North Star Pediatrics

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Breastfeeding : Painful Breasts

Sore Nipples

Breastfeeding is, for the most part, an enjoyable experience for mom and baby. While extreme pain, bleeding and scabbing are often a sign of improper latch, mild tenderness in the first couple of weeks is fairly common and not unexpected. Mild to moderate discomfort at the beginning of feedings in the first days post-partum is normal and typically requires no treatment. As you and baby become more practiced at breastfeeding and your body adjusts to your baby’s unique sucking habits, this should subside completely. More severe pain, or pain that lasts through an entire feeding, can be due to incorrect positioning of baby’s mouth on your breast (the most common cause) or an infection of your breast.

If you are experiencing sore nipples:

Examine your baby’s latch to see if she is positioned well. Make sure your breast is well supported, that baby’s tummy and chest face you and that her body is curled around yours. Help your baby to get a full, deep latch with her mouth well beyond the nipple onto the areola. An off-center latch is often less painful for sore breasts: stroke your baby’s upper lip until she opens wide then pull her onto your breast with her head slightly tilted back and her chin touching your breast first. This positions her lower lip farther from the nipple, the upper lip closer. Make sure both upper and lower lips are flanged out, not tucked in, which can pinch and be painful. You can flip her lips out with you pinky without detaching her completely from the breast.
The first sucks are usually the strongest, so choose your less sore breast first, or pump briefly until let-down occurs so your baby does not have to suck as hard to get the milk flowing.
Keep your nipples dry and clean and change breast pads frequently.
Many moms swear by a thin layer of Lanolin on the nipples after each feeding to soothe, heal and protect. Another alternative are the new gel pads available that can be cooled to provide relief.
If you are unable to nurse due to pain, it’s time to have a professional take a look. Have a Lactation Consultant evaluate your baby’s latch. In the meantime, you may have to pump for a few days while your nipples heal.

If your breast pain is severe, you have any redness on your breast or if you have any flu-like symptom – chills, fever, achiness- you may have an infection and will need to call your doctor.

Engorgement

Postpartum engorgement occurs 2-5 days after delivery when your hormones signal your body to start producing milk and your breasts fill for the first time. It usually lasts just a few days while your body adjusts its milk supply to the needs of your baby.

To prevent engorgement or help with the pain, nurse frequently, at least every 2-3 hours.
Some babies have difficulty latching onto very full breasts. You can help by pumping briefly before a feeding to soften your nipple and areola to permit an easier latch.
Warmth helps with let-down and a warm shower or warm washcloth on your breasts just prior to feeding will help.
If you still feel very full after a feeding, pump afterward enough to reduce your discomfort.
Cool washcloths may provide comfort between feedings.
Chilled cabbage leaves left in place for 20-30 minutes between feedings will help alleviate pain and soften the breasts.

Plugged Ducts

A plugged duct occurs when one or more milk ducts becomes clogged by residual milk and your breast develops a hard, tender knot. Nursing can become painful and your breast may ache between feedings. These plugged ducts are typically the result of ineffective or incomplete emptying of you breast by baby, but are occasionally caused by compression by a tight bra, stress or fatigue. Some women are more prone to plugged ducts than others and find this to be a recurrent problem. Unplugging the duct is essential as it can lead to infection if left untreated.

Nurse on the affected side first, every time, until the duct becomes unplugged. Baby’s initial suck is the strongest and can eventually pull out the plug.
Try to position baby with her chin pointed toward the plug, as this is the direction of the strongest suction. This may take some creativity on your part.
Massage the breast with the plug between feedings and apply gentle pressure behind the plug during nursing to encourage it to move.
Pump the affected breast with gentle massage a few times a day.
Apply moist heat to the affected breast between feedings.
Be persistent. It may take effort to get the plug to pass. You may feel a pinching sensation when the plug clears and may actually see it leave your breast.

To help prevent plugged ducts, be sure to breastfeed or pump on a regular basis and try to make sure your breasts are completely emptied with each feeding. If you find you are prone to plugged ducts, an herb called lecithin may help by decreasing the viscosity (stickiness) of your breastmilk. The dosage is 1200mg four times a day.

Mastitis

Mastitis is an infection in the breast, often caused by the bacteria normally present on the breast or in baby’s mouth. It is more common in cracked or damaged breasts, as seen in moms whose babies latch improperly; it is a possible complication of plugged ducts, caused by inadequate emptying of the breast (see above.) Stress and fatigue, so common to new mothers, also contribute to its development. Symptoms resemble those of the flu - chills, fever, achiness and headache - and most moms also have a hard, tender, red lump on one breast. You will need antibiotics from your OB/Gyn to treat mastitis and prevent further complications, such as a breast abscess, so you must call you doctor as soon as you are suspicious. If you are breastfeeding and feel like you are coming down with the flu, the diagnosis is mastitis until proven otherwise!

In addition to the antibiotics it is important to continue breastfeeding to keep your breasts well emptied. If possible, breastfeed more often, especially on the side that is affected. Your milk will not make your baby ill. If the pain is too severe to nurse, you will need to pump often. It is fine to take pain medication, such as ibuprofen, for discomfort. Rest, drink plenty of fluids and stay in bed as much as possible.

Yeast Infections

Yeast infections are caused by a naturally-occurring fungus, Candida albicans. Candida normally lives on our skin and 90% of babies are colonized with it within hours after birth. It only causes infections when the integrity of the skin is compromised, such as when nipples become cracked or damaged during breastfeeding. Diagnosis of a yeast infection of the breasts is difficult as no good test exists; in general, it is based on history and symptoms. The presence of thrush (white patches on the gums or tongue) or diaper rash in baby helps to suggest the diagnosis. The symptoms of a Candidal breast infection include a burning or shooting pain in the nipple and/or breast that worsens during a feeding and continues or even increases when the feeding ends; pain that is often worse at night; and sometimes a blanching or whitening of the nipple when baby detaches. Treatment is usually at the discretion of your OB/Gyn but often includes a topical anti-fungal, like nystatin, with or without the addition of an oral anti-fungal, fluconazole. It is helpful to treat your baby at the same time with topical nystatin (applied to the white patches in his mouth), which is by prescription through your pediatrician.

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