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Introduction
The best
treatment of sore nipples is prevention. The best prevention is latching
the baby on properly from the first day.
Sore
nipples are usually due to one or both of two causes. Either the baby is not
positioned and latched properly, or the baby is not suckling properly, or both.
Incidentally, babies learn to suck properly by getting milk from the breast when
they are latched on well. (They learn by doing). Fungal infection (due to
Candida albicans), may also cause sore nipples. The soreness caused by poor
latching and ineffective suckle hurts most as you latch the baby on and usually
improves as the baby nurses. The pain from the fungal infection goes on
throughout the feed and may continue even after the feed is over. Women describe
knifelike pain from the first two causes. The pain of the fungal infection is
often described as burning, but may not have this character. Sudden,
unexplained onset of nipple pain when feedings had previously been painless
is a tipoff that the pain may be due to a yeast infection, but the pain may come
on gradually or may be superimposed on pain due to other causes. Cracks may
be due to a yeast infection.
Proper
Positioning and Latching (See When Latching)
It is not uncommon for women to experience difficulty positioning and
latching the baby on. Proper positioning facilitates a good latch and good
latching reduces the baby's chances of becoming "gassy", and also allows the
baby to control the flow of milk. Thus, poor latching may also result in the
baby not gaining adequately, or feeding frequently, or being colicky (Colic in the Breastfed
Baby).
Positioning - For the purposes of explanation, let us assume that you are
feeding on the left breast.
Good
positioning facilitates a good latch. A lot of what follows under latching comes
automatically if the baby is well positioned in the first place.
At first,
it may be easiest to use the cross cradle hold to position your baby for
latching on. Hold the baby in your right arm, the web between your thumb and
index finger behind the nape of his neck (not behind his head) with your
fingers (except for the thumb) supporting the baby's face from underneath, and
your forearm supporting his back and buttocks. Hold the baby's buttocks between
your chest and your forearm—this should give you good control. The baby should
be almost horizontal across your body and should be turned so that his chest,
belly and thighs are against you with a slight tilt so the baby can look
at you. Hold the breast with your left hand, with the thumb on top and the other
fingers underneath, fairly far back from the nipple and areola.
The baby
should be approaching the breast with the head just slightly tilted
backwards. The nipple then automatically points to the roof of the baby's mouth. (See When Latching)
Latching
1. Now, get the baby to open up his mouth wide. The way to do this is
to run your nipple, still pointing to the roof of the baby's mouth, along the
baby's upper lip, lightly, from one corner of the mouth to the
other. Or you can run the baby along your nipple, something some mothers find
easier. Wait for the baby to open up as if yawning. WAIT FOR HIM. As you
bring the baby toward the breast, his chin should touch your breast first. Do
not bring him around so that the nipple points to the middle of his mouth, but
rather to the roof of his mouth.
2. When the baby opens up his mouth, use the arm that is holding him to bring
him onto the breast. Don't worry about the baby's breathing. If he is properly
positioned and latched on, he will breathe without any problem. If he cannot
breathe, he will pull away from the breast. Don't be afraid to be vigorous.
3. If the nipple still hurts, use your index finger to pull down on the baby's
chin in order to bring the lower lip out. You may have to do this for the
duration of the feed, but this is usually not necessary.
4. The same principles apply whether you are sitting or lying down with the baby
or using the football hold. Get the baby to open wide, don't let the baby latch
onto the nipple, but get as much of the areola (brown part of breast) into the
mouth as possible (not necessarily the whole areola).
5. There is no "normal" length of feeding time. If you have questions, call the
clinic.
6. A baby properly latched on will be covering more of the areola with his
lower lip than with the upper lip.
Improving the baby's suckle
The baby learns to suckle properly by nursing and by getting milk into his
mouth. The baby's suckle may be made ineffective or not appropriate for
breastfeeding by the early use of artificial nipples or from poor latching on
from the beginning. Some babies just seem to take their time developing an
effective suckle. Suck training and/or finger feeding (Finger Feeding) may
help.
"My
nipple turns white after the baby comes off the breast"
The pain associated with this blanching of the nipple is frequently
described by mothers as "burning", but generally begins only after the feeding
is over. It may last several minutes or more, after which the nipple returns to
its normal colour, but then a new pain develops which is usually described by
mothers as "throbbing". The throbbing part of the pain may last for seconds or
minutes and may even blanch again. The cause would seem to be a spasm of the
blood vessels in the nipple (when the nipple is white), followed by relaxation
of these blood vessels (when the nipple returns to its normal colour). Sometimes
this pain continues even after the nipple pain during the feeding no longer is a
problem, so that the mother has pain only after the feeding, but not during it.
What can be done?
1. Pay
careful attention to getting the baby to latch onto the breast properly. This
type of pain is almost always associated with, and probably caused by whatever
is causing your pain during the feeding. The best treatment is the treatment of
the other causes of nipple pain.
2. Heat (hot washcloth, hot water bottle, hair dryer) applied to the nipple
immediately after nursing may prevent or decrease the reaction. Dry heat is
usually better than wet heat, because wet heat may cause further damage to the
nipples.
3. On occasion, we have had to use a medicated paste (nitroglycerine) or an oral
medication (nifedipine) to prevent this type of reaction. Vitamin B6 can also be
used [Treatments for Sore Nipples & Sore Breasts].
General Measures
l. Nipples can be warmed for short periods of time after each feeding, using
a hair dryer on low setting.
2. Nipples should be exposed to air as much as possible.
3. When it is not possible to expose nipples to air, plastic dome-shaped breast
shells (not nipple shields) can be worn to protect your nipples from
rubbing by your clothing. Nursing pads keep moisture against the nipple and may
cause damage that way. They also tend to stick to damaged nipples. If you leak a
lot you can wear the pad over the breast shell.
4. Ointments can sometimes be helpful. If you do use an ointment, use just a
very small amount after nursing and do not wash it off. [Treatments for Sore Nipples & Sore Breasts].
5. Do not wash your nipples frequently. Daily bathing is more than
enough.
6. If your baby is gaining weight well, there is no good reason the baby must
be fed on both breasts at each feeding. It may save you pain, and speed healing
if you feed your baby on only one breast each feed. It will help to compress the
breast (Breast Compression),
once the baby is no longer swallowing on his own in order to continue his
getting milk. You may be able to manage this some feedings, but not others. In
very difficult situations, a lactation aid (Using a Lactation Aid)
can be used to supplement (preferably expressed milk), so that the baby will
finish the feeding on the first side.
If you
are unable to put the baby to the breast because of pain, in spite of trying all
the above measures, it may still be possible to continue breastfeeding after a
temporary (3-5 days) cessation to allow the nipples to heal. During this time,
it would be better that the baby not be fed with a rubber nipple. Of
course it is also best for you and the baby if the baby is fed your expressed
milk. Use the technique called "finger feeding" (Finger Feeding) or
cup feeding.
Nipples
shields are not recommended for sore nipples, because, although they may
help temporarily, they usually do not. They may also cut down the milk supply
dramatically, and the baby may become fussy and not gain weight well. Once the
baby is used to them, it may be impossible to get the baby back onto the breast.
In fact, many women who have tried nipple shields find that they do not help
with soreness. Use as a last resort only, but get help first.
About The Author: Dr. Jack Newman is a Toronto
pediatrician who has practiced medicine since 1970. In 1984 he established the
first hospital based breastfeeding clinic in Canada, at the Hospital for Sick
Children in Toronto. He now holds breastfeeding clinics in several Toronto area
hospitals. Jack has been a consultant with UNICEF's Baby Friendly Hospital
Initiative and has spoken at conferences around the world. He is the father of
three children, all breastfed.
Dr. Newman is the author of
"The Ultimate Breastfeeding Book of Answers"
NOTE: The article above titled "Sore
Nipples" was written by Dr. Jack Newman and is the opinion of its author. "The New Parents Guide" does not guarantee the information to
be factual. Always use the guidance of your personal
doctor or your child's doctor over information you read on this site or elsewhere; your doctors know what is
best for you and your baby.
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