Sore Nipples
Nipple pain has to be one of the biggest fears surrounding breastfeeding and incorrect latch is the number one cause. However, there can be several reasons a baby is not latching correctly:
- There can be issues with infant anatomy such as tongue and lip restrictions, severe cleft lips or palates, syndromes or facial anomalies
- Infant ability related to how they use their tongue
- Birth traumas causing pain or inability to move the necessary muscles correctly
But the majority of soreness in the newborn period occurs simply because breastfeeding is a skill and is remedied with knowledge and practice. If nipple soreness is more than you can tolerate or is not improving, please reach out to an IBCLC.
If the cause incorrect latch, the solution is to fix the latch.
- See positions and latch section
- You can apply expressed breastmilk after feeding or lanolin for sore/red but intact
- Broken skin may need soothies type gel pad
- Unbearable needs LC assessment to determine reason
- Please let an LC assess before you apply a nipple shield – you can actually cause more damage to yourself and baby if used improperly.
- If you have sudden pain after breastfeeding has been going well, it could be a yeast infection, aka thrush. Call an LC for the treatment protocol.
If nipple soreness coincides with baby teething
- Babies don’t bite to be malicious and most don’t make a habit of it
- They are typically at the age when cause and effect are coming in to play. They don’t understand it is hurting you, but when you jump, it’s funny to them. A baby who does it to get a reaction can be interrupted and given a baby time-out. They get the message quickly.
- Or baby might simply be uncomfortable and need to chew on a cold (refrigerated not frozen ) teether first, or have age/weight related dose of baby ora-gel or Tylenol.
Engorgement
This is when the breasts are full of milk and can become firm or inflamed.
- Usually generalized warmth and pain
- You can run a temp of up to 100 degrees
- The breasts can become non-compressible if not addressed
- Typically seen day 2 or 3 as milk volume increases, or if baby suddenly sleeps through a night
- Temporary, as body adjusts to amount of milk needed
- Use ice packs 20 min on/20 min off between feeds
- Nurse frequently
- May also need expressing milk by hand or pump but only to the point of some relief.
Mastitis –
- Breast inflammation that according to the Academy Of Breastfeeding Medicine constitutes a spectrum, from congestion, to plugs/blocked ducts, blebs, and bacterial infections to abscesses
- Can be due to an infection or not
- Important to note the milk is not contagious or contaminated!
- Yes, continue breastfeeding. It is not caused by unhygienic practices.
- Mastitis can often be managed without medical interventions
- Generally, you feel like you’ve got flu with fatigue and body aches as well as a temperature
- The breasts will have more acute pain, swelling, and redness.
- The Academy of Breastfeeding Medicine Protocol #36, suggests antibiotics be reserved for documented bacterial infection but if fever and chills lasts more than 24 hours or your breast isn’t responding to more conservative measures, please contact your doctor.
- Antibiotics can be taken with breastfeeding, the milk is still fine. If you need antibiotics, ask for Diflucan too to ward off vaginal yeast infection.
- Consider probiotics, as mastitis can occur because the breast microbiome is off but antibiotics will contribute to disruption of that biome.
- Feed on demand
- Minimize any pumping
- If unable to express any milk from affected breast, feed from the unaffected side and use ice packs on affected breast, possibly even lymphatic drainage until milk will express
- Avoid deep massage of lactating breasts and restrictive bras
- Avoid nipple shields,
- Avoid applying saline soak, castor oil or other topicals
- Maintain clean equipment but no routine sterilization of pumps
- In case of blebs, call LC
- If condition is worsening or not improving, call LC and MD