long term breastfeeding - anyone doing it?

[Rivi]

Is anyone out there a long term breastfeeder? If you are how long? how's it going? etc etc

Hi Rivi, Im still breastfeeding ds who is just over 13 months. He still feeds when he likes, but more if we are in than out and about. I want to start weaning him really as we are trying for number 2 (had always planned to wean around a year anyway) but I think it is going to be a hard job as he loves it. I have also let him use me for comfort feeds, so I think getting him to sleep without a feed is going to be the hardest job, especially as he will no longer have a dummy. I would love any suggestions.

I breastfed my twins till they were 18 months- I'm not sure if this counts as long term or not- a very few aquaintances are still feeding over 2s and others consider anything much past 6 months a long time.
All 3 of us seemed ready to stop around the the year and a half mark so weaning wasn't a problem really.
One thing to look out for is dental problems if you go on feeding much past a year. I thought that it was mainly bottlefed babies who had early tooth decay but one of my mates has just stopped feeding her 20 month old son on the orders of the dentist- his tooth enamel has eroded due to the pooling of breastmilk in his mouth.

Riva - yes I am a very long term breastfeeder. My son is 27 months old and I am now 4 months pregnant with our second child. How is it going? Hmmm, well sometimes I get fed up with it, particularly during my first trimester of pregnancy as my nipples were quite tender but they seem to have eased now. My son feeds mostly for comfort but it still seems to be doing him good as he is never ill. He has never vomited, had sickness/diarrohea, ear troubles etc so I feel it is worth the effort.

Very few people know I breastfeed now as I don't do it in public - generally it is evenings and at night. Advice from the health visitor for example I know would be to finish before the next baby arrives but I feel now he will remember and it is too late really. I know you can b/feed two children - this is known as tandem feeding. It can sometimes help with jealousy. I don't really have a set time for stopping - I'd rather just gradually phase it out. There are an awful lot of myths and negative opinions about long term breastfeeding which are based on mere predjudice not fact. It can never do your child any harm, only good, no matter how long you do it.

Joe1 - you won't have any problems conceiving if your periods have started so no worries about stopping yet.

Okapi - nighttime feeding can result in tooth decay so best to give this up rather than give up breastfeeding completely. However it is most likely that tooth decay is related to food eaten during the daytime. Breastmilk actually has enzymes in it that prevent tooth decay.

Riva - what about you? What are your experiences?

I fed two of mine for well over a year and another for two years. It's such an easy way to comfort a baby. The main problem with my youngest child was that she would wake and only go back to sleep when I fed her and I found that exhausting to do, many times a night. But I think it was more to do with the fact that she simply doesn't need much sleep and my being older by the time she came along, not breastfeeding. None of mine have had any tooth decay related to breastfeeding, either.

I fed mine for 11 months - not long by these standards but as Okapi said some people see six months as a long time. I also run a dental website www.kidsteeth.ic24.net/index.html and therefore have been in touch with quite a few people who breastfed for extended periods and had children with decay. They are quite adamant that their children had no more sugar than other children. Breast milk is deficient in vitamin D. There is no proof that vitamin D deficiency causes dental problems but some reason to believe it might. However you feed your child you need to ensure they get outdoors regularly. There are also steps you can take to reduce the risk of tooth decay - like wiping the child's teeth after a feed.

Okapi - if your friend would like some support at a difficult time she can e-mail me at [email protected] Please ask her to say where she got my e-mail as I'll then have more idea what type of support to offer.

Thanks, Wendym. I'll definitely pass that on next time I see her. I don't know too much about the enzymes in breastmilk, Eulalia, but my friend's dentist was very clear that he thought continued breastfeeding was the cause of the problem. I was surprised too.
Feeding a toddler and a newborn together sounds interesting! What happens to the breast milk? I'd heard it changed over time to meet the needs of growing babies so that its quality was different at eg 1 day, 2 months, 6 months, 18 months. Does it go back to square one and 'favour' the newborn?
Aren't our bodies amazing to be able to do all this, btw? I love being a woman.

When I'm not cursing my downtrodden state, that is!

The possible bf/tooth decay link is interesting. I was thinking that if there were a link between the two, then in counties where extended bf is the norm, such as in developing countries, dental decay would be rife. But if the Vit D theory is correct, those children would be protected from decay by the extra Vit D available in sunlight in most developing countries.

I think there is a bit of debate about dental caries and breastfeeding and not everyone entirely agrees. Those most at risk are those infected with streptococcus mutans (about 5-10 % of the population). So many could breastfeed at night without problems. For those at risk it is not necessary to give up breastfeeding altogether but to cut out night feeds (or brush after them) and clean the teeth regularly during the daytime when food is consumed.

Wendym I am sure can advise further if necessary.

These quotes explain my earlier comments:

"Several components of human milk may also protect against the development of caries. IgA and IgG have the potential to retard streptococcal growth; streptococcus mutans is highly susceptible to the bactericidal action of lactoferrin, a major component of human milk.9,10 Rugg-Gunn reported that cariogenic bacteria may not be able to utilize lactose, the sugar found in breastmilk, as readily as sucrose.8 Confirming the findings of other researchers, this author has evaluated approximately 600 skulls to find little evidence of problems with dental decay among our prehistoric breastfed ancestors"

Some assume that because breastmilk contains lactose, it can be as cariogenic as any sugar solution in a bottle. However, lactose is protected by the antibacterial and enzymatic qualities of breastmilk.18 Furthermore, lactase enzyme splits lactose into glucose and galactose in the intestines, rather than in the mouth. There are 4,640 species of mammals, all of whom breastfeed their young. Lactose is present in most of the breastmilk of these species. Humans are but one species of mammals, but are the only species with any significant decay in deciduous teeth. Mammals, starting with the Australopithecines have been on the earth for 2 to 4 million years.19 Modern Homo sapiens have been around for 30,000 to 35,000 years. Dental decay, however, did not become a significant problem until about 8,000 to 10,000 years ago. Anthropologists believe the increase in decay was primarily due to the advent of the cultivated crops. Some anthropologists believe it would be evolutionary suicide for breastmilk to cause decay and that evolution would have selected against it.
quote from Brian Palmer, D.D.S.
'Breastfeeding and Infant Caries: No Connection'. Published in: ABM NEWS and VIEWS, The Newsletter of The Academy of Breastfeeding Medicine, 2000, Vol. 6, No. 4 (Dec), p27 & 31.

Okapi - yes the breastmilk favours the newborn over and above the older child. The composition changes towards the end of your pregnancy and the quantity reduces. Some children may give up because of this. At birth you will produce colustrum, again the older child may not like the taste and the quantity will increase. Most toddlers are only taking feeds a couple of times a day by this stage so there is really no problem about producing enough milk. Indeed your older child could start to get the supply going as this is often a problem with new mothers and they actually don't breastfeed enough in the early weeks.

As you will know having had twins there is plenty milk - our bodies just cope to meet the demand.

From what I have read feeding past a year is regarded as 'extended breastfeeding'. However a fraction of the population actually do this. Indeed in the UK only 21% of the population were breastfeeding at 6 months (although what one terms 'breastfeeding' can vary as many do mixed feeding with formula by this stage), the figure dropping to 14% at 9 months. However current advice by health professionals indicates doing it for at least a year or as long as you wish. I've talked about this extensively on other message boards so won't go on here.

Breastfeeding is a lot safer for teeth than bottle feeding. However there are examples of high levels of early decay in populations where bottle feeding is not practised and diets are low in other sugars - e.g studies in Thailand and Pukapuka (mid pacific ocean). However as I doubt many mumsnet readers or their children are living on the type of diet used in those countries the real issue is whether extended breastfeeding would be damaging for children being fed a western diet.

Dental decay is intitiated by streptococcus mutans although other bacteria (lactobacillus) become important once decay starts. Streptococcus need something to stick to so they don't colonise the mouth until teeth are present. In fact children acquire them at varying ages up to about 2 and some acquire a more vigorous strain than others. It is normally the chief carer who passes on the bacteria to the child. Mothers who themselves have dental problems are more likely to have a child with dental problems.

Breastfeeding until a child has bacteria in their mouth is obviously no risk - but that is at varying ages and no-one knows how to predict when it will happen. I don't know of any testing service in this country. As extended breastfeeding is no longer common there isn't enough research to provide a good answer on how risky it is after that time. If there is a risk it is likely to be related to frequent feeding and/or nightime feeding and the pooling of milk in the mouth. Wiping the teeth with a cloth after feeding and turning the baby over so that any pooled milk moves will reduce the risk. It is possible to delay the transmission of bacteria to children (and reduce decay) by regular use of products containing xylitol - preferably chewing gum. Avoiding any sugar would also remove the risk - but that is extremely difficult in this country.

Since I have corresponded with some very distressed parents I do think it important that anyone who is breastfeeding past the time when their child has teeth is aware that this does NOT prevent decay. It is less common than in bottle fed children but it isn't possible to compare it with children who drink from a cup.

For the survival of the human race it is decay in permanent teeth that would be most relevant but I am not well informed about the skull studies. Decay was rare in prehistoric times because the diet included very little sugar. That can't be compared with the type of diet children in this country receive.

I fed number one until he was 23 months, at which time it was down to one feed a day. He didn't seem at all inclined to give up himself - in fact getting it down to just the morning feed had been imposed by me. It wasn't the feeding I minded so much as all the poking and proding that went with it - that really started to bug me! He then did spend a whole month being sick it seemed - just to make me feel extra guilty.

Number two was 3.5 months at the time and No1 was very pissed off about the little one getting feeds and it did cause some problems. Now he is pretty happy to let the baby feed so long as he gets the cuddles (and continues to poke and probe so didn't manage to get rid of that!).

In retrospect I wish I had stopped feeding No1 before No2 arrived as I think it might have made things easier. I think maybe it added to rather than helped with jealousy, & for the last couple of months I really felt I was doing it out of a duty rather than enjoying it. But I had got to the point where I thought it was too close to the babies arrival to stop before hand, then he had to get used to the baby, so carried on until we came back from holiday and then stopped.

I'm still breastfeeding my daughter who is nearly four! For the last year or so it has only been to get off to sleep and ocasionally during the night (she sleeps on a matress next to my bed). I got fed up with it about a year ago, and tried to stop, I went away several times for two or even three nights having been reliably informed that my milk would disappear, but it didn't! I don't mind now, I feel free knowing she can sleep happily without me, I see that she is very happy and healthy and I always wanted to stop naturally - I just thought it would happen before this!! Anyone have a similar experience? Tell me they stop before they get into double figures!!!

I wonder if anyone can help me. I have a good friend who has just had her first baby. He was 2 weeks early and weighed only 5lb 7oz. She is finding breast-feeding incredibly painful and difficult, which is of course not unusual at the beginning. She is feeding 'on request' but he was just not putting on any weight, having dropped to 5lb 3oz. She has bleeding nipples and her NCT counsellor thinks she has thrush in her milk ducts. Has anyone heard of this? Her doctor hadn't and refused her anti biotics until she stopped feeding. She is very keen to continue feeding despite feeling as though she has been kicked in the boobs even when not feeding. On the advice of her hv she offers him 1oz formula after the breast which he devours. He is now up to 5lb 7oz again. I just feel so sorry for her. Mine were such good feeders and there is enough to feel guilty about as parents. I think it is making her very anxious and unhappy which obviously doesnt help. I told her she really shouldn't feel guilty if she decides she's had enough and goes onto the bottle, although she's still keen to make it work. She has been receiving so much conflicting advice, it's so hard for a new mum whose confidence has been knocked. Another thing, she has been told to feed 15 minutes on each boob. I never fed more than one at a time. Surely she isn't allowing her nipples a break if she does this? and maybe he isn't getting enough hind milk to keep him satisfied. I'm sorry I've gone off the thread but I would be really grateful if anyone could advise me how best to help her - and especially about the thrush/ antibiotics whilst feeding. Or any thoughts.

Thank you...

Also.........
I breast-fed mine till 16 months and 18 months, neither keen to give up and no.2, now just 2 still looks at them wistfully and says "your boobies, eat them?!" No. 3 was due yesterday and I have literally been pregnant or breastfeeding, with no break since March 1997. I can't believe it. Altho' it was only one bedtime feed at the end I wonder if I have ever got back on to an even keel, (if I was ever on one!) since I began this motherhood mallarky.

I've seen thrush in the breast lots of times. She needs to get a script from her gp for nystatin drops for the baby and some nystatin or daktarin cream for her.She needs to rinse the babys mouth with cooled boiled water after each feed and then give the drops.She should change her bra daily and give it a very hot wash and dry outside or in a very hot place to kill the bugs. She should also try to exclude sugar,mushrooms and tomatoes from her diet.
If the baby needs more milk after breast then she should give expressed breast milk(ebm).If she gives milk that she has expressed after a feed then this is hind milk which has very high fat content and will help weight gain.try to have milk ready in the fridge which has been expressed earlier.
I think she should seek advice from a breast feeding clinic if she lives in London or Oxford I know of ones there.
I hope this is of some help,mothers just don't get good support and advice in this country

Qd - I would strongly recommend the short-term use of nipple shields for your friend. I too suffered from sore and bleeding nipples with child no. 1, and found that nipple shields meant I could continue breeastfeeding (relatively) painlessly. They are, however, only designed for short term use because extended use would hinder the overall milk production cycle.

Anyway - they certainly worked for me, because after a pretty uncomfortable start, I continued to breastfeed child no 1 until he was over two years old, and no. 2 is still going stong at 14 months.

Boo321 is absolutely right. My SIL just had thrush as well... it was horrible, get it treated... It is hell to breastfeed in these conditions and she will need all the support she can get (including moral support : understanding and encouragement).

Nipple shields help but it will still be painful. She could try calendula lotion on her nipples after a feed and then breast in the open air (for a few minutes at least).

She needs to gets professional support from a breastfeeding councellor - in her case it will be worth it (if she is keen to continue). Also she must be careful to make sure she doesn't feed on every cry (as all cries are not necessarily for food - common error of first time mums...) and she needs to make sure (as Boo321 says) that the baby gets the hind milk... that requires at least a good 5 to 10 minutes on a breast - she can always express the rest of her milk from a breast and give it to the baby later.
Good luck

QD - I should add that with DS I breastfed each time 20 minutes on both sides... he was very hungry and gained 8 oz every week ! With DD I am breastfeeding 1 side 7 minutes ! She is also gaining a lot of weight (but clearly doesn't want any more)... so every child is different.
With DS I was also finding it very painful (even though I didn't have a thrush problem), I had sore, cracked nipples. For me it was painful for 6 weeks and I found that by expressing a feed at 11PM when he was getting his last feed, I could

1. get a break from his sucking
2. get hubby to give a bottle (he liked that)
3. prepare to go to bed in a more relaxed atmsophere... I did have to get up in the middle of the night anyway.

Hope this helps.

If the thrush is deep in the breast, then oral antifungals will be required. Cream isn't sufficient as it can't reach inside to the ducts where the bug lurks. The counsellor may have a leaflet about thrush while breastfeeding, or your friend may be able to get one from the Breastfeeding Network. (Sorry, I don't have a contact number for them.)

As regards expressing, it's worth being aware that if you feed the baby with milk expressed and frozen when you have thrush, you can reinfect the baby and consequently yourself, if you then use the milk at a later date. My friend couldn't understand why she kept getting reinfected, until she twigged what was going on!

I breast fed my first 2 children for 1 year (I used to take a pump to work to express the milk for the next day at the creche). The second 2 children (i.e; 3 and 4) I fed 8 months each, also expressing milk at work but I had built up such huge reserves in the freezer that they were still on breast milk until they were over 10 months old.

I think tooth decay is an inheritable characteristic- I have very strong teeth but my brother always had dreadful teeth as a child. My first child also has dreadful teeth whereas the other 3 all have strong teeth.

Thank you all for this advice. I am really worried about her and it will be great to pass on this positive feedback. Poor girl, I spoke to her this morning, hoping she'd have had a better weekend only to find she's now developped mastitis and was being sick all weekend. Thank you again..

QD - I have found this as well on another website.
WHAT IS THRUSH:

Thrush is a yeast infection of the throat and mouth of an infant or the nipples of a nursing mother. Candida albicans is normally present in our bodies, but certain circumstances (such as stress, a weakened immune system or use of antibiotics) may cause it to reproduce wildly and colonize the vagina, intestines, diaper area, throat, mouth, nipples and/or skin folds of the host.

SYMPTOMS OF THRUSH:

In Baby:

Red, irritated skin patches in the creases of the baby's neck, thighs, and arm pits; white patches and/or sores on the inside of the mouth, cheeks, or tongue; refusing the breast or a reluctance to nurse (due to pain); a white pasty discharge in the folds of the vagina; an angry red diaper rash (looks scalded) possibly with pinpoint sized bumps; baby may be irritable and gassy. The baby may also be without symptoms. A mother may have thrush on her nipples even if her baby has no sign of it!

In Mother:

Prolonged or sudden onset of sore nipples during or after the newborn period; pink, flaky, crusty and itchy or red and burning nipples; cracked and possibly bleeding nipples; a vaginal yeast infection (or history of). An intense stabbing or burning pain in one or both breasts during or just after a feeding may indicate a secondary yeast infection has developed within the milk ducts (especially common with cracked nipples). NOTE: Nipple yeast may be combined with other causes of soreness such as eczema.
The sooner you catch this annoying little yeast the easier it will be to get rid of it. mother and baby both need to be treated for at least two weeks after all symptoms have cleared.

COMFORT MEASURES:

What can you do while you're waiting for the treatment to take effect? If the pain is really bad try these comfort tips:

• rinse nipples with clear, cool water and air dry after every nursing, thrush thrives on moisture and the sugar (lactose) in breastmilk.
• offer short, frequent feedings, nurse on the least sore side first (if there is one); if necessary, suspend nursing on a particularly sore breast for 24 hrs. (carefully hand express to prevent mastitis).
• don't let baby slide off the nipple, make sure you break the suction first by inserting your (clean) finger in the corner of baby's mouth.
• A salve made with goldenseal, calendula, plantain, burdock, and chickweed will heal cracked and inflamed nipples.
• Lansinoh for Breastfeeding Mothers heals & protects sore, cracked nipples.

HOME TREATMENT:

I don't like to take a lot of drugs but there is no substitute for prompt treatment when it comes to thrush. However there are some natural treatments for thrush that may speed your recovery (most are available through your local health food store or co-op):

GENERAL RECCOMENDATIONS:

• Yeast thrives in dark, moist places. Exposure to fresh air and sunlight is one of nature's best cures. Outdoors and naked for hours is most effective but even 10 minutes of sunlight through a window will work. Go braless as often as possible. I had thrush off & on for years, what finally got it to go away and stay away was when I quit wearing a bra.
• Keep baby's bum dry; let baby go diaperless as much as possible, eliminate rubber pants; use 100% wool or cotton covers (but limit time in them to when wet clothes would be unacceptable); change diapers promptly.
• Breast shells (for inverted or sore nipples) may contribute to yeast overgrowth - stop using them or, if you must wear them, make sure to boil for them 20 minutes every day to kill the yeast.
• Use excellent hygiene. Wash you hands after you change baby's diapers, touch your nipples, or touch the baby's mouth. This will prevent the thrush from spreading.
• Use towels, bras and breast pads only once, wash in HOT water, and use 1/4 cup vinegar in the rinse water (for all your laundry) to help kill yeast - weather permitting hang them in the sun to dry (the sunlight kills yeast); same thing for diapers.
• Avoid dairy (except yogurt), sugar and yeast containing foods and supplements like the plague. Stay away from highly processed foods, baked goods, heavy starches, wheat, sugars, honey, fruit and fruit juices. Eat organic grown, fresh vegetables, meats, beans and whole grains while you are treating the infection. And, as always, drink plenty of distilled water to keep up your milk supply (a good guide is 1/2 oz/lb of body weight, more if you are very active).

ORAL & NIPPLE THRUSH:

• Gentian Violet solution, 1% swab on nipples and inside babies mouth once daily for up to four days, you should feel an improvement by the 3rd day, if not stop. May be used up to seven days if needed but no longer. NOTE: this remedy will stain everything purple (just like iodine stains things red) so wear old clothes.
• Lactobacillus acidophilus and/or Lactobacillus bifidus supplements (look for them in the coolers, they need to be refrigerated to maintain potency). Infants and toddlers should be given bifidus rather than acidophilus, there are many bifidus supplements made just for kids. Lactobacillus is a "friendly" bacteria that keeps yeast growth in check.
• yogurt, homemade is best but acidophilus yogurt is a close second. Eat it, smear it on your nipples, freeze small cubes of yogurt & let baby mouth them, coat the inside of your baby's mouth with it after each feeding - dip a clean finger in the yogurt and let your babe suck it off or smear the yeast patches with yogurt on a cotton swab (do not double dip, you will contaminate the yogurt - throw it away after 1 application!). Take special care not to contaminate your yogurt with thrush!
• Garlic, garlic, garlic! Use fresh garlic in your cooking or take a garlic supplement (unsolicited product endorsement: Try Kwai brand, orderless - extra potent).
• Rinse nipples with an organic, raw apple cider vinegar solution made from 1 tablespoon vinegar in 8 oz of water. WARNING: may sting if thrush is severe.
• Dissolve a level teaspoon of baking soda in 8 oz of water. Use a fresh cotton swab to wipe the insides of your baby's cheeks, gums, and tongue after every nursing - bathe your nipples after every nursing too. Make a fresh solution every day. WARNING: some health care providers worry about the baby ingesting too much salt with this method - use your judgement.
• large quantities of vitamin C (1 gram every 2 hours for a week or longer if immune system is very weak) is said to discourage the growth of yeast.
• Caprylic acid, take according to directions.
• Grapefruit seed extract is supposed to be good for stubborn cases.
• Black Walnut (tincture), painted in baby's mouth and on mom's nipples 2-3 times a day. In stubborn cases mom can also take the tincture internally, 10 to 15 drops 2-3 times a day. Be careful near clothing, it stains!
• Pau d'Arco tea 2-3 cups daily. Pau d'Arco is a South American tree that resists fungus growth.

And I also found this FAQ from La Leche League : www.lalecheleague.org/FAQ/FAQthrush.html

Sarenka - From all the research I've done on the Internet I have found that around age 7 is the maximum age for breastfeeding. This tends to be in countries where diet is poor and the child relies upon the mother's breastmilk. I wouldn't worry about it if you are happy to carry on - she will grow out of it in time. There is no 'natural' age of weaning as such but some anthropologists believe that in modern society we do wean very early. It is argued that a child's immune system takes 4-5 years to develop and that breastmilk is beneficial for toddlers in just the same way as it is for very young babies. Also the age of 7 seems to coincide with the arrival of adult teeth. I've got loads of stuff on this - it is all very interesting.

Qd - you have a brave friend! Timing feeds is a complete myth - take as long as you like - I used to take 45 mins - 1 hour to feed my newborn. Some say use the last breast first on the next feed as this means that the hind milk is more accessible then shift to the other one and start again with that one next time. I tried this but often forgot which boob was which! .... but try not to get too worried about it. As Boo says she should try expressing to get the hind milk and also to keep the supply going. Feeding formula just means that the breast is not being stimulated and therefore the supply not increasing. Also mastitis is best cured by continuing to feed as giving up suddenly can make the situation worse.

There is no reason why she can't take antibiotics if this is necessary (it may be for the mastititis (thrush should go away anyway). I am afraid most doctors don't know a great deal about breastfeeding and tend to err on the side of caution and not prescribe. If a drug is safe to be given during pregnancy then it is safe for breasfeeding as the baby gets much less of the drug that it does in the womb. I was prescribed antibiotics when I was 37 weeks when I had flu. Thrush is quite common and it is a shame that this doctors idea of a 'cure' is just to give up breastfeeding! She should seek a second opinion and get support from a lactation consulatant. La Leche League is a worldwide organisation which has local counsellors. They have a great website at www.lalecheleague.org/ which gives contact details and also has lots of information.

Is she positioning the baby properly? I had this problem where my son was only sucking the nipple and hence causing pain. Baby should have all of the nipple and some of the aureole in his mouth too.

The first 5/6 weeks are the worst and if she can get through them then it gets much easier. It can feel like hell at the time but knowing that it won't last does help. Keep us informed.

Qd - you could pass this onto your friend (from LLLI website)

FAQ on Mastitis (Sore Breasts)

----------------

Our FAQs present information from La Leche League International on topics of interest to parents of breastfed children. Not all of the information may be pertinent to your family's lifestyle. This information is general in nature, and not intended to be advice, medical or otherwise. If you have a serious breastfeeding problem or concern, you may want to talk to a La Leche League Leader directly. Please consult health-care professionals on any medical issue, as La Leche League Leaders are not medical practitioners.

My Breast Hurts. What Can I Do?
For someone who is new (or not so new) to breastfeeding, a sore breast can be a painful and alarming experience. A mother with a sore breast may be told she has a breast infection or mastitis. (The terms breast infection and mastitis are often used interchangeably.) Breasts can become sore when milk is blocked from flowing. A plugged milk duct may decrease the flow of milk from a section of the breast. However, once the milk is flowing the soreness will decrease. Sore breasts can occur after an illness, such as a cold, goes through the family, or during a particularly busy or stressful time, or just without warning.

What do all these terms mean?

Sore breast—Occurs when the milk flow blocked. Breast feels tender. There may or may not be redness or a hard spot in that area of the breast.

Plugged duct—Milk flows through a duct system in the mother’s breasts. Sometimes an area of the ducts becomes blocked and milk no longer flows as well. A section of the breast may or may not be red. When a mother has a plugged duct, her breast is usually tender and painful. If the blockage is not treated, the area may become infected.

Breast infection—A sore breast or plugged duct can become a breast infection. This means that not only is the breast tender, but also the mother feels achy, run-down and feverish. Mastitis is another term that may be used. This condition may or may not be treated by antibiotics.

Whether coping with a sore breast, a plugged duct or a breast infection, the initial care is similar. Nurse frequently, rest and apply heat to the tender area.

Frequent nursings serve to provide comfort, reduce inflammation and encourage opening the blocked area. Mothers find that varying breastfeeding positions more effectively drains all areas of the breast. For example, if you most commonly use the cradle hold, try the clutch (“football”) hold or lying down to breastfeed. (Please note that it is a common myth that it is unhealthy for the baby to breastfeed when the mother has a breast infection. This is definitely not true. The antibacterial properties of human milk protect the baby from infection.)
Rest is an important component in recovery from sore breasts, plugged ducts or breast infections. To do this, try resting in bed with baby cuddled next to you. This will also encourage frequent breastfeeding sessions to drain the breast. Keep supplies such as diapers, toys, books, the telephone, a glass and a pitcher of water nearby to minimize trips out of bed.
Applying wet or dry heat with a heating pad or hot water bottle and gently massaging the sore area of the breast before breastfeeding can assist the breast in further emptying. Many mothers find that taking showers or baths and gently massaging with a warm cloth on the sore breast is a relaxing treatment during a stressful time. Another technique is to lean over a basin of warm water and soak the sore breast for about 10 minutes three times a day. This will also remove any dried milk secretions that may be blocking the flow of milk out of the nipple. Breastfeed immediately, while the breast is warm, to help unplug the blocked duct.
If fever and discomfort are still present after about 24 hours of rest, heat, massage and frequent nursing, then the mother may want to contact her health care professional. If a medication is prescribed, it is important to remind health care professionals that it should be compatible with breastfeeding. While the mother is on medication, continued rest, heat treatment and frequent breastfeeding will promote recovery. If an antibiotic has been prescribed, using the entire prescription will help to avoid recurrence of the infection.

Breastfeeding should continue during treatment of any of these conditions. If an infection is present, the baby is safe from any germs due to the antibacterial properties of human milk. Continuing to breastfeed when experiencing a sore breast, plugged duct or breast infection will speed recovery.

In order to prevent future plugged ducts or breast infections, the breastfeeding mother may find it helpful to be cautious of sudden long stretches between nursings. A poorly fitting bra, or a bra that constricts (such as an underwire bra) may contribute to plugged ducts. Heavy purses, diaper bags and baby carriers can also contribute. When breastfeeding, periodically changing the baby' position, while maintaining good positioning will help to empty all the ducts around the breast. Maintaining general health through a healthy diet and getting extra rest may help the breast from becoming sore again.

I fed my daghter until she was 29 months and my son is almost 13 months and he now has only two breastfeeds a day.

I had no problems with my daughter and my son loves being breastfed (although he will take a bottle of milk from my partner when I am unavailable). However, my dilemma is that my doctor has advised me to stop breastfeeding because I am experiencing recurrent illness and generally not on top of the world. He wants to prescribe medication that will not be conducive to breast feeding. (My reaction to this is, if it's not safe for my baby what will it do to me?) To be honest this goes utterly against the grain but having had homeopathy, reflexology and vitamin supplements which have not worked this time (but ALWAYS have in the past) I am at a loss (any advice would be greatly appreciated). I have high blood pressure. I enjoy breastfeeding and the baby loves it and frankly I am offended that my doctor talks to me as if I am 'a silly little girl' because I am still breastfeeding. I also think that the stress involved in trying to wean a baby who clearly loves being breastfed will not help my condition.

Rivi, longterm breastfeeding is a wonderful experience for both mother and baby but in my experience it is often other peoples responses that are negative. My daughter (now 11)is frequently reminded by my family that she was fed for such a long time (only at bedtime in the end)as if there was something wrong with her!