Sore Nipples

Many moms report that breastfeeding can be tender at first until both they and their baby find comfortable breastfeeding positions and a good latch. Once you have done this, breastfeeding should be comfortable. But it is possible to still have pain from an existing abrasion. Make sure to treat the wound so that it doesn’t get worse. Other problems can cause pain, including engorgement, infections, and Raynaud’s. Raynaud’s (Ray-NIHDS) phenomenon is a rare disorder of the blood vessels that can affect the nipples, causing painful breastfeeding in some women. You may also have pain if your baby is sucking on only the nipple. Gently break your baby’s suction to your breast by placing a clean finger in the corner of your baby’s mouth and try again. Your nipple also should not look flat or compressed when it comes out of your baby’s mouth. It should look round and long, or the same shape as it was before the feeding. If your baby is latched on correctly and sucking effectively, he or she should be able to nurse as long as he or she likes without causing any pain.

Tips:

• Don’t delay feedings, and try to relax so your let-down reflex comes easily. You also can hand-express a little milk before beginning the feeding so your baby doesn’t clamp down harder, waiting for the milk to come.
• If your nipples are very sore, it can help to change positions each time you breastfeed. This puts the pressure on a different part of the nipple.
• After breastfeeding, you can also express a few drops of milk and gently rub it on your nipples. Human milk has natural healing properties and emollients to soothe them. Also try letting your nipples air-dry after feeding, or wear a soft-cotton shirt.
• Wearing a nipple shield during breastfeeding will not relieve sore nipples. They actually can prolong soreness by making it hard for the baby to learn to feed without the shield.
• Avoid wearing bras or clothes that are too tight and put pressure on your nipples.
• Change nursing pads often to avoid trapping in moisture.
• Avoid using soap or ointments that contain astringents or other chemicals on your nipples. Make sure to avoid products that must be removed before breastfeeding. Washing with clean water is all that is necessary to keep your nipples and breasts clean.
• Try rubbing ultra-purified, medical-grade lanolin on your nipples after breastfeeding to soothe the pain.
• Make sure you get enough rest, eat healthy foods, and get enough fluids to help the healing process. If you have very sore nipples, you can ask your doctor about using non-aspirin pain relievers.
• If your sore nipples last or you suddenly get sore nipples after several weeks of unpainful breastfeeding, you could have a fungal infection that can form on your nipples from the milk. Make sure to see a lactation consultant and/or your doctor.

Ask for help if you have nipple pain during or after breastfeeding or if you still need help with getting your baby to latch on well. Sore nipples may sometimes lead to a breast infection, so it’s important to get help.

Engorgement

It is normal for your breasts to become larger, heavier, and a little tender when they begin making greater quantities of milk on the 2nd to 6th day after birth. Sometimes this fullness may turn into engorgement, when your breasts feel very hard and painful. You also may have breast swelling, tenderness, warmth, redness, throbbing, and flattening of the nipple. Engorgement sometimes also causes a low-grade fever and can be confused with a breast infection.

Engorgement is the result of the milk building up, and usually happens during the third to fifth day after birth. This slows circulation, and when blood and lymph move through the breasts, fluid from the blood vessels can seep into the breast tissues.

All of the following can cause engorgement:

• poor latch-on or positioning
• trying to limit feeding times or infrequent feedings
• giving supplementary bottles of water, juice, formula, or breast milk
• overusing a pacifier
• changing the breastfeeding schedule to return to work or school
• baby changing the breastfeeding pattern by beginning to sleep through the night or breastfeed more often during one part of the day and less often at other times
• having a baby that has a weak suck who is not able to breastfeed effectively
• fatigue, stress, or anemia in the mother
• an overabundant milk supply
• nipple damage
• breast abnormalities

Engorgement can lead to plugged ducts or a breast infection, so it is important to try to prevent it before this happens. If treated properly, engorgement should only usually last for one to two days

Tips:

• Minimize engorgement by making sure the baby has a good latch and is feeding effectively. Breastfeed frequently after birth. Allow the baby to feed as long as he or she likes, as long as he or she is latched on well and sucking effectively. In the early weeks after birth, you should wake your baby to feed if four hours have passed since the beginning of the last feeding. Breastfeeding often on the affected side helps to remove the milk, keep it moving freely, and prevent the breast from becoming overly full.
• Avoid supplementary bottles and overusing pacifiers.
• Try hand expressing or pumping a little milk to first soften the breast, areola, and nipple before breastfeeding, or massage the breast and apply heat (only use heat if the breasts are leaking freely, otherwise it may worsen the swelling).
• Cold compresses in between feedings can help ease pain. Some women use cabbage leaves to soothe engorgement. Although their effectiveness has not been proven, many women find them soothing. You can use either refrigerated or room temperature leaves. Make sure to cut a hole for your nipple, apply the leaves directly to your breasts, and wear them inside your bra. Remove them when they wilt and replace with fresh leaves.
• If you are returning to work, try to pump your milk on the same schedule that the baby breastfed at home.
• Get enough rest and proper nutrition and fluids.
• Wear a well-fitting, supportive bra that is not too tight.

Ask for help if the engorgement last for two days or more.

Plugged Ducts

It is common for many women to have a plugged duct in the breast at some point if she breastfeeds. A plugged milk duct feels like a tender and sore lump in the breast. It is not accompanied by a fever or other symptoms. It happens when a milk duct does not properly drain and becomes inflamed. Then, pressure builds up behind the plug, and surrounding tissue becomes inflamed. A plugged duct usually only occurs in one breast at a time.

Tips:

• You can help relieve soreness and speed healing by applying heat to the sore area. You can use a heating pad or a small hot-water bottle. Cabbage leaves should not be used for a plugged duct. It also helps to massage the area, starting behind the sore spot. Use your fingers in a circular motion and massage toward the nipple.
• Breastfeed often on the affected side. This helps loosen the plug, keeps the milk moving freely, and keeps the breast from becoming overly full. Nursing every two hours, both day and night on the affected side first, can be helpful.
• Getting extra sleep or relaxing with your feet up can help speed healing. Often a plugged duct or breast infection is the first sign that a mother is doing too much and becoming overly tired.
• Wear a well-fitting supportive bra that is not too tight, since this can constrict milk ducts.

Ask for help if the plugged duct is not loosening. It can turn into a breast infection.

Breast Infection

A breast infection, also called mastitis, is soreness or a lump in the breast that can be accompanied by a fever and/or flu-like symptoms, such as feeling run down or very achy. Some women with a breast infection also have nausea and vomiting. You also may have yellowish discharge from the nipple that looks like colostrum or the breasts may feel warm or hot to the touch and appear pink or red. A breast infection can occur when other family members have a cold or the flu, and like a plugged duct, it usually only occurs in one breast. It is not always easy to tell the difference between a breast infection and a plugged duct because both have similar symptoms and can improve within 24 to 48 hours. Most breast infections that do not improve on their own within this time period need to be treated with an antibiotic. Learn more about medicines and breastfeeding.

Tips:

• You can help relieve soreness and speed healing by applying heat to the sore area. You can use a heating pad or a small hot-water bottle. Cabbage leaves should not be used for a plugged duct. It also helps to massage the area, starting behind the sore spot. Use your fingers in a circular motion and massage toward the nipple.
• Breastfeed often on the affected side. This helps loosen the plug, keeps the milk moving freely, and keeps the breast from becoming overly full. Breastfeeding every two hours, both day and night on the affected side first, can be helpful.
• Getting extra sleep or relaxing with your feet up can help speed healing. Often a plugged duct or breast infection is the first sign that a mother is doing too much and becoming overly tired.
• Wear a well-fitting supportive bra that is not too tight, since this can constrict milk ducts.

Ask for help if you do not feel better within 24 hours of trying these tips, or if you have a fever or your symptoms worsen. You can see both a lactation consultant and your doctor since you might need an antibiotic. If you have a breast infection in which both breasts look affected, or if there is pus or blood in the milk, red streaks near the area, or your symptoms came on severely and suddenly, see your doctor right away. Even if you need an antibiotic, continuing to breastfeed during treatment is best for both you and your baby.

Fungal Infections

A fungal infection, also called a yeast infection or thrush, can form on your nipples or in your breast because it thrives on milk. The infection forms from an overgrowth of the candida organism. Candida usually exists in our bodies and is kept at healthy levels by the natural bacteria in our bodies. When the natural balance of bacteria is upset, candida can overgrow, causing an infection. A key sign of a fungal infection on your nipples or in the breast is if you develop sore nipples that last more than a few days even after you make sure your baby has a good latch and positioning, or you suddenly get sore nipples after several weeks of unpainful breastfeeding. Some other signs of a fungal infection include pink, flaky, shiny, itchy or cracked nipples, or deep pink and blistered nipples. You also could have shooting pains deep in the breast during or after feedings, or achy breasts.

Some of the things that can cause thrush include: having an overly moist environment on your skin or nipples that are sore or cracked; taking antibiotics, birth control pills or steroids; having a diet that contains large amounts of sugar or foods with yeast; or having a chronic illness like HIV infection, diabetes, or anemia.

The infection also can form in your baby’s mouth from having contact with your nipples, and appear as little white spots on the inside of the cheeks, gums, or tongue. This is called thrush. Many babies with thrush refuse to nurse, or are gassy or cranky. A baby’s fungal infection can also appear as a diaper rash that looks like small red dots around a rash. This rash will not go away by using regular diaper rash ointments.

Ask for help if you have or your baby has these symptoms. You also should contact both your doctor and your baby’s doctor so you can be correctly diagnosed and receive treatment at the same time to prevent passing the infection to each other. Fungal infection may put you at risk for another kind of breast infection so it is important to get help. Your doctors will decide the best course of treatment for both of you.

Tips:

• Fungal infections may take several weeks to cure, so it is important to try not to spread them. Don’t freeze milk that you pump while infected. Change disposable nursing pads often and wash any towels or clothing that come in contact with the yeast in very hot water (above 122° F).
• Wear a clean bra every day.
• Wash your hands often, and wash your baby’s hands often, especially if he or she sucks on his or her fingers.
• Boil any pacifiers, bottle nipples, or toys your baby puts in his or her mouth once a day for 20 minutes to kill the infection. After one week of treatment, discard pacifiers and nipples and buy new ones.
• Boil daily for 20 minutes all breast pump parts that touch the milk.
• Make sure other family members are free of thrush or other fungal infections. If they have symptoms, get them treatment.

Nursing “Strike”

A nursing “strike” is when your baby has been breastfeeding well for months, then suddenly loses interest in breastfeeding and begins to refuse the breast. A nursing strike can mean several things are happening with your baby and that she or he is trying to communicate with you to let you know that something is wrong. Not all babies will react the same to different situations that can cause a nursing strike. Some will continue to breastfeed without a problem, others may just become fussy at the breast, and others will refuse the breast entirely. Some of the major causes of a nursing strike include:

• mouth pain from teething, or from a fungal infection like thrush, or a cold sore
• an ear infection, which causes pain while sucking
• pain from a certain breastfeeding position, either from an injury on the baby’s body or from soreness from an immunization
• being upset about a long separation from the mother or a major change in routine
• being distracted while breastfeeding—becoming interested in other things around him or her
• a cold or stuffy nose that makes breathing while breastfeeding difficult
• reduced milk supply from supplementing with bottles or overuse of a pacifier
• responding to the mother’s strong reaction if the baby has bitten her
• being upset about hearing arguing or people talking in a harsh voice with other family members while breastfeeding
• reacting to stress, overstimulation, or having been repeatedly put off when wanting to breastfeed

If your baby is on a nursing strike, it is normal to feel frustrated and upset, especially if your baby is unhappy. It is important not to feel guilty or that you have done something wrong. Your breasts also may become uncomfortable as the milk builds up.

Tips:

• Try to express your milk on the same schedule as the baby used to breastfeed to avoid engorgement and plugged ducts.
• Try another feeding method temporarily to give your baby your milk, such as a cup, dropper, or spoon. Keep track of your baby’s wet diapers and dirty diapers to make sure he or she is getting enough milk.
• Keep offering your breast to the baby. If the baby is frustrated, stop and try again later. Try when the baby is sleeping or very sleepy.
• Try various breastfeeding positions.
• Focus on the baby with all of your attention and comfort him or her with extra touching and cuddling.
• Try breastfeeding while rocking and in a quiet room free of distractions.

Ask for help if your baby is having a nursing strike to ensure that your baby gets enough milk.