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Make a list of what you want to know, what you need to know, and what you already know about this subject.

Engorgement, sore nipples, breast infection, and an abscess - one breast trouble can certainly lead to another, more complex problem. It’s necessary to know how to identify these problems and learn how to prevent them early.

Your breasts can become distended on both sides when the milk comes in, or after a longer than normal wait between feedings. Engorgement can be uncomfortable, but is relieved by breastfeeding. A plugged milk duct is different. You may slowly develop hard areas in one breast, which hurt when you feel them.

Sometimes the whole breast gets involved. Your breast usually will not feel warm, but your temperature may go up to 100.5F (38C). Germs multiply in milk clogged in the ducts, setting the stage for a breast infection (mastitis). You possibly have a breast infection if you get a fever of 101F (38.5C) or more, sometimes accompanied by chills, have little energy and feel flu-like pain in your arms and legs. The breast also changes: Infected areas appear as red patches, and the skin is hot, puffy and very sore to the touch.

If the infection is left untreated, the infected areas may form abscesses - fluid-filled lumps under the skin. Abscesses require to be drained by a doctor. A woman can continue to breastfeed even if she has had an abscess treated surgically. Often the cut is made well away from the nipple, so uncomplicated breastfeeding is still possible.

Likely Causes

1. The time between feedings is too long, and the milk ducts have become too filled. They push against each other and can’t clear.

2. Tension, insecurity and ache inhibit the let-down reflex.

3. Emotional troubles, conflicts, difficulties adjusting to parenting, societal pressures and stress, among other things, can inhibit milk flow and produce engorgement.

4. External obstacles (such as a tight bra or poorly adjusted straps from a baby carrier), press into the breast and stop milk from flowing in certain areas, plugging ducts.

5. A milk-duct opening at the nipple may be plugged with dried milk.

6. Bacteria have multiplied in a milk duct because of an infected nipple.

7. Your immune system may be taxed for any number of reasons: exhaustion, poor nutrition, medication or a job. You may be overdoing it with too much attention to external responsibilities and too little time for rest.

8. The baby doesn’t drink well because he has a cold, is teething or is being distracted too much.

If your breast is swollen, painful, red and you have a temperature, you might try some of these remedies. The sooner you intervene, the better:

1. Remain calm! Go to bed with your baby, and ask somebody to take care of you for a day or two. If you can’t rest in bed, at least take it easy for a couple of days.

2. Keep your breast empty! Breastfeed twice as often as usual - every one or two hours so your breast doesn’t get too full.

3. Position your baby so his lower jaw rests on the hard spot. For example, if the right side of the right breast has a hard spot, position your baby so his legs are cuddled along the right side of your body. If the upper side of your breast is swollen and painful, then your baby’s legs need to lie above your shoulders (while you lie stretched out on your back). It sounds impossible, but give it a try - it works! You can also knead milk out of the engorged ducts, though nothing is as helpful and powerful as the baby’s sucking.

4. Use ice packs between feedings to lessen the ache, and warm compresses just before the feeding to open milk vessels. Employ the warmth directly on the breast. Often milk begins to flow because of the heat even before the feeding begins. Hot-water bottles are not appropriate because they are heavy - their weight on the breast can inhibit milk flow instead of support it.

5. Employ “nurturing touch” to your breasts and envisage you are dissolving all the tension and engorgement at the painful spot and getting your milk to flow well.

6. How about treating yourself to a warm foot bath? Foot baths can decrease feelings of stress in your whole body.

7. Place a small brown paper sack packed with warm, slightly mashed baked potatoes in their jackets - or a compress of cool, raw, white cabbage leaves - on the breast outside the areola. These remedies can lessen swelling swiftly, often within hours. Replace wilted cabbage leaves with fresh, chilled ones after a few hours.

8. Add essential oils of yarrow, chamomile blue or lavender essence to cottage cheese or honey. Spread the mixture on your breast and cover it with a light cloth to help shield the breast and inhibit infection.

9. It can help to drink two cups of fenugreek-seed tea (use 1 heaping teaspoon of seed to 1 cup hot water). After sipping the tea, you can reuse the seeds as a compress on the breast.

10. Avoid wearing tight clothing. Some restrictive clothing can inhibit milk flow in the ducts. If it is not too uncomfortable, try to go without a bra for a few days, or wear one that is a size larger.

11. If the duct is plugged by dried milk at the nipple opening, bathe the nipple with water to dissolve the milk residue.

12. Nurse the baby on the affected side first and often to keep the breast as empty as possible.

13. Many nursing troubles have emotional origins. Perhaps you feel overwhelmed or insecure. Maybe your husband is jealous of the attention your baby is getting and that bothers you. Maybe you have mixed feelings about certain people who’ve announced a visit. If something is bothering you, admit it to yourself. Then look for somebody you can trust and who listens well. Talking with someone can often solve the problem. You and your good health are at stake. Ponder whether your body may be telling you that you’ve tried to do too much.

14. You might try a homeopathic remedy under the guidance of a specialist. Let the practitioner know you are breastfeeding.

15. You may want to try Bach Flower remedies. Could there be internal, emotional reasons for the breast infections? A trained therapist may be able to help you select an effective remedy based on your answer.

16. You and your practitioner may choose to use antibiotics if other remedies do not affect the swelling or pain, or if a true infection occurs.

Continue breastfeeding. Breast infections can be cured within three days with frequent nursing, bed rest, warm and cold compresses and antibiotics. Women who wean regularly have pain and infection for quite a while longer.