Home
> Breastfeeding
> Jack Newman's Breastfeeding
Handouts
Sore Nipples
Handout #3a. Sore nipples. Revised
January 2005
Written by Jack Newman, MD, FRCPC. © 2005
Introduction
The best treatment of sore nipples is prevention.
The best prevention is getting the baby to latch 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. However, babies learn to suck properly by getting
milk from the breast when they are latched on well. (They learn
by doing). Thus, “suck” problems are often caused by
poor latching on. Fungal infection (due to Candida
albicans) may also cause sore nipples. The soreness caused
by poor latching and ineffective suckling 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. A
new onset of nipple pain when feedings had previously been
painless is a tip off that the pain may be due to a yeast infection,
but the pain may be superimposed on pain due to other causes. Cracks
may be due to a yeast infection. Dermatologic conditions
may also cause late onset nipple pain. There are several other causes
of sore nipples.
Proper Positioning and
Latching (see also the handout 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 (handout #2
Colic in the
Breastfed Baby). See also www.thebirthden.com/Newman.html
for videos that show how to latch a baby on, how to know a baby
is getting milk and how to use compression.
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, pushing in the baby’s bottom with
the side of your forearm so that your hand turns
palm upwards. This will help you support his body more easily, and
also bring the baby in from the correct direction so that he gets
a good latch. Your hand will be palm up under the baby’s face
(not shoulder or under his neck). The web between your thumb and
index finger should be behind the nape of his neck
(not behind his head). The baby will be almost horizontal across
your body, with his head slight tilted backward, 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 handout When
Latching and the videos at www.thebirthden.com/Newman/html)
Latching
-
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
(not lower), 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. As you bring the
baby toward the breast, his chin should touch
your breast first. Do not scoop him around so that the nipple
points to the middle of his mouth, but rather to the roof of
his mouth.
-
When the baby opens up his mouth, use the arm
that is holding him to bring him straight 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.
-
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. The pain will usually
subside. Do not take the baby on and off the breast several
times to get the perfect latch. If the baby goes on and off
the breast 5 times and it hurts, you will have 5 times more
pain, and worse, 5 times more damage. Fix the latch when putting
him to the other breast, or at the next feeding.
-
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).
-
There is no "normal" length of feeding
time. If you have questions, call the clinic.
-
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 (handout #8 Finger
Feeding) may help, but note, taking the baby off the breast
to finger feed instead is not a good idea and should be done as
a last resort only.
"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 (often
called “vasospasm” or Raynaud’s Phenomenon)
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?
-
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 for this vasospasm
is the treatment of the other causes of nipple pain. If the
main cause of the nipple pain is fixed, the vasospasm also disappears.
-
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.
- On occasion, we have had to use an oral medication (nifedipine)
to prevent this type of reaction. Vitamin B6 can also be used
(see handout #3b Treatments
for Sore nipples and Sore Breasts)
General Measures
-
Nipples can be warmed for short periods of
time after each feeding, using a hair dryer on low setting.
-
Nipples should be exposed to air as much as
possible.
-
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.
-
-
Do not wash your nipples frequently. Daily
bathing is more than enough.
- 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
(handout #15 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 (handout #5 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"
(handout #8 Finger
Feeding) or cup feeding. This is a last resort and taking
a baby off the breast should not be taken lightly. Furthermore,
it often doesn’t work.
Nipples shields are not recommended for sore nipples,
because, although they may help temporarily, they usually
do not, or they seem to help only. 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.
Questions?
see
my book Dr. Jack Newman's Guide to Breastfeeding (called
The
Ultimate Breastfeeding Book of Answers in the USA)
Handout #3a. Sore nipples. Revised
January 2005
Written by Jack Newman, MD, FRCPC. © 2005
This
handout may be copied and distributed without further permission,
on
the condition that it is not used in any context in which
the WHO code on the marketing of breastmilk substitutes is violated
