With good preparation and support, most breastfeeding moms have very few difficulties. The concerns that some mothers have will be helped by this list of common problems. If you need more help, contact a lactation consultant, a La Leche League leader, Nursing Mothers Association, childbirth educator, baby’s pediatrician or certified nurse midwife. Get help as soon as you think there is a problem so you can keep breastfeeding your baby.
Poor positioning or latch-on is the most common cause of sore nipples, especially at first.In the first week of breastfeeding, some nipple soreness is usual in the first minutes as the baby positions the nipple in its mouth and his sucking stretches the nipple and areola far back into his mouth. The tenderness usually eases up when the milk lets down. Soreness usually peaks on the 3rd day and starts to go away on the 6th day if your baby is positioned well and latched-on correctly. If you have nipple soreness longer than this, then some adjustment needs to be made. Ask for help when:
• it hurts to breastfeed after the first day
• your nipples burn during feedings, at the end of feedings, or between feedings
• nipple soreness does not improve after 3 days of trying hard to find the cause and fix it. Persistent soreness could mean your baby is not getting enough milk because he has a problem sucking.
• Soreness at the beginning of feedings but not after the milk begins to flow could mean your baby is not latched-on correctly.
• Soreness on the first day usually indicates a problem with latching on or a sucking problem. It’s best to fix these problems before they become a habit.
• Soreness during the entire feeding the problem could be positioning and latch-on, a sucking problem, or thrush (especially if you have burning or itching). If you have soreness during the entire feeding, get help right away.
• Soreness at the top of the nipple indicates your baby is not latched-on to enough breast tissue.
• Soreness at the bottom of the nipple could mean your baby’s lower lip is in the way, gently pull it out of the way. Or, your baby may be getting too much of the upper part of the breast and not enough of the underside.
• Soreness at the tip of the nipple means your baby is not getting enough of the nipple deeply into his mouth. This can happen if your point the nipple up or down at latch-on, instead of straight ahead and into your baby’s mouth; your baby is thrusting his tongue.
• Soreness of the whole nipple could be from poor latching on or positioning, your baby is retracting his tongue or curling up the tip of his tongue. It may also be that you are not breaking suction before taking your baby off your breast or you are leaning over while nursing.
In most cases, sore, cracked or bleeding nipples can be cured by proper positioning and latching-on. Pay attention to see if your baby’s position or latch-on changes during feeding which can cause sore nipples. Engorgement can lead to poor latch on, so you might try expressing some milk with a breast pump before the feeding so your baby can latch on correctly. Taking your baby off your breast without first breaking the suction can also cause soreness. To break the suction you can either insert a finger in the corner of your baby’s mouth, gently pull down on your baby’s lip or press down on your breast.
Giving your baby bottles or pacifier in the early weeks may affect how he sucks and cause sore nipples. Nipple shields can also change how your baby sucks. If you’re having sore nipples, try stopping all artificial nipples until you and baby learn breastfeeding well.
General Solutions for Sore Nipples
Start feeding on the least sore side first. Then, air dry your nipples. After a feeding, express a little breast milk and coat the nipple and areola with it. Nipple soreness is usually a temporary condition for a few days, which will go away as the nipples become adjusted to breastfeeding.
• Cause ~ Baby not positioned properly on the breast
• Solution ~ Your baby should be in a flexed, comma-like position with his head and body facing your breast, head and feet tucked in, so baby is chest to breast. Support baby at breast level, with baby’s head held close, to avoid pulling down as baby feeds. Support the breast — four fingers underneath, thumb on top. Using the football hold can give you more control and make latching on easier.
• Cause ~ Baby’s gums and tongue put pressure on same areas of areola and nipple.
• Solution ~ Use a different feeding position for every feeding, or at least one out of every three feedings for the first 10-14 days.
• Cause ~ Going too long between feedings—your baby is so hungry that he sucks too hard, and your breasts become engorged making it hard for your baby to grasp your nipple and areola properly.
• Solution ~ Feed every 2-3 hours while you’re awake hours and every 4-5 hours at night. Let your baby have enough milk and to keep your breast from becoming distended. Hand express milk or use a breast pump to let out enough milk to soften the nipple and areola. Warm cloths or a warm shower before breastfeeding will speed up the let down and make it easier for your baby to get the milk flow started.
• Cause ~ Nipples remain wet.
• Solution ~ After each feeding, express a little milk and coat the nipple and areola with it, then air dry your nipples for at least 5 minutes. Change pads and bra when they get wet. Do not use plastic liners that keep the moisture against the skin.
• Cause ~ Using soap, antiseptic or alcohol to clean your nipples.
• Solution ~ These substances can remove protective skin oils causing drying and soreness. Don’t use them. All that is needed to clean your nipples is plain water.
It’s important to figure out what is causing the cracked nipples and fix the problem so your efforts at treating will help heal your breast. If you don’t figure out the cause, you will just keep having cracked nipples. As with sore nipples, the most common cause of cracked nipples is positioning and latch-on.
The following will help if you have broken skin with or without bleeding and help you continue breastfeeding your baby without interruption.
Cause ~ Same as for Sore Nipples.
Solution ~ Treat the same as for sore nipples. Feed only 6-8 minutes from the cracked nipple. Use a small amount of a pure substance such as lanolin, or olive oil, on the nipple and areola, but not on the crack itself. These do not need to washed off before feeding. You can also try Lansinoh HPA Lanolin to keep the nipple moist between feedings. (Avoid lanolin, if there are wool allergies in the family). Do not use breast creams or lotions because they often contain alcohol which is drying to the nipples. Don’t use baby oil or Vaseline as these may not taste good to your baby or be good for your baby to ingest.
Painful area in your breast, often with a lump.
General Solutions ~ Breast feed every 2-3 hours, starting with the affected breast first. Use warm, moist cloths on the affected area. Use gentle, even pressured, massage from the chest, over the lump toward the nipple. Sufficient rest is essential. Drink plenty of fluids. Further backup of milk may lead to mastitis.
Cause ~ Sticking to a rigid feeding schedule resulting in milk backup.
Solution ~ Pay attention to your baby’s hunger signals and your own sensations of breast fullness rather than the clock. Feed your baby every 2-3 hours in the day and every 4-5 hours at night. Use both breasts at each feeding.
Cause ~ Pressure on a duct from a bra that is too tight.
Solution ~ Wear a better fitting bra with a larger sized cup.
Cause ~ Breastfeeding in only one position.
Solution ~ Alternate your baby’s position as well as your own. Changing up positions with each feeding will help milk flow through all ducts around your breasts.
Cause ~ Skipping or delaying feedings because of your schedule such as holidays, traveling, illness, vacation or visitors
Solution ~ Make an effort to breast feed every 2-3 hours even during unusual times and schedules
Cause ~ Weaning.
Solution ~ Wean your baby gradually. Begin by eliminating one feeding each day, per week.
Red, lumpy, painful area of breast accompanied by fever, chills or other flu-like symptoms.
Cause ~ Can have the same cause as Blocked Ducts (see above).
General Solutions ~ Treat as you would for Blocked Ducts. Stay in bed with baby and feed every 2 1/2 hours. Use warm, moist compresses on affected breast. Take acetaminophen for discomfort and/or fever. Seek medical attention if symptoms persist. Antibiotics may be needed. Continue to breast feed your baby.
Baby is difficult to quiet and comfort, even though well fed. Your baby may be squirming, throwing her head back, arching her back and seems to not want to nurse.
Cause ~ Normal irritability.
Solution ~ Babies are not always quiet and cooperative. Most babies have fussy times.
Cause ~ Your baby may have stuffy nose and can’t breathe while sucking.
Solution ~ Try using a suction bulb to clean any mucus out of her nose so she can breathe.
Cause ~ Foods that mother eats or medicine prescribed for mother may affect baby.
Solution ~ Foods eaten by mothers which cause problems for the breast fed baby vary from baby to baby. Check your diet. Omit one suspicious food at a time. Start with caffeine (in coffee, tea, chocolate, soft drinks), dairy products, citrus fruits, some vegetables, eggs and shrimp. Reintroduce one at a time every 4 days. Watch for a change in your baby in relation to changes you make in your diet. If your baby’s fussiness started at the same time you started a new medicine, talk with your doctor or your baby’s doctor.
Cause ~ Milk comes into baby’s mouth so fast that he swallows air and chokes, pulls away from nipple or breast and cries.
Solution ~ Raise baby’s throat level by making sure his neck is higher than the nipple.
Breastfeeding Points to Remember
~ Break suction before removing your baby from your breast by inserting your finger into the corner of your baby’s mouth and between the gums. Keep your finger between the gums so he doesn’t bite down on your nipple.
~ Drink 2-3 quarts of fluids per day. Avoid drinks that have caffeine because it is passed to your baby through the breast milk and can make your baby fussy. Drinks and foods that include caffeine are coffee, cola drinks, tea and chocolate.
~ Growth spurts occur at 6-10 days, 6 weeks, 3 months, and 4-6 months. Your baby’s feeding patter will change and he may want to eat as often as every 1 1/2 to 2 hours for about a day as your milk supply increases to meet his needs.
~ Engorgement can occur 3-5 days after delivery and is temporary, lasting about 24 hours. Early treatment can reduce much of the discomfort of engorgement. Nurse every 2-3 hours around the clock to get the milk out and soften your breast. Use ice packs on your breasts between feedings to relieve swelling. Do not apply the ice directly to your skin, use a cloth between the ice pack and your skin. Ask your doctor if it’s OK to take a mild analgesic for discomfort and which one would be OK since you are breastfeeding.
More Information About Breastfeeding