roughly the size of a cherry and holds only 7 to 10 mL per feed in the first few days, so the small amounts produced are usually enough.

Some mothers worried that milk isn't enough, may introduce formula top-ups. Because the baby's demand is now partly met by formula rather than the breast, the body never receives the full signal to increase production, and supply can genuinely start to fall.

The baby then cries again after latching, the mother reaches for more formula, and the cycle repeats until breastfeeding stops altogether, even though the original problem was a misreading of normal newborn behaviour rather than true low supply.

What Causes Oversupply (Hyperlactation) and How Is It Managed?

Oversupply is usually self-induced rather than something that happens on its own, says Dr. Preethi S.D. Pumping on a fixed schedule, say every 2 to 3 hours, regardless of whether the baby has actually fed, is a common cause, as is the use of certain herbal galactagogue preparations (commonly referred to as leygiyam) sometimes given to “boost” supply.

Managing oversupply means avoiding the instinct to keep fully emptying the breast, since that signals the body to keep producing more. Instead:

• Feed on demand, not by the clock

• If pumping for comfort, express only enough to relieve discomfort, not a full emptying

• Try block feeding, staying on one side for 2 to 3 feeds if the baby is choking or passing greenish, frothy stools, both signs of an oversupply-foremilk imbalance

• Use a laid-back feeding position so milk has to work against gravity, reducing the force of let-down and the risk of choking

Clogged Milk Ducts vs. Mastitis: How to Tell the Difference

Both conditions cause breast pain, but they are not the same, says Dr. Priyanka Bagdi, and telling them apart changes what to do next.

For a blocked duct, the priority is effective milk removal: gentle kneading massage, a warm compress over the breast (not the nipple or areola) before feeding, an effective deep latch, hand expression afterward if the breast still feels full, and an ice pack over the area once the feed is done. Vigorous massage should be avoided, as it can worsen inflammation.

Antibiotics for mastitis are generally recommended when: symptoms are severe from the start, fever and systemic illness are present, there's no improvement after 24 hours of conservative management, or bacterial infection is strongly suspected. If symptoms don't improve within 48 hours of starting antibiotics, a breast ultrasound may be arranged to check for an abscess.

When Should You See a Doctor for Breastfeeding Problems?

Although most breastfeeding challenges improve with early support, some symptoms in either the mother or baby require prompt medical evaluation.

Seek medical care for the baby if:

• The baby has fewer wet nappies than expected for age or shows signs of dehydration, such as a dry mouth or reduced tear production.

• The baby is excessively sleepy and difficult to wake for feeds.

• Weight gain is poor or the baby is losing weight beyond what is expected after birth.

• Jaundice appears to worsen or persists beyond what the baby's healthcare provider considers normal.

• The baby develops a fever (100.4°F/38°C or higher in infants younger than 3 months), which requires immediate medical assessment.

Seek medical care for the mother if:

• Fever develops along with breast pain or redness.

• A painful, red, swollen area continues to worsen despite frequent feeding or milk removal.

• Pus or foul-smelling discharge is seen from the nipple.

• Severe breast pain interferes with feeding or daily activities.

• A breast lump becomes increasingly painful or an abscess is suspected.

• Bleeding nipples persist despite correcting breastfeeding technique or are associated with signs of infection.

Early assessment can help prevent complications while allowing breastfeeding to continue safely whenever possible.

Breastfeeding Challenges for Working Indian Mothers

"Returning to work doesn't have to mean the end of breastfeeding, but it does need a routine adjustment", says Dr. Preethi S.D. "A practical approach is to pump every 3 to 4 hours during work hours: take a short break, sit somewhere calm, and express for about 10 minutes on each side or until only drops come, storing the milk in an insulated bag with ice to bring home. Feeding the baby before leaving for work and again in the evening and at night helps the body adapt milk production to the new schedule rather than dropping supply".

Dr. Priyanka Bagdi adds a few clinical realities worth factoring in for Indian mothers specifically:

• Iron deficiency and anaemia does'nt directly lower milk production, but they add to fatigue and can make consistent, frequent feeding harder to sustain

• Recovery after a Caesarean section can complicate positioning; the football hold and side-lying position protect the incision while still allowing effective feeding

• Family pressure around “insufficient milk” is best managed by learning the basics of breastfeeding and normal newborn behaviour before delivery, so unsolicited opinions carry less weight in an already exhausting period

Conclusion

Breastfeeding is rarely perfect in the first few weeks. Both mother and baby are learning together, and challenges such as engorgement, blocked ducts, and concerns about milk supply are common rather than signs of failure. Most improve with time, good positioning and attachment, frequent feeding, and the right support. However, persistent pain, fever, poor milk transfer, or concerns about the baby's growth should never be ignored. Recognising which challenges are part of the normal learning process, knowing the warning signs, and seeking timely help from an obstetrician, pediatrician, or lactation professional can make breastfeeding more comfortable, sustainable, and reassuring for families.

References

1. Neville, M. C., and J. Morton. “Physiology and Endocrine Changes Underlying Human Lactogenesis II.” Journal of Nutrition 131, no. 11 (2001): 3005S–3008S. https://doi.org/10.1093/jn/131.11.3005S.

2. Mitchell, Katrina B., Helen M. Johnson, Juan Miguel Rodríguez, Anne Eglash, Charlotte Scherzinger, Irena Zakarija-Grkovic, Kyle Widmer Cash, Pamela Berens, and Brooke Miller. “Academy of Breastfeeding Medicine Clinical Protocol #36: The Mastitis Spectrum, Revised 2022.” Breastfeeding Medicine 17, no. 5 (2022): 360–376. https://doi.org/10.1089/bfm.2022.29207.kbm.

3. Johnson, Helen M., Anne Eglash, Katrina B. Mitchell, Kathy Leeper, Christina M. Smillie, Lindsay Moore-Ostby, Nadine Manson, and Liliana Simon. “ABM Clinical Protocol #32: Management of Hyperlactation.” Breastfeeding Medicine 15, no. 3 (2020): 129–134. https://doi.org/10.1089/bfm.2019.29141.hmj.

4. Farah, Ebtisam, Mary K. Barger, Carrie Klima, Barbara Rossman, and Patricia Hershberger. “Impaired Lactation: Review of Delayed Lactogenesis and Insufficient Lactation.” Journal of Midwifery & Women's Health 66, no. 5 (2021): 631–640. https://doi.org/10.1111/jmwh.13274.