Go through these in order and stop at the first one that applies. If you are reading this for someone else, answer for them.
1
Is any of this happening now?
Call 911
Emergency care is rarely needed for engorgement alone.
Seek emergency help for confusion, fainting, trouble breathing, severe weakness, inability to keep fluids down, or other signs of serious illness.
Other emergency signs, for anyone
Someone who is struggling to breathe, gasping, choking, or cannot get words out
Someone who has chest pain, tightness or pressure lasting more than a few minutes
Someone who has sudden weakness or drooping on one side of the face or body, slurred speech, or sudden confusion
Someone who is unconscious, or cannot be woken
Someone who is bleeding heavily and it will not stop with firm pressure
Someone who has had a seizure that will not stop, or does not wake up afterwards
Someone who has lips or skin that look pale, blue, grey or blotchy
Someone who you believe has taken an overdose or swallowed something poisonous
2
Is any of this happening?
Be seen today
Seek prompt medical advice for:
Fever, chills, body aches, or feeling increasingly unwell
A localized area of redness, warmth, or pain that is worsening
Pus or unusual drainage from the nipple or damaged skin
Severe pain or swelling that prevents feeding or expression
Symptoms that persist or worsen despite conservative care
A soft or fluid-like lump that may represent an abscess
The baby also needs prompt assessment if feeding is consistently ineffective, the baby is difficult to wake for feeds, urine output decreases, the mouth appears dry, or there are concerns about weight gain.
3
Does any of this apply?
Book an appointment
Routine follow-up with an obstetric clinician, midwife, primary care clinician, pediatric clinician, or lactation professional is appropriate if engorgement keeps returning, feeding remains painful, or the baby has difficulty latching.
Arrange an assessment if a breast lump persists after feeding or if symptoms are not beginning to improve with supportive care.
Every sign above is quoted from the sofidex article on Breast engorgement. If you are not sure, err upward — it is always reasonable to be checked.