What are the treatment options for common lactation issues?

Treatment Options for Common Lactation Issues

Most common lactation problems—including breast engorgement, plugged ducts, mastitis, and insufficient milk supply—originate from inadequate breast emptying and can be effectively managed through specific interventions focused on improving milk removal, proper latch technique, and addressing underlying causes. 1

Core Principle: Effective Breast Emptying

The fundamental approach to preventing and treating most lactation complications centers on ensuring the breasts are emptied effectively and frequently 1:

• Incorrect breastfeeding techniques, infrequent feeding, scheduled feeding times, and use of pacifiers or supplemental bottles are major risk factors that predispose mothers to lactation problems 1
• Exclusive breastfeeding for approximately 6 months is recommended, with continuation as mutually desired by mother and child until 2 years or beyond 2
• Frequent breastfeeding without scheduling should be encouraged to maintain adequate milk supply and prevent engorgement 1

Assessment Framework

When evaluating lactation problems, focus on two key criteria 3:

• Adequate infant weight gain as the primary indicator of successful breastfeeding 3
• Maternal comfort while nursing as evidence of proper technique 3
• Observation of breastfeeding technique should be incorporated into routine care to identify latch problems early 2

Specific Treatment Approaches

Breast Engorgement

Primary management involves frequent, effective breast emptying 1:

• Increase breastfeeding frequency to remove milk more effectively 1
• Apply warm compresses before feeding to facilitate milk flow 1
• Use cold compresses between feedings to reduce swelling 1
• Express milk manually or with a pump if the infant cannot effectively empty the breast 1

Plugged Milk Ducts

Treatment focuses on clearing the obstruction through targeted milk removal 1:

• Continue frequent breastfeeding, starting with the affected breast 1
• Position the infant so their chin points toward the plugged area to maximize drainage 1
• Apply warm compresses and gentle massage before and during feeding 1
• Ensure complete breast emptying at each feeding 1

Mastitis (Breast Infection)

Management requires both continued breastfeeding and appropriate medical treatment 1:

• Continue breastfeeding from the affected breast—stopping increases risk of abscess formation 1
• Apply warm compresses before feeding to improve milk flow 1
• Ensure adequate rest and hydration for the mother 1
• Antibiotics compatible with breastfeeding should be prescribed when bacterial infection is suspected 1
• Monitor for signs of abscess formation requiring surgical intervention 4

Insufficient Milk Supply (Chronic Lactation Insufficiency)

This affects an estimated 5-15% of lactating individuals and requires comprehensive evaluation 5:

• Distinguish between perceived and true low milk supply through assessment of infant weight gain and output 5, 3
• Evaluate for both extrinsic factors (infant feeding challenges, poor latch, infrequent feeding) and intrinsic factors (endocrine disorders, metabolic conditions, breast hypoplasia) 5
• Increase breastfeeding frequency to 8-12 times per 24 hours 1
• Ensure proper latch technique—this is critical for effective milk transfer 3
• Consider galactagogues such as domperidone or metoclopramide after addressing mechanical and technique issues 2
• Domperidone may increase milk supply when taken orally, though levels in milk are low due to first-pass metabolism 2
• Metoclopramide is also used as a galactagogue and may increase milk supply 2

Nipple Pain and Injury

Persistent pain requires focused evaluation to determine the specific cause 6:

• Conduct a focused history and physical examination to distinguish between poor latch, infection (bacterial or fungal), vasospasm, or dermatologic conditions 6, 4
• Correct latch technique is the primary intervention for mechanical causes of pain 3
• Screen for postpartum depression, as pain with breastfeeding is associated with increased risk 6
• For pain management, ibuprofen and paracetamol are safe during breastfeeding 7
• Diclofenac and naproxen are also compatible with breastfeeding and widely used postpartum 7
• Avoid aspirin in analgesic doses during lactation 7

Medication Safety During Lactation

Most medications are compatible with breastfeeding, and treatment should not be unnecessarily interrupted 2:

• Use LactMed (National Center for Biotechnology Information's Drugs and Lactation database) as the primary resource for medication safety information 2, 6
• NSAIDs (ibuprofen, diclofenac, naproxen) are safe for short-term use during lactation 7
• Prednisone <20 mg daily is compatible with breastfeeding; with doses ≥20 mg daily, delay breastfeeding or discard milk for 4 hours after administration 2
• Antibiotics used perioperatively are generally safe during breastfeeding 2
• Local anesthetics can be used with no need to interrupt breastfeeding 2

Support and Education

Skilled lactation support must be readily available in maternity care facilities 2:

• Provide anticipatory guidance at prenatal visits and each well-child visit 2
• Educate mothers on breast milk expression and return to work 2
• Train staff to follow telephone triage protocols for breastfeeding concerns 2
• Link families with community breastfeeding resources 2
• Many women experience early undesired weaning due to persistent pain or injury that could be prevented with proper support 6

Critical Pitfalls to Avoid

Healthcare providers often lack adequate knowledge about lactation complications 5:

• Patients report not being believed or taken seriously when presenting with lactation problems 5
• Fragmented care from discrepancies between providers leads to inconsistent advice 5
• Even lactation consultants may lack knowledge about complex conditions like chronic lactation insufficiency 5
• Do not recommend scheduled feeding times or pacifier use in the early weeks, as these increase risk of supply problems 1
• Do not advise stopping breastfeeding for mastitis—continued nursing is essential for resolution 1
• Pharmaceutical labeling often lists breastfeeding as contraindicated due to insufficient testing rather than proven harm—consult evidence-based resources instead 8

Systemic Barriers

Societal factors significantly impact breastfeeding success 6:

• Limited access to paid maternity leave contributes to early weaning 6
• Workplace barriers to breastfeeding prevent continuation 6
• Policies supporting universal paid maternity leave, workplace break time with private space for milk expression, and the right to breastfeed in public are essential 2