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Breastfeeding and Nipple Soreness

GENERAL INFORMATION:

What nipple problems may I have while breastfeeding? Sore nipples are common for the first 1 to 2 weeks of breastfeeding. Your nipple and areola (the dark area around your nipple) may look red and feel sore. After the first week of breastfeeding, this discomfort should decrease. It should not hurt to breastfeed. It is never normal for your nipples to bruise or get blisters. Your nipples should not crack, scab, or bleed.

Normal Breast

What causes nipple soreness?

  • Incorrect latch-on: Nipple soreness occurs when your baby is not latching onto your breast the right way. When your baby latches on, his chin and lower lip should touch your areola first. Then his upper lip takes most of the areola into his mouth. If it hurts when your baby latches on, take him off your breast and try again. When you have a good latch, you will soon hear your baby sucking slowly and deeply. Your nipples should have the same shape before and after each feeding.
    Correct Infant Latch-on Position


  • Incorrect positioning of your baby: When your baby is not positioned correctly, he may not be able to latch onto your breast correctly. Hold your baby so his ear, shoulder, and hip are in a straight line while he feeds.

  • Engorgement: When your milk comes in, or if you wait too long between feedings, engorgement can occur. Your breasts will look shiny and feel hard and painful. Your areolas and nipples may be so swollen that your baby cannot latch on correctly. Express some milk before feeding to help your baby latch on. Feed your baby or express your milk often to help prevent engorgement, reduced milk supply, and breast infections.

What conditions can lead to nipple soreness?

  • Flat or inverted nipples: The shape of your nipples may make it hard for your baby to latch on and get milk. Put cold compresses on your breasts, or pull or roll your nipples before a feeding to help your baby latch on.

  • Problems with your baby's tongue or neck: Your baby needs to open his mouth wide and stick out his tongue to breastfeed well. If he was born with a condition called tongue-tie, it is hard for him to stick out his tongue. He may take long pauses between sucks, choke, cry, or fall asleep while feeding. A condition called torticollis can prevent your baby from moving his head and neck away from one shoulder. This condition can also cause feeding problems.

  • Skin conditions and infections: Your nipples may look red and feel itchy and sore if you have dermatitis or psoriasis. A fungal infection called thrush can spread to your breast from your baby's mouth. Thrush causes nipples to look red, shiny, and flaky. You may feel a burning or stabbing pain in your breasts. Blocked milk ducts and engorgement can lead to a breast infection called mastitis. Mastitis causes soreness, pain, and flu-like symptoms.

How can nipple soreness affect breastfeeding? You may feel tense if it hurts to breastfeed. This tense feeling may prevent milk from traveling to your nipple (milk let-down). If your baby needs to suck harder to get milk, this can make your nipple pain worse. Do not wait to get help if your nipples are cracked, sore, and painful. You may want to stop breastfeeding when you have sore nipples. Caregivers recommend breastfeeding for at least 6 months.

How can I manage nipple soreness while breastfeeding?

  • Relieve pain: Warm water compresses or expressed breast milk placed on your nipples may offer relief. An over-the-counter pain reliever, such as ibuprofen, may also help you feel better.

  • Ask about ointments: Ointments, such as lanolin, may help to prevent nipple dryness and scabbing. Ask your caregiver about ointments or dressings that can be used for damaged nipples.

  • Try holding your baby in different positions during feedings: This may help to keep pressure off of sore areas. Caregivers can help you guide your baby to a correct latch. They can also show you ways to support and position your baby during breastfeeding.

  • Offer your baby the nipple that is less sore first: Your baby's suction is usually harder when he first starts breastfeeding.

  • Use a breast pump: A breast pump can be used to express your milk until your nipples heal if it is too painful for you to breastfeed.

How can I prevent nipple soreness?

  • Keep your nipples clean and dry: Wash your breasts with warm water only. Do not use soaps that contain alcohol, because the alcohol can dry and irritate your nipples. Pat your nipples dry after each feeding. Do not use nursing pads that are lined with plastic.

  • Break your baby's suction gently: Break your baby's suction gently to help protect your nipple and areola. You may try placing your finger in the corner of your baby's mouth between his gums to break his suction.

  • Breastfeed your baby often: Breastfeeding your baby often can help prevent engorgement and sore nipples. Watch and listen to your baby to learn when he wants to breastfeed. You may hear sucking, cooing, or sighing sounds. He may seem restless, and may suck on his hands and fingers. Breastfed infants feed 8 to 12 times each day.

  • Talk with a caregiver about your breast pump: A breast pump may cause nipple swelling and pain. Ask your caregiver how to use your breast pump properly.

What should I know about having a pierced nipple and breastfeeding?

  • Remove your jewelry before breastfeeding: Nipple jewelry is dangerous for a breastfeeding baby. Your baby may swallow your jewelry or hurt his mouth or lips on it. When you take your jewelry out, it is normal for milk to squirt from the piercing in your nipple. The hole may close in a few weeks if you do not replace your jewelry after feedings.

  • If you must leave jewelry in your nipple, tighten or change it: Tighten each part of your jewelry before you breastfeed. The suction your baby creates while breastfeeding may be painful with some kinds of nipple jewelry. Use plastic barbells instead of metal jewelry. This may help your baby latch on, and prevent the piercing from closing. Tell caregivers if your pierced nipple hurts while you breastfeed.

When should I schedule a follow-up visit with my caregiver? Follow up with your caregiver as directed. Write down your questions so you remember to ask them during your visits. Your caregiver may suggest that you see a lactation consultant. This is a caregiver who can help you with breastfeeding.

Where can I get more information?

  • American Academy of Pediatrics
    141 Northwest Point Boulevard
    Elk Grove Village , IL 60007-1098
    Phone: 1- 847 - 434-4000
    Web Address: http://www.aap.org

When should I contact my caregiver? Contact your caregiver if:

  • You have a fever.

  • One or both of your breasts are red, swollen or hard, painful, and they feel warm or hot.

  • Your nipple has pus coming out of it.

  • Your nipples are red, dry, cracked, bleeding, or they have scabs on them.

  • You see or feel a tender lump in your breast.

  • You have nipple pain while breastfeeding or between feedings.

  • You have questions or concerns about your condition or care.

CARE AGREEMENT:

You have the right to choose how you feed your baby. To help with this plan, you must learn as much as you can about breastfeeding. Ask your caregiver for more information, or join a group with other breastfeeding mothers. You and your caregiver can work together to plan the best way to feed your baby.

© 2013 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of the Blausen Databases or Truven Health Analytics.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.


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