Breastfeeding and Nipple Soreness

Breastfeeding and Nipple Soreness

What is nipple soreness? Many women who breastfeed get nipple soreness. Sore nipples are common when you first begin to breastfeed right after your baby is born. The discomfort may last for 1 to 6 weeks after you have started to breastfeed. Some nipple soreness is normal, and usually goes away or decreases after seven days. Breastfeeding often or for long periods of time does not increase your risk for nipple soreness. The discomfort can range from mild to severe (very bad), depending on the cause. Your nipples may become cracked, have peeling skin, or look blistered and dry. If they get worse, they may also bleed, or get red, sore, or swollen.

What causes nipple soreness? You may get bleeding, blistering, or swelling with nipple injuries. Ask your doctor for more information about breast care for breastfeeding.

·         Breast adjustment to breastfeeding: It is very common to some have nipple soreness with breastfeeding during the first few days after giving birth. Your baby will be learning to suckle during this time, and may have trouble doing it at first. Your breast milk may also be coming out of your breasts for the first time.

·         Breastfeeding position: Being in an uncomfortable position may cause your baby to have a hard time latching-on and suckling. When little or no milk comes out of your breast, your baby may suck harder and cause pain. Pulling your baby away from your breast while he is still suckling also pulls your nipple. This may also damage your nipple. Ask your caregiver for more information about how to hold and breastfeed your baby.

·         Decreased nipple blood supply: You may get nipple pain if there is decreased blood flow to your nipple during breastfeeding. This will cause your nipple to blanch (turn pale). This can be caused by any of the following:

Certain medicines and substances: 

·         Caffeine: Caffeine is found in drinks such as coffee, tea, and soda.

·         Medicines: Some medicines can cause blood vessels to get smaller. These include medicines to help breathing such as terbutaline and theophylline.

·         Smoking: Smoking cigarettes puts nicotine into your body, which causes blood vessels to get smaller.

Pressure while breastfeeding: Vigorous suckling by your baby can squeeze on blood vessels in your nipple.

Reynaud disease: This is a condition where the muscles around blood vessels tighten and makes the blood vessels smaller. Ask your caregiver for more information about Reynaud disease.

Latch-on difficulties: Nipple soreness can happen if your baby does not take your nipple far enough into his mouth for breastfeeding. This is a sign that your baby has not latched-on well during feeding. To latch-on means that your baby has taken all of your nipple and part of your areola (dark circle around your nipple) far into his mouth. When your baby is well latched-on during breastfeeding, you should have little or no discomfort in your nipple or breast.

The following can cause problems with latching-on:

·         Breast engorgement: This is a condition where your breasts are too full of milk and swell. Engorgement often happens when your milk first comes in, usually 3 to 7 days after your baby's birth. It may also happen if you are not breastfeeding often or your milk does not fully come out. Your areola may also swell, which can make it hard for your baby to latch-on correctly. With engorgement, he may only be able to suck on the nipple, but not the areola. This will cause him to suck hard on your nipple as he tries to get milk and cause your nipple to crack and be painful. Ask your caregiver for more information about breast fullness versus breast engorgement.

·         Tongue tie: Your baby may not be able to latch-on well if he has tongue tie, also called ankyloglossia. This is something he is born with where his tongue is attached tightly and cannot move as freely as it should. The frenulum attaches your baby's tongue to the bottom of his mouth. Having a short frenulum prevents your baby from sticking out his tongue past his gums. This may give him trouble suckling and make him suck harder on your nipple. During breastfeeding, his tongue should be between his gums and your nipple. This decreases pain in your nipples and increases the flow of breast milk. Ask your caregiver for more information about ankyloglossia.

Not releasing latch-on suction: When your baby is latched-on to your breast, he sucks and creates negative pressure (suction) on your nipple. Pulling your baby away from your breast while he is still suckling will pull and stretch your nipple. This can cause injury to your nipple when you remove him from your breast.

Skin conditions: 

·         Eczema: If you are prone to having allergies, you may get eczema (allergic skin disorder) on your nipples. Eczema is also called atopic dermatitis. It can cause the skin on your nipples to have redness, itching, weeping, and skin breakdown. Ask your caregiver for more information about atopic dermatitis.

·         Yeast infection: This is a frequent cause of nipple soreness and is an infection caused by a yeast (germ). You can get candidiasis (yeast infection) on your nipples if your baby has a yeast infection in his mouth. This is called thrush or oral candidiasis. Your nipples may become dry or cracked, and have more soreness. This kind of infection does not easily go away and can come back several times. Both you and your baby will need to be treated. This will keep the infection from being passed back and forth between the two of you. Ask your caregiver for more information about oral candidiasis.

Other nipple injuries: 

·         Breast pump use: A breast pump is a device which uses suction to get milk from your breast. Using one too often or in the wrong way may cause nipple soreness. Ask your caregiver for more information about the proper way to use a breast pump.

·         Breast device use: Using nipple shells or shields for flat or inverted nipples may cause nipple injury.

·         Dried on clothing or pads: Your nipples may stick to your clothes or to a nursing pad after leftover breast milk on them dries. This can cause small cracks on the nipples when you remove them from being stuck. 

·         Irritation from cleaning or care: Your nipples can get injured from rough cleaning or irritating soap, lotions, or creams that you use.

How can nipple soreness affect breastfeeding? Having sore nipples can make you not want to breastfeed as often as you should. Your nipples may be so painful that you want to stop breastfeeding soon after you have started and not do it anymore. When you do not breastfeed often, your breasts may get engorged. You may also have an increased risk for having plugged ducts (blocked milk ducts). Over time, your body will make less milk and may stop making milk all together. Do not be afraid to breastfeed even if you have some nipple soreness. The good effects for you and your baby are important reasons to continue to breastfeed.

What is prenatal nipple conditioning?

Prenatal nipple conditioning uses exercises to help decrease nipple pain when you start to breastfeed your baby. These exercises may also cause your uterus to have contractions. This can cause your baby to be born too early. Ask your doctor first before you try any nipple conditioning exercise. 

These exercises are done two times each day starting six weeks before your baby is due to be born.

·         Massaging your breasts gently.

·         Rolling your nipples between your fingers for 1 to 2 minutes. You can also use a special cream while rolling your nipples.

·         Rubbing your nipples gently with a soft towel for 15 seconds.

You can also dress so that your nipples rub against the clothes you wear.

How should I care for my nipples to prevent nipple soreness?

·         After breastfeeding, leave your nipples out to air dry with some of the last breast milk on them.

·         Always keep your nipples dry and clean. Wash them with plain warm water once every day. Do not use soaps or products that may be irritating to your nipples.

·         If your nipple sticks to your clothes or nursing pads, put some warm water on it to make removal easier.

·         Put a warm moist cloth over the breast and sore nipple before or between breastfeeding sessions. 

·         Use breast milk or pure lanolin ointment on your nipples if needed to keep them from getting chapped and dried out.

·         Wear breast pads to protect your nipple from rubbing and sticking to clothes. Change the pads often to prevent your nipples from getting irritated by wetness.

What can I do when I breastfeed to prevent nipple soreness?

·         Be relaxed while breastfeeding. You should be relaxed and calm during breastfeeding. This helps increase the flow of your breast milk. Put a warm wet cloth on your breast or take a warm shower to increase your milk flow. Massaging your breasts also help milk start coming out.

·         Break the suction from your baby's suckling before taking him off your breast. Make sure your baby is not suckling anymore before taking him off your breast. To stop your baby from suckling, gently insert a finger into his mouth. This will loosen his attachment to your breast and you can lift him off easily without pulling on your nipple.

·         Express some milk if your baby is not latching-on correctly. Try expressing some milk if your baby is not easily getting a good latch-on, especially if you are engorged. This will help to make your nipple and areola softer and easier for him to take into his mouth. You should also do this if you have flat or inverted nipples.

Find a comfortable position during breastfeeding. Being uncomfortable while you breastfeed can make you anxious, and decrease or stop your milk flow. Learn the feeding positions that are comfortable and line your breast up well with your baby's mouth. Use one of these positions every time you breastfeed your baby. If your baby is not in the right position he may have trouble latching-on and suckling easily. He may not get enough milk and may suck harder. This can cause pain or change the shape of your nipple for a few minutes. Milk may have trouble coming out of these blocked nipples and increase your risk for having plugged ducts. Ask your caregiver for more information on how to hold and breastfeed your baby.

Make sure your baby's mouth is relaxed during breastfeeding. If your baby is suckling too hard and breastfeeding becomes painful, you need to relax his mouth. To do this you need to massage his jaw below his ears. Stroke in a circular motion to relax and widen his mouth. You can gently pull your baby's chin down using a finger. This lets his tongue stick out and rest between his gums and your nipple. Hold your baby's head so that his jaw is behind your nipple. In this way, milk can be squeezed out and there will be enough milk flowing out.

Use devices for breastfeeding correctly: Read the instructions that come with your breast pump. Use the device as instructed and always keep it clean. If it causes any injury to your breast, stop using it. You may need help to learn how to use it. You can get this from a caregiver or other professional, such as a lactation consultant. Do not use breast pads that irritate your breasts or trap too much moisture. These breast pads increase your risk for nipple damage and infection. Use breast shields or shells only as directed by your caregiver or lactation consultant.

How can I avoid breast infections to prevent nipple soreness? Call or go to your caregiver if you see or feel anything different with your breasts. Diagnosing and treating certain breast conditions as soon as possible will help prevent nipple soreness. Your caregiver may give you medicines to treat infections. You may do the following to prevent getting breast infections:

·         Always wash your hands thoroughly for 15 seconds before breastfeeding, expressing, or pumping. Then dry them completely and always use a clean paper towel after every washing. You can also dry with a cotton towel, but you should only use it once before washing it. Wash cotton towels in hot water and dry them completely after use.

·         Boil any objects that are placed in your baby's mouth, such as bottle nipples, teething toys, or pacifiers. Boil objects that come in contact with your breasts or breast milk, such as the breast pump accessory parts or collection containers. Boil them for at least 20 minutes every day.

·         Check household pets for signs of yeast or other infections, especially their ears. Take them to the veterinarian if you suspect they have an infection.

·         Clean the areas where you breastfeed and where your baby usually stays. You can use a cleaning solution made of one quart (four 8 oz cups) of tap water and one-quarter cup of household bleach. You may wipe this on baby furniture, the diaper changing pad, and toys. Rinse off the solution with water, and let the objects dry. Do not save this cleaning solution as it quickly loses its disinfecting power.

·         If you already have a yeast infection, throw away all bottle nipples and pacifiers after a week. The germ can stay in these objects and cause another infection. Buy new bottle nipples, pacifiers for your baby, and new toothbrushes for the whole family.

What can I do to feel better if I have nipple soreness?

·         Ask your caregiver if you can take an over-the-counter (OTC) medicine for pain, such as acetaminophen.

·         Ask your caregiver if you should use a breast shell or breast shield on your sore nipple.

·         Gently pump your breasts instead of breastfeeding and feed the milk to your baby with a bottle or cup.

·         Put breast milk or pure lanolin on your nipples to help them heal.

·         Use warm moist cloths on your nipples, or take a warm shower.

When should I call my doctor? Consult your doctor  if:

·         Your breast is very swollen and so painful that you cannot breastfeed.

·         You feel a lump or hard area in your breast.

·         You have a fever or feel sick, and you cannot breastfeed your child.

·         Your nipple is bleeding or has yellow fluid coming from it.

·         Your nipple is getting blisters, cracks, or scabs on it.

·         Your nipple or areola is very painful.