Pain in the breasts may be caused by engorgement, a plugged duct, mastitis or something else.
It is often difficult for a mother (and doctor) to tell whether the inflammation is due to engorgement or a plugged duct, neither of which needs antibiotics, or mastitis, which usually, but not always, requires antibiotics.
Use the guidelines in the chart to help you figure out what the problem is and how to treat it.
Use the links to find additional information on how to relieve sore breasts.
SORE BREASTS: STAGES OF SEVERITY
| FEATURES | NORMAL BREAST FULLNESS | ENGORGEMENT | PLUGGED DUCT | MASTITIS |
| Usual onset | 2-4 days after birth | Within the first two weeks | Most noticeable after feedings | Most common around third week postpartum; may occur at any time during lactating. |
| Where/Location | Both breasts | Both breasts | Localized area in one breast | One breast |
| Breasts feel: | Generally swollen, uncomfortable, not hard, but tight | Hard, swollen, sore, warm | Mildly tender lump beneath areola, reddened skin above | Very painful: hot, tender, swollen, red streaking |
| Maternal fever | None | 101 or below | None | Higher than 101 |
| Mother generally feels: | Well | Well | Well; may see a white milk plug in a nipple opening. | Achy, tired, chills, “like I’ve got the flu.” |
| Treatment | Frequent, unrestricted feeding, empty breasts | Frequent, unrestricted feeding, empty breasts alternating warm and cold compresses; rest | Frequent, unrestricted feeding; moist, hot packs, massage plugged duct to loosen plug and encourage milk flow | Frequent, unrestricted feeding, empty breasts; rest, relaxation; physician may prescribe antibiotics |