Breast and Nipple Problems While Breastfeeding

Sore Nipples

Breastfeeding is not supposed to hurt.In the first day or two of breastfeeding, your breasts may feel tender when your baby’s first few sucks stretch your nipple and areola way back in her mouth. Usually, this tenderness will go away when your milk comes in and begins to flow. If after two to four days, your breasts/nipples still feel tender or hurt, the most common reason would be that your baby is not latched-on to your breast correctly. If not corrected, you will continue to hurt, and your baby will not get enough milk. So, take these steps:

• Review all the “Latch-on” information in the “How To Feed Your Baby” section above. If you’re not sure your baby is latched-on right, ask a nurse or lactation consultant to help you. A little adjustment may make all the difference in your ability and pleasure in breastfeeding your baby.

• If your baby is latched-on correctly at the beginning of the feeding, check again during or at the end of the feeding. Some babies fall asleep and slide down the breast to hang on to the nipple, which, if done often, can cause nipple pain.

• Make sure that you are breaking the suction in the right way when removing your baby from your breast.

Breastfeeding is not supposed to hurt. However, aside from incorrect latch on, there are other less common reasons why your breasts and nipples might feel tender or painful when nursing, such as:

• The use of artificial nipples (bottles, pacifiers or nipple shields) in the early weeks, which can affect your baby’s suck.

• You have flat or inverted nipples. More information on this later.

• Your bra is too tight or has a rough seam against the nipple.

• Your baby has a short tongue or short frenulum, the string-like membrane that attaches the tongue to the floor of the mouth.

• Your baby has a strong clenching response, which is pretty rare.

• You or your baby develops thrush, a fungus that grows in moist, dark places, such as on the nipples, in the milk ducts, and in the baby’s diaper area. Thrush may cause intense breast or nipple pain and nipples that are itchy or burning.

• Your baby is teething and has sore gums.

• You have a clogged milk duct or skin over a duct. More information on this later.

• You develop a Herpes sore on the nipple, which can be dangerous to the newborn.

• You may have a skin condition like dermatitis, eczema or impetigo, or an infection.

• You have become engorged. More information on this later.

Treating Sore Nipples

If you are working on getting your baby’s position and latch-on corrected, you can treat your sore nipples with warm compresses. Limiting the time your baby nurses may help cracked, sore nipples heal, but it won’t fix the problem and it will limit your milk production. So the best course is to find out what the problem is and fix it.

If your breasts and/or nipples are sore, cracked and even bleeding, but it is not caused by poor positioning or latch-on to your breast, call your doctor or lactation consultant for help in diagnosing and treating the problem. Almost every problem can be treated. See the section below for more information on engorgement, clogged ducts, and flat/inverted nipples. The sooner you find out what is wrong and how to treat it, the faster you can enjoy breastfeeding your baby.


Newborn nursingIt is normal for your breasts to become larger, heavier, and a little tender beginning on the second to the sixth day after birth. This is due to the extra blood and fluids that go to your breasts to get them ready to produce the breast milk and the milk itself. This fullness will usually decrease within two to three weeks after birth if your baby is breastfeeding often and well. Then your breasts will feel softer even when you are making a lot of milk for your baby. Engorgement is when your breasts have too much milk because your baby is not getting enough out. Signs of engorgement are hard, taut, painful breasts.

Causes of engorgement are:
• Poor latch-on to your breast
• Infrequent or shortened feedings
• Baby sleeps through night-time feedings
• Not pumping milk from breast when baby can’t nurse
• Sudden reduction to your nursing or pumping schedule

Treating Engorgement

If your breasts are hard and engorged because your baby is not latching-on to your breasts correctly so she is not getting enough milk out, try these steps:
• Express milk from your breasts before you begin to nurse so your areola is soft and your nipple sticks out
• Check all the correct latch-on steps in this booklet and let your baby nurse
• While your baby is nursing, massage your breasts to move the milk down the ducts to the nipple. Massage each quadrant (fourth) of the breast using small circular motions with your thumb or fingertips from the outer part towards the nipple.

If your breasts are engorged because your baby hasn’t been nursing enough, try these steps:
• Nurse as often and as long as you can.
• If you can’t nurse your baby that often or you are separated from your baby, express excess milk and feed it to your baby in a bottle or cup.

To treat your painful, swollen breasts, ice packs before or between feedings can help reduce the swelling, and ibuprophen can help relieve the pain. And remember to always wear a well-fitting bra.

Not Enough Milk

The most common reason mothers stop breastfeeding their babies earlier than planned is they are not making enough milk for their hungry babies. Sometimes this is the result of your baby’s growth spurts which can happen at:

• 10-14 days
• 6 weeks
• 3 to 4 months
• 4 to 6 months

If you think you are not producing enough milk, try these steps:

• increase the number of feedings
• increase the length of feedings
• offer both breasts at each feeding
• pump milk after each feeding
• stop all supplemental feedings (milk, juice or water bottles)
• avoid the use of alcohol or nicotine

If these steps fail to increase your milk supply, call your doctor or lactation consultant for more suggestions.

Taking Medicine While Breastfeeding

Many medicines can pass into your breast milk, although usually in small amounts. For instance, some medicines for asthma, allergies, depression, hypertension, insomnia, migraine headaches, autoimmune diseases, and heart problems can affect your milk supply. How a medicine affects your baby and milk supply varies from mother to mother and from medicine to medicine. You should always check with your doctor before taking any prescribed or over-the-counter medicine. If a medicine reduces your milk supply, your doctor may tell you to take a different medicine or to take the medicine you have at a time that will have less of an effect on your milk. Your doctor can work with you so you don’t have to reduce or interrupt your frequent breastfeeding schedule, which would reduce your milk supply.

Plugged Ducts And Mastitis

If your baby is not getting all the milk out of your breast, the remaining milk may plug or clog one of your milk ducts. If this happens, you may feel a hard lump with redness, and a little warmth and tenderness around the lump. You can treat this by:
• using wet or dry heat to the area and massaging it gently
• taking warm showers or lying on your side in a warm bath tub and soaking your breast between feedings and massaging the area gently
• nursing the baby often on the breast with the lump to clear out the milk If your breast is red, hot and swollen, your pain is intense, you have a fever, and you feel like you have the flu, you probably have a more serious infection of the breast and need to see a doctor for treatment.

Flat/Inverted Nipples

If you have flat nipples, ones that are even with the dark areola area, or inverted nipples, ones that are concave or indented from the areola area, they may or may not affect breastfeeding. Remember, babies feed on breasts, not nipples. If your baby is positioned for breastfeeding and latched-on to the breast correctly, she may be able to draw your nipples out. If, however, your baby is having trouble latching on to your breasts because of inverted nipples, you can try these treatments:

Use the Hoffman technique — Place a thumb on each side of the base of the nipple, press firmly against the breast tissue pulling the thumbs away from each other. This should stretch out the nipple and loosen the tightness at the base, which should make the nipple move up and outward. Do this several times a day, moving around the base of the nipple.

Use a breast pump — Use a breast pump to draw out the flat or inverted nipple just before breastfeeding.

If your nipples are flat because of engorgement — Express some milk before you begin breastfeeding, which should help return your nipple to it’s protruding position.


More about Breastfeeding for Beginners

Overview of Breastfeeding
When to Feed Your Baby
How to Feed Your Baby
Breast Care While Breastfeeding
Breast and Nipple Problems While Breastfeeding
Expressing and Storing Breast Milk
Keeping up the Milk Supply
Nutrition While Breastfeeding
Breastfeeding in Special Situations
Returning to Work While Breastfeeding
Resources for Support While Breastfeeding

Newborn breastfeeding

Baby has latched-on well!

Tips from Baby
• Remember, if I’m latched on right, I shouldn’t hurt your nipples.
• If you can keep my tummy full of your breast milk, your breasts won’t become “engorged.”
• If I’m eating often, it will help keep your milk supply up.
• If you don’t stop breastfeeding while you are treating problems, I’ll be happy getting all the milk I need.

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