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NIPPLE PAIN

Transient soreness, Prolonged abnormal soreness, Contributing FactorsBreastfeeding Assessment, Helpful Links


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.

Prolonged 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.

Conditions 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:

Breastfeeding Assessment

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. Examples include:

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 while nursing.

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 the nipple.

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.

Dermatitis, or 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 causing irritation..

High Palate

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 her side.

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.

A milk 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. 

Treatment 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.

 

Helpful Links:

For more information on nipple soreness:

http://www.lalecheleague.org/llleaderweb/LV/LVFebMar00p10.html

 

For more information on thrush:

http://breastfeeding.hypermart.net/thrush.html

http://www.lalecheleague.org/llleaderweb/LV/LVOctNov98p91.html

 

For more information on engorgement:

http://breastfeeding.hypermart.net/engorgement.html

http://www.lalecheleague.org/llleaderweb/LV/LVDec99Jan00p134.html

 

Sources: Breastfeeding and Human Lactation, Riordan & Auerbach; The Breastfeeding Answer Book, LLL

Jan 2001, Paula Yount

Copyright 2000 - 2006  Jim Yount

Send email to Paula Yount for any questions or comments about this site.

Disclaimer:  The pages contained herein are meant purely for informational purposes and every effort is made to provide accurate and up-to-date information. This information, however, is not meant to take the place of your doctor, nor should the information contained on this web site be considered specific medical advice with respect to any specific person and/or any specific condition. The author, therefore respectfully but specifically disclaims any liability, loss or risk - personal or otherwise - that is, or may be, incurred as a consequence, directly or indirectly, from use or application of any of the information provided on this web site.