soreness, Prolonged abnormal
soreness, Contributing Factors,
One of the most
common questions an expectant mother who is considering breastfeeding
asks is "Does breastfeeding hurt?" Many times a mom who
might consider breastfeeding is hesitant because she has heard "horror"
stories about cracked and bleeding nipples, or excruciating pain
associated with breastfeeding. Click here
for feedback from real moms regarding nipple soreness.
Some moms ask if there is something they can do
to prevent nipple pain. Years ago, it was suggested to do "nipple
preparation" but research has shown that this has little or
no benefit in reducing or eliminating nipple pain. Sometimes it
can even result in nipple pain! It is not true that with preparation,
nipple tissue will become "toughened" up!
The best preparation for the nipples is simply normal
involvement of the breasts and nipples in lovemaking (except when
there is risk of preterm labor); avoiding washing the nipples with
soap; and providing brief occasional exposure to air and sunlight.
There are two common types of sore nipples that
take place early in the breastfeeding experience, and either reason
can be a reason why the mother stops breastfeeding before she intended
to do so.
The first is called transient
soreness. It can occur during the first week after the birth,
usually being at it's worst between the third and sixth days. Most
women do develop some nipple tenderness or discomfort as they begin
to feed their new babies, but this transient tenderness usually
resolves after about one week, and by 10 days the transient soreness
is usually completely resolved, and mom is breastfeeding normally.
Unfortunately, mothers are often advised (by well
meaning persons) that to prevent soreness, just limit the duration
of the nursing session. Sadly, placing a time limit on the length
of feedings has several negative effects. The first and foremost
problem with this is that it delays nipple soreness. Secondly, mom
has to interrupt the baby's nursing to "change sides"
or stop the feeding within the specified limit - and this can result
in unnecessary pain and trauma to the nipple, especially if breaking
suction isn't done carefully.
abnormal soreness is the second type, and it lasts beyond
the first week of breastfeeding. Chronic pain, according to Riordan
& Auerbach in "Breastfeeding and Human Lactation"
is a warning that something is wrong.
When nipple pain becomes severe, and lasts beyond
the initial early days of breastfeeding, or if there is cracking
and/or bleeding, mother should check into the most common factors
that result in this type of nipple pain. It is at this point that
she should have help from an experienced person in the field of
breastfeeding management. This can be an International Board Certified
Lactation Consultant (IBCLC), a Certified Breastfeeding Educator,
a La Leche League leader, etc., but the more experience a person
has in breastfeeding management, the more likely it is to locate
the source of the nipple pain and get it resolved.
that contribute to abnormal nipple pain and trauma can include (these
are not listed in any particular order) Click on the links for
more information about these issues:
If mother is experiencing prolonged nipple pain,
a careful assessment of the breastfeeding relationship should be
made. This includes asking:
What do the baby's cheeks look like while nursing?
They should round outward if baby is effectively
nursing. If they are drawn inward, or sucked in causing a "dimpling"
effect, it can be an indication that the baby may not be sucking
effectively. Mom usually feels little or no "sensations"
during the feeding. Baby may appear to be "flutter sucking"
(sometimes referred to as "comfort sucking")
Where is your baby's tongue?
The baby's tongue should be visible between the
baby's lower lip and mom's breast when the lip is gently pulled
away (careful not to break suction when checking for this). If you
do not see the baby's tongue, it can be because the baby's tongue
is too short (often called "tongue-tied")
or because baby is curling the tongue up in an improper position
(often due to early introduction of bottles or pacifiers)
What can you hear while baby is nursing?
A baby who is breastfeeding well will make a swallowing
sound that is sometimes very quiet, but will occur between one and
every three sucks. There should be no "slurping" (an indication
that baby is sucking his/her own tongue or doesn't have good seal
at the breast), and no clicking sound (an indication of rush of
milk usually associated with over-supply, improper tongue position,
or presence of thrush).
Do we have a good latch?
The baby should have a good solid latch, and not
able to "fall off" the breast easily, rather mom would
have to insert finger and break suction to release latch. Positioning
should be reviewed in this case, so that mom is not leaning down
over the baby to nurse, and /or that if cradle position is used,
baby is not facing "tummy up" and having to turn head
to the side to nurse.
In addition to the above, the breast and nipple
can often indicate the cause of continued or prolonged soreness.
Soreness on the underside of the breast:
Too much of the top of the areola and not enough
of the bottom part is drawn into the baby's mouth (baby is "off
center", resulting in stretching and cracking of nipple tissue
on the underside of the breast. Baby may also be sucking in the
lower lip while nursing. Bringing the baby close in to the breast
so that the tip of the baby's nose and the chin touch mom's breast
lightly, and being sure baby's lips are flanged out - like little
fish lips - will usually resolve this problem.
Soreness at the top of the breast:
This can indicate that baby is not latched onto
the breast well or that baby is raising up the back of the tongue
Soreness at the tip of the nipple:
This can be due to latching on when the nipple is
either pointing up or down, rather than being centered in baby's
mouth, tongue thrusting, or due to short frenulum (tongue
tie). There may or may not be a horizontal red stripe across
Entire nipple is sore:
When the entire nipple is sore, it can be
a result of poor positioning and latch in a baby with a very vigorous
suck; the baby retracting the tongue while breastfeeding; or the
baby curling up the tongue while breastfeeding (this will often
produce a vertical red stripe on the nipple after feeding) It can
also be a result of suction not being broken properly, or leaning
over the baby while nursing. Thrush is another possibility.
Engorgement can result in the nipples becoming
flat and taunt, resulting in the baby grasping only the tip of the
nipple. This can be very painful for mom, and it can be resolved
by taking steps to reduce and treat the engorgement. Mom can express
enough milk to soften the areola so that baby can latch on well,
helping to resolve the problem. Different nursing positions also
can be helpful.
Nipple confusion can result in continued
nipple soreness because the baby sucks differently from the bottle
(artificial nipples) than from the breast. Avoiding use of artificial
nipples until the situation is resolved and breastfeeding is going
well can help.
Eczema can develop on
mom's nipples if baby nurses and has food particles in his or her
mouth. To reduce the risk of this, mom can offer the baby a sippy
cup of water with the solid foods to help rinse away any food particles.
Eczema can cause considerable pain and discomfort. This may warrant
a referral to a skin specialist. Mom should make dietary adjustments
(esp. avoiding cow's milk products), and she may see her health
care provider about using a cortisone cream for a brief
period of time.
inflammation of the skin, can occur from use of ointments, creams,
cologne, deodorant, hair spray, or powder. Sometimes it can be traced
to laundry detergents, rinse aides or dryer sheets. If dermatitis
is suspected, mom should stop using all ointments and creams on the
nipples. She should also avoid using soap or shampoo on
the breast/nipple area. She should wash her bras and breast pads
with pure soap and air her nipples regularly. If mom is comfortable
doing so, going "bra-less" can be beneficial.
Another common but often missed
cause of sore nipples may be related to mothers bra. A bra that
is too snug compresses the nipples causing them to become sore.
Rough seams in the bra can rub against the nipples causing irriation
as well. Synthetic bras may also be a problem because the fabric
does not "breathe" like cotton, and so the nipples may remain moist
Babies with a
high arch to their palate tend to flick the nipple up into the
'cavity' very easily. There really needs to be so much breast tissue
in the baby's mouth that the nipple is forced further back.
There are many ideas and techniques
that are used to help in this situation. Experimenting with positioning
is important to find the best position for mom and baby.
Some moms try sitting the baby beside her so that the chin
is on the underside of the breast. Gravity seems to help get more breast tissue in like this.
Sometimes mom leaning over the baby works, again with gravity on
Some moms use a modified football
hold with the baby wrapped around her hip, facing her side, and
baby's lower lip about a half inch under the nipple.
She would then position
the lower lip on the areola, and wait for the mouth to open wide,
then pull the baby on by the shoulders to get a deep latch. Leaning
back helps hold baby against her chest.
If this is done right, baby's
head will be a little extended, and the latch will be asymmetrical,
with more breast tissue over the tongue and less under the palate.
The more breast in the mouth, the less the tongue restriction
seems to matter, because when the mouth is more full of breast,
the tongue has to lift less to press milk out of the breast.
This situation usually gets better with a little
time. As baby grows
he/she is able to take
more breast tissue in the mouth, resulting in a better latch. Many
times this seems to spontaneously resolve at around the age of 8
to 10 weeks.
blister is a blocked duct on the surface of the nipple. It may
resemble a pimple, or a tiny white blister on the nipple, and
is often called a milk bleb, or nipple blister. It is usually
very painful to nurse.
for the nipple blister includes using a hot compress (but not
hot enough to burn nipple) and allow the heat to "soak in",
then remove compress and immediately place baby on the breast
to nurse. The combination of the heat and the baby's vigorous
sucking is usually enough to open the plug.
For more information on nipple soreness:
For more information on thrush:
For more information on
Sources: Breastfeeding and Human Lactation,
Riordan & Auerbach; The Breastfeeding Answer Book, LLL
Jan 2001, Paula Yount