NURSING
MOTHERS, INC.
Sore and Cracked Nipples
Factsheet 4
Many women who breastfeed their babies have sore nipples at some time during their experience. While mothers nursing their first babies and some mothers with delicate skin seem to develop sore nipples more easily than other mothers, any woman can get them if she doesn't follow proper nipple care and nursing techniques.
The best way to prevent sore nipples is to make sure your baby is properly positioned at the breast and has latched on correctly, taking all the nipple and as much of the areola (colored part of the breast) as possible into his mouth. Check to see that your baby is turned in to you, tummy to tummy, his mouth at the level of your nipple, and that he doesn't have to turn his head to grasp the nipple. When you help him latch on, gently touch his lower lip with your nipple and wait until he opens his mouth wide, as if yawning. Then hug him quickly onto your breast. Ninety percent of sore nipple complaints are caused by poor positioning and poor latches. Your Nursing Mothers counselor can help you evaluate if you need to make adjustments in getting your baby to breast.
Sore nipples generally occur first around the twentieth feeding, worsen for a day or two, and then rapidly disappear. Nipple soreness may vary from a slight tenderness while the baby is nursing to extreme pain both during and between nursings. The pain is usually most severe when the baby first latches on to the breast and tends to lessen once your milk "lets down." The nipple or areola may become chapped and reddened, and will sometimes crack and bleed. While alarming to you, the blood will not harm your infant.
Sore nipples can also be caused by:
·
Normal "newborn" irritation of the
nipples. This soreness seems to be a natural consequence of breastfeeding
for many mothers. It takes time for the nipples to become accustomed to
breastfeeding and for the
· Failure to break suction before removing the baby from the breast.
· Letting the baby chew on the nipples
· Not letting nipples dry out between nursings.
· Leaking colostrum which causes the nipples to stick to your bra.
· Inadequate letdown or milk supply, causing your baby to struggle at the breast.
· Destruction of natural lubricants by drying agents (alcohol, soap, deodorant, witch hazel), use of rough or vigorous nipple preparation.
· Sensitivity to detergent residue left in the bra or clothing after laundering.
· Thrush in the baby's mouth (the baby can communicate thrush to your breast), or thrush in your nipples.
· Sucking problems (sometimes the baby will not get his tongue under the breast, will thrust his tongue during nursing, or his lips won't flange out properly).
While treatment is usually not necessary for normal newborn soreness, some of the following techniques might minimize your discomfort and prevent the soreness from getting worse. Neither sore nor cracked nipples need be a reason to wean; with proper care your nipples should heal quickly in spite of the sucking, provided you use no harmful lotions. If your nipples are red, chapped, or extremely painful, it is best to try only one or two of the following at a time, giving the body a chance to respond before trying something else.
· Be sure your breast is placed correctly in your baby's mouth: he should have as much of the areola as possible. His lips should flange outward (not tucked inn). His tongue should extend over his lower gum and cup the underside of your breast (you or a support person can gently pull back the lower lip to see that his tongue is forward. See Factsheet #8 for more information on latching.
· Vary the positions you sue to nurse, trying to point your baby's chin away from the sore area.
· Stimulate letdown before putting your baby to the breast by using breast massage, warm compresses and other techniques.
· Nurse on the least sore side first. This stimulates letdown and makes the milk more easily available on the sore side.
· Try shorter, more frequent nursings temporarily. Your baby will suck more gently if he is not too hungry.
· Always break suction before removing your baby from the breast. Insert your little finger into the corner of his mouth to help him detach.
· Air dry nipples between nursings or place vented breast shell over your nipples under the bra to allow air to circulate around the nipples.
· Eliminate plastic liners in bras or nursing pads, and wear clothing made with breathable materials. Nursing pads can trap moisture against your skin; change them with every feeding.
· Sun bathe nipples in front of an open window indoors.
· Don't let your baby chew on your nipples.
· Try using relaxation techniques (remember that deep breathing!!) to help minimize pain.
· Consult your doctor about taking a nursing safe pain reliever.
· Some mothers find treating the nipples as if they were burned is helpful. Applying ice wrapped in cloth before and after nursing helps numb the pain.
· Sometimes, improving your nutritional intake will help promote healing.
· In persistent cases, have your doctor check the baby for thrush (noticeable as white milk patches in your baby's mouth that cannot be gently scraped away). If your doctor diagnoses thrush, both you and your baby will need to be treated to avoid the possibility you both keep re-infecting each other.
· If you suspect your baby has a sucking problem, try "suck training". Let him suck on one of your well-cleaned fingers, making sure his lips flange out and his tongue is forward. You can "walk" your finger back along his tongue to encourage him to move it forward.
Prevention of Sore Nipples
Proper nipple care, such as keeping nipples dry, and proper nursing techniques are the best preventatives for sore nipples.
Prenatal nipple preparation consisting of exposing nipples to the air
and avoiding soaps and drying agents on the nipples can
be beneficial. Recent studies have shown that additional prenatal
preparation, such as "nipple rolls" and massage may actually cause
sore nipples (not to mention possible causing premature contractions), although
they have often been recommended as a means of preventing sore nipples in the
past. Any nipple preparation that uses friction on the nipples (as
opposed to gentle pressure) can actually destroy the protective keratin coating
on the nipples and encourage soreness to develop.
Original: 3/86, CPM
Revised: 1/03 Megan Allen
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