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There are a number of potential risks associated with breastfeeding, including:

• Thrush. This condition is caused by overgrowth of the fungus Candida. Although Candida usually exists in the human body, an overgrowth can cause an infection. This fungal infection thrives on milk. As a result, it can form on the nipples or in the breast. Signs of thrush include sore nipples, and pink, flaky, itchy or cracked nipples. The condition may also cause shooting breast pains during or after breastfeeding, or achy breasts. The mother should be treated quickly for this condition.
The infection can also develop in the baby’s mouth, as a result of having contact with the nipples. Signs of oral thrush include small white spots on the inside of the cheeks, gums or tongue. It can also appear as a diaper rash that will not respond to treatment with diaper rash ointment. Antifungal medications can be used to successfully treat thrush in a mother and her baby.

• Breast infection (mastitis). Breast infections are usually caused by Staphylococcus aureus, a bacterium commonly found on the skin. The infection may develop as a result of the bacteria entering the breast tissue through a break or crack in the skin, usually the nipple. Mastitis can cause soreness or a lump in the breast. The infection is often accompanied by a fever and flu-like symptoms, such as fatigue and achiness. In some cases it may also cause nausea, vomiting and discharge from the nipple. The breasts may appear pink or red and feel warm or hot to the touch. In severe cases, pus or blood may be found in the milk and there may be red streaks near the area of infection. It usually affects one breast, but can affect both. Mastitis is commonly treated with antibiotics.

• Nursing strike. Some babies may refuse the breast after months of successful breastfeeding. Known as a nursing strike, a baby's loss of interest in nursing can be due to several factors. Common causes include pain, distraction and distress. With patience and persistence, however, a baby will usually return to accepting the breast. Although a nursing strike may cause feelings of frustration or distress, a nursing mother should not feel guilty about the strike.

• Vitamin D deficiency. Babies who breastfeed or are fed formula are at risk for vitamin D deficiency (not having enough vitamin D) and rickets (a condition in which the bones are softened and weakened due to a lack of vitamin D). The American Academy of Pediatrics (AAP) recommends that all babies who are exclusively breastfed and those who are fed formula receive at least 200 International Units (IU) of vitamin D every day. The vitamin D should be given during the first two months of life, and continue into adolescence. Women should discuss vitamin D supplements with their baby’s pediatrician.

Patients should discuss these risks with their obstretician-gynecologist (ObGyn) and their baby’s pediatrician. The physician may be able to offer prevention information. Women who suspect thrush, mastitis or a nursing strike should contact their ObGyn and their baby’s pediatrician for diagnosis and treatment. If any of these conditions return after treatment, the mother may benefit from meeting with a lactation consultant or peer counselor.