Common Causes of Breastfeeding Issues: Insights from a Tongue Tie Doctor

As a doctor with a special interest in tongue tie releases and circumcisions, I frequently encounter families struggling with breastfeeding. Understanding the underlying causes of breastfeeding difficulties is essential for effective support and intervention.

Here are the most common reasons breastfeeding can become challenging, and how timely recognition can make a difference for both mother and baby.

Figure 8.1: Common causes of Breastfeeding Issues

1.  Incorrect Attachment or Latch

   The most frequent cause of breastfeeding problems is poor positioning or latch. When a baby is not attached well to the breast, it often leads to nipple pain, ineffective milk transfer, and even nipple trauma. This can quickly spiral into low milk supply and unenjoyable feeding times if not addressed.

2. Mastitis and Blocked Ducts

   Mastitis is inflammation of the breast, typically resulting from blocked milk ducts. Causes include missed feeds, poor drainage, tight clothing, or trauma. Symptoms range from breast pain and redness to swelling and flu-like symptoms.

3. Nipple and Breast Infections

   Infections such as thrush (a fungal infection) or bacterial infections can cause pain, redness, and discomfort. If left untreated, these infections may lead to early weaning.

4. Nipple Vasospasm

   Nipple vasospasm occurs when the blood vessels in the nipple constrict, often triggered by cold or a history of Raynaud’s phenomenon. This leads to intense pain, burning, or throbbing, sometimes so severe that mothers consider stopping breastfeeding. Keeping nipples warm and ensuring a good latch can help reduce symptoms.

5. Tongue Tie (Ankyloglossia) and Upper Lip Ties

   A Tongue tie, (a short or tight frenulum under the tongue) or a lip tie, (a short or tight frenulum under the lip), can restrict the baby's tongue or lip movements, making it difficult to latch and feed effectively. This can result in nipple pain, poor milk transfer, and frustration for both mother and baby. While tongue tie and lip tie is a recognized cause of breastfeeding issues, it is important to have a thorough assessment, as not all feeding problems are due to tongue tie.

6. Engorgement or fast Flow

   When breasts become overfull, they can be painful and/or make latching difficult. This sometimes leads to blocked ducts or mastitis if not managed promptly.

7. Low Milk Supply

   Low supply may result from infrequent feeding, poor latch, or underlying maternal health issues. Early intervention is key to restoring supply.

8. Insufficient Glandular Tissue (IGT) or mammary hypoplasia

   Insufficient Glandular Tissue (IGT), also known as mammary hypoplasia, refers to a condition where the breast does not develop enough milk-producing (glandular) tissue. This can occur during several developmental stages, including in utero, puberty, or pregnancy and can result in the inability to produce an adequate milk volume, regardless of correct breastfeeding management and frequent feeding.

   Even with perfect technique and enough breastfeeding sessions, parents with IGT may not make enough milk to fully nourish their baby

9. Nipple Shape or Trauma

   Flat, inverted nipples, or damaged nipples, can make breastfeeding more challenging.  They can make it harder for babies to latch and breastfeed effectively, which may lead to issues like poor milk transfer, nipple pain, and low milk supply. With extra support and proper techniques, many breastfeeding challenges related to nipple shape or damage can often be overcome.

10. Other Contributing Factors

    Exhaustion, emotional stress, and maternal health problems can also impact breastfeeding success. Fatigue and stress may disrupt the hormonal processes needed for milk production and let-down, while health issues like thyroid disease or postpartum depression can further hinder lactation and make feeding more challenging. Comprehensive support, proper rest, treatment of health conditions, and access to lactation professionals are crucial in helping mothers overcome these obstacles and establish successful breastfeeding.

11. Birth Trauma

    Birth trauma can cause breastfeeding issues by making it physically painful for mothers to nurse, interfering with a baby’s ability to latch and feed, and causing separation that disrupts bonding and milk supply. Emotional stress or psychological trauma from a difficult birth can further hinder milk production and make breastfeeding emotionally challenging, leading to early cessation or ongoing difficulties.

Early recognition of these issues and seeking support from healthcare professionals - such as lactation consultants, osteopaths, chiropractors, speech pathologists or tongue tie specialists - can make a significant difference in breastfeeding outcomes. If you are experiencing persistent pain, difficulty with latch, or concerns about your baby’s feeding, don’t hesitate to reach out for professional guidance.

For further support, consult a lactation consultant or a healthcare professional experienced in breastfeeding challenges and tongue tie management.

Book a Consultation with Dr Carly Hupfeld

Whether your child has a tongue tie or lip tie, or you’re seeking an assessment, we’re here to support you in making the best choice for your family.

Dr. Carly Hupfeld specialises in circumcision and the assessment and management of oral ties at:

Medical On Robina

T3/299 Scottsdale Dr, Robina QLD 4226

(07) 5690 1290

Reference List

1. Pregnancy, Birth and Baby. Nipple vasospasm and breastfeeding. Australian Government. Found at Nipple vasospasm and breastfeeding - symptoms, causes, management | Pregnancy Birth and Baby

2. The Royal Women’s Hospital. Nipple vasospasm. Accessed July 15, 2025. Found at: Nipple vasospasm | The Royal Women's Hospital

3. Better Health Channel. Mastitis and other nipple and breast problems. Victorian State Government. Accessed July 15, 2025. Found at:  Breastfeeding – mastitis and other nipple and breast problems | Better Health Channel

4. La Leche League International. Tongue and lip ties. Found at: Tongue and Lip Ties - La Leche League International

5. Cleveland Clinic. Tongue-tie (ankyloglossia): symptoms, causes & treatment. Found at: Tongue-Tie (Ankyloglossia) Symptoms, Causes & Treatment

6. Arbour MW, Kessler JL. Mammary hypoplasia: not every breast can produce sufficient milk. J Midwifery Womens Health. 2013;58(4):457-461. Found at: Mammary hypoplasia: not every breast can produce sufficient milk - PubMed