Breastfeeding - sore breasts and nipples
breast; breastfeeding; breast; feeding; nipples; pain; engorgement; vasospasm; thrush; cracked; blocked; ducts; mastitis; sore; bite; biting;
Contents
Many women have sore breasts or nipples, especially when they begin breastfeeding. Try the ideas here, but seek help if the pain persists.
- An engorged breast becomes very tight, hard and uncomfortable.
- It usually happens during the first week after the birth or if you suddenly feed the baby a lot less than usual.
What you can do
- Wear a supportive bra, but make sure it is not too tight.
- It usually helps if you demand feed - whenever the baby wants a feed.
- It is important that your baby's position and attachment are right (see 'attachment' in the topic "Breastfeeding - the new baby").
- A hot shower or hot pack before feeding can help. You can buy hot and cold packs from chemists, or use hot and cold flannels or cloths.
- Express some milk before the baby starts to feed to soften the areola (brownish area around the nipple), so the baby can attach more easily.
- Use cold packs after feeds.
- Cabbage leaves may help your breasts feel more comfortable. Cut out the thick stem and cover your breast with cold leaves, stem end down. Leave the nipple uncovered. Change the leaf at each feed (or when the leaf goes limp). Stop as soon as your breasts feel comfortable. Using them for more than a short time may decrease your milk supply too much. If weaning you might use them for a longer time.
- If necessary you can take paracetamol for pain.
- A one-off complete emptying of both breasts may help, for example using an electric breast pump after a feed.
Blocked ducts
- A blocked duct feels like a tender (or sore) lump in your breast.
- It can be caused by:
- Missed, rushed or interrupted feeds
- Not feeding at regular times
- Not having the baby in the right position
- Pressure from clothes or bra
- An awkward sleeping position
- Pressing your finger on your breast during the feed
- Injury or bumps to the breast
- Often there is no reason that can be found.
What you can do
- Check the baby's position and attachment (see the section 'Attachment' in the topic "Breastfeeding - a new baby"). Make sure the nipple and most of the areola are in the baby's mouth.
- Try to feed often, starting on the breast that is sore.
- Use heat (a shower, hot pack or hot flannel) before the feed to encourage milk flow.
- Use a cold pack or cold flannel after feeds to relieve pain.
- Use a different position for feeding (eg baby under the arm instead of across the front).
- Try gentle massage of the breast and express some milk after the feed if the lump is still there (see the section on 'Expressing' in the topic "Breastfeeding - Expressing and storing breastmilk").
- Make sure you get plenty of rest, and eat well yourself.
- If the lump gets bigger and more painful, and the skin over it looks red or you feel ill, you may have mastitis.
Mastitis
If your breast gets inflamed (hot) and sore you may have mastitis. There is usually a red, sore, lumpy area in the breast, and you feel as if you have the flu and may have a fever.
Mastitis is caused by:
- an inflammation or infection in a blocked duct, so all causes of blocked ducts can cause mastitis as well,
- cracked nipples, which may allow a ‘bug’ to get into the breast,
What you can do
- First see your doctor, as you may need antibiotics. A mild attack of mastitis may settle without antibiotics, however.
- Feed often and express if you need to, to empty the breast as well as you can. Milk from the affected breast will not hurt the baby.
- Start feeds on the sore side, or if it is too sore, start on the other side and change to the sore breast as soon as the milk starts to flow.
- Change your feeding position - eg hold your baby under the arm instead of across the front.
- Gently massage your breast while the baby is feeding.
- Hot packs (or a hot shower) before feeds helps the milk to flow and cold packs after feeds can relieve pain. You can buy hot and cold packs from chemists, or use hot and cold flannels or cloths.
- Get plenty of rest and eat healthy food.
- Take paracetamol for the pain if you need to.
- Try not to wean the baby at this time.
- If all this does not help go back to your doctor. Sometimes antibiotics need to be given into your veins by a drip, which will mean going to hospital for a day or two.
- Rarely, an abscess may develop. This may need to be drained and more antibiotics given. Breastfeeding can usually continue, though.
If you keep getting mastitis:
- Check the causes of blocked ducts (see 'Blocked Ducts' above)
- Wear looser clothing and try sleeping without a bra
- See your doctor or breastfeeding consultant if there is anything wrong with your nipple, such as a crack.
- It could be that you are getting some infection from the baby. Ask your doctor about it.
Sore or cracked nipples
Many mothers have sore nipples when they start breastfeeding but this should get better quickly. If soreness goes on, or lasts through the whole feed, or if there are cracks in the nipple, help is needed. See your doctor or child health nurse.
What you can do
- Check the position and attachment of the baby. (see 'Attachment' in the topic "Breastfeeding - a new baby") This is often the cause. It is important that the baby has a big mouthful of nipple and areola and is sucking properly, not chewing on the nipple. If you are not sure, get a doctor or child health nurse to watch you feed and check that the baby is sucking well.
- Start feeds on the least sore breast.
- Try your best to relax when you are feeding so the milk will come easily. Take some deep breaths and drop your shoulders.
- Express a little milk before feeding. This may help the baby to attach.
- Let your baby suck for as long as the sucking is strong, but if the baby starts to doze or just nibble, stop the feed.
- To take your baby off the breast, put your finger in the baby's mouth alongside the nipple to get the baby to let go. Don't just pull the baby off.
- Express a little of the fatty milk at the end of the feed and smear it over the nipple area.
- Between feeds leave your top and bra off some of the time so air can get to your nipples. You can use a nipple protector (see "Breastfeeding - devices to help with breastfeeding").
- Don't use soap or any drying lotions on nipples.
- Don't use creams or any other medicines on your nipples unless a doctor or nurse suggests it. Purified lanolin (Lansinoh**) is sometimes helpful.
- Don't use plastic-backed breast pads, and replace damp pads often.
- Nipple shields can be tried but are usually not helpful.
- If a nipple is cracked and/or very painful, stopping feeding on the affected breast is often suggested, but research suggests that this does not help the nipple to heal more quickly.
- However, some mothers find it too painful to continue to breastfeed and prefer to hand express or pump from the affected breast for 24 to 48 hours and give the breast milk to the baby by bottle, cup or spoon.
- Feed as usual from the better side.
- Rarer causes of nipple pain include skin problems, eczema, dermatitis (including reactions to nipple creams), thrush and vasospasm (see below).
Thrush
- Thrush is an infection which sometimes affects the baby's mouth and nappy area and the mother's skin of and around the nipples.
- Thrush infection may be the cause of sore nipples which don't get better.
- There may be an itchy pink rash on the nipples.
- It is possible that thrush may cause sharp, shooting or burning pain in the breast without the nipples being very sore. Whether it is thrush that cause these pain is not known for sure.
- The baby may have thrush in the mouth. In the baby's mouth it looks like white patches, while on the breast it looks pink or red.
- You need to see your doctor if you think you or your baby might have thrush so it can be properly treated.
Vasospasm
- This is a rare cause of sore nipples and breast pain.
- It happens more often to people who get Raynaud's Disease (cold, white, painful fingers and toes in winter).
- With vasospasm, the nipples are very sensitive to cold. They will look white when the baby comes off the breast, then change to blue or purple, with stinging or stabbing pain. Some women feel this between feeds or even during pregnancy.
- If this is a problem for you, keep yourself as warm as possible, especially before or during feeds.
- Make sure the baby attaches and sucks well. If the nipple is really "squashed" by feeding it will be even more painful.
- As soon as the baby comes off one breast, put a hot pack or hot flannel or towel over the nipple and keep it there while you offer the other side. Have another hot flannel ready to put on the second side.
- Hot showers may help between feeds.
- Both caffeine (in coffee, tea, cola drinks) and smoking may make vasospasm worse.
- If vasospasm is severe, see your doctor as other treatments may be possible.
Some babies start to bite the nipple during or towards the end of a feed. Sometimes this seems to happen when their gums are uncomfortable due to teething. If they are teething you could try giving them lots of things to chew at other times during the day. Some teething gel on the gums before a feed may help.
Sometimes babies start to bite when they have finished sucking. Older babies are able to feed quite quickly and they may only need to suck for 5 minutes or less. If they are left on the breast they may start to nibble on the nipple rather than suck. If they bite at this time, you could detach them as soon as their sucking pattern changes.
Pulling them off and saying "no" when they bite is not likely to work as babies are not able to understand that the biting action is what you are saying "no" about.
Resources
South Australia
Parent Helpline
- 24 hours per day, every day - 1300 364 100
Your local Child and Family Health Centre
- see Locations for more information.
Australian Breastfeeding Association
- Helpline 1800 686 2 686 (1800 mum 2 mum) (24 hour service)
http://www.breastfeeding.asn.au/
General
Australian Breastfeeding Association
Helpline 1800 686 2 686 (1800 mum 2 mum) (24 hour service)
www.breastfeeding.asn.au
The Australian Government's National Breastfeeding Strategy - information for parents, professionals, child care providers and employers.
www.health.gov.au/pubhlth/strateg/brfeed/index.htm
World Health Organisation, 'Breastfeeding'
http://www.who.int/topics/breastfeeding/en/
Book
Children, Youth and Women's Health Service: "The Feeding Book (for babies and young children)". AUD$5.50 plus postage and handling. Ph: (08) 8303 1500.
The information on this site should not be used as an alternative to professional care. If you have a particular problem, see a doctor, or ring the Parent Helpline on 1300 364 100 (local call cost from anywhere in South Australia).
This topic may use 'he' and 'she' in turn - please change to suit your
child's sex.