What is breast engorgement, and what causes it?

Breast engorgement is the painful overfilling of the breasts with milk. This is usually caused by an imbalance between milk supply and infant demand. This condition is a common reason that mothers stop breast-feeding sooner than they had planned.

Engorgement can happen:

• When milk first "comes in" to your breasts, during the first few days after birth.
• When you normally have a regular breast-feeding routine but cannot nurse or pump as much as usual.
• If you and your baby suddenly stop breast-feeding.
• When your baby's breast-feeding suddenly drops, either when your baby is starting or increasing solid foods or when the baby is ill with a poor appetite.

Your breasts start making milk for your baby about 2 to 5 days after your baby is born. When your milk comes in, your breasts will most likely feel warm and heavy. Some women feel only slight swelling. Others feel uncomfortably swollen.

Early breast fullness is completely normal. It occurs as your milk supply develops and while your newborn has an irregular breast-feeding routine. The normal fullness is caused by the milk you make and extra blood and fluids in your breasts. Your body uses the extra fluids to make more breast milk for your baby.

If you don't breast-feed after your baby is born, you will have several days of mild to moderate breast engorgement. This gradually goes away when the breasts are not stimulated to make more milk.

Overfilled breasts can easily become very swollen and painful, leading to severe engorgement. Common causes of severe engorgement are:

• Waiting too long to begin breast-feeding your newborn.
• Not feeding often enough.
• Small feedings that do not empty the breast well. Babies who are fed formula or water are less likely to breast-feed well.

Severe engorgement can make it difficult for your baby to latch on to the breast properly and feed well. This can make the problem worse. As a result:

• Your baby may not receive enough milk.
• Your breasts may not empty completely.
• Your nipples may become sore and cracked. This is caused by your baby's attempts to latch on to your overfull breasts. If you then breast-feed less because your nipples are sore, the engorgement will increase.

Without treatment, severe engorgement can lead to blocked milk ducts and breast infection, which is called mastitis.

What are common symptoms of breast engorgement?

Engorged breasts:

• Are swollen, firm, and painful. If severely engorged, they are very swollen, hard, shiny, warm, and slightly lumpy to the touch.
• May have flattened-out nipples. The dark area around the nipple, called the areola, may be very hard. This makes it difficult for your baby to latch on.
• Can cause a slight fever of around 100 F.
• Can cause slightly swollen and tender lymph nodes in your armpits.

How can you prevent breast engorgement?