Expert: Sally Wendkos Olds - 4/3/2009

Question
Hi!  I have a 12 month old son that I am working on weaning from the breast.  I have been down to 3x per day for two weeks and was ready to drop to to 2x per day, but early this week I developed a plugged duct.  I believe that I got the plug to move quickly through warm compresses and massage, but 3 days later my breast is still sore and tender to the touch. (It is not red or hot or hard, just sore)
My question is... should I continue nursing 3x per day until the soreness is gone? Or is this just how weaning is going to be, so I should just go ahead and drop to two?  I don't know whether the soreness means there is still a small plug, or if it is just still recovering from the plug that moved.
thanks for any advice you can give!

Answer
Dear Amy,

First, congratulations for giving your son the best start in life by breastfeeding him!

On your plugged duct, no, this is not supposed to go along with weaning! However, in view of the problem you're having, I would suggest that you continue nursing 3x a day for a few more days. I am attaching an excerpt from my book (see below), and I hope some of these suggestions work. But if they don't bring relief in a couple of days, I urge you to see a lactation consultant or your ob/gyn. You don't want this condition to deteriorate into a breast infection. Also, there's no reason why you should continue to be in pain!

Good luck!

Sally
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Sally Wendkos Olds
Author, THE COMPLETE BOOK OF BREASTFEEDING: Eiger & Olds, 3rd edition 1999, published by Workman Publishing & Bantam Books, and available in most public libraries, bookstores & La Leche League chapters. Now in revision for a fourth edition, with pediatrician Laura M. Marks, M.D.
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Clogged Duct (Plugged Duct, “Caked” Breasts)
In this condition, which can occur any time during nursing, one or more milk ducts are blocked so that the milk cannot pass through them. If you develop a clogged duct, you’re likely to find a small reddened lump on your breast that’s painful to touch. If not treated, this condition can lead to a breast infection, so take immediate measures, as suggested below.
• First, continue to nurse. If you stop suddenly, your breast is likely to get too full, the condition will worsen, and infection may result.
• Be sure your bra (or other clothing, like a T-shirt or sweater) is not so tight that it’s pressing on the milk ducts. Try a bra in the next larger size. Or try going without one, at least while you’re nursing. Also check other items that may be putting too much pressure on your breasts, like a baby carrier or a shoulder bag.
• Breastfeed more often and for a longer period of time, so that your baby can help you empty the breast, release the lump, and unclog the duct.
• Change your position with every feeding, so that the pressure of your baby’s suckling will hit different places on your breast, exerting pressure on different ducts.
• Express or pump milk from the affected breast after each feeding if your baby has not nursed long and vigorously, to get out as much milk as possible.
• If dried secretions seem to be covering your nipple openings, wash them off very gently after each nursing with a piece of cotton saturated with warm water.
• Offer your sore breast first, so that your baby will drain it more thoroughly.
• Apply moist heat several times a day (with a moist-heating pad, a hot water bottle, hot wet towel or washcloth, disposable diaper filled with hot water and squeezed out, or tub bath or shower). Be careful not to burn yourself!
* Gently massage the area of the clogged duct, especially after moist heat treatment.
* Try ultrasound at a physical therapy office or sports medicine clinic for one or two consecutive days. If the therapist is not familiar with this use of ultrasound, ask your lactation consultant to recommend the dosage.
• Rest as much as you can.
• Don’t wear a nipple shield, which will make it harder for your baby to drain your breast adequately.
• Don’t sleep on your stomach, which puts pressure on your breast.
• If your baby refuses to nurse on the breast with the clogged duct, see your obstetrician. There may be a changed taste in the milk from that breast, which may be a sign of an infection or other problem.
• If a lump remains for more than three days, see your obstetrician. While the lump is probably related to breastfeeding, it may not be and must be looked at promptly.
• If you repeatedly suffer from clogged ducts, consult a lactation specialist to reevaluate the way you’re holding your baby or the way your baby is suckling.