Sore Nipples

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Breastfeeding is meant to be a comfortable and pleasant experience.

During the first week or two, however, many Mothers notice nipple tenderness. This may be related to normal postpartum skin changes, or to inexperience with latching on. Tenderness of this kind soon disappears. In the meantime, USP modified, 100% purified lanolin such as Lansinoh™, Medela’s Tender Care Lanolin™ and Hydrogel pads are safe and soothing.

Nipple pain that occurs between feedings, or that continues during the entire feeding, is not a normal part of the Breastfeeding experience.
Please tell your Lactation Consultant, La Leche League Leader, or your Health Care Provider if your nipples become cracked or blistered.
Breastfeeding assistance from a knowledgeable breastfeeding professional can often correct these problems.

Most nipple injury results from a poor latch. Effective latch-on, insures that the most sensitive part of the nipple tissue, is pulled deeply into the baby’s mouth. The tongue is forward over the lower gum to help cushion the compression.
When a baby is incorrectly latched, the baby grasps just the nipple shaft, rather than locating the gum compressions on the breast itself.

Mothers can identify a shallow, improper latch by removing the baby and checking the shape of the nipple. If the nipple looks creased, or drawn into a point (like a new lipstick), this is a sign that the baby is compressing the nipple shaft and is wrong. Cuts or abrasions can form across the crease line, as well as at the base, or junction of the nipple, and areola.

If the milk flow is pinched-off due to a ‘nipple latch,’ if the milk supply is low, or the breast is hard to draw in because of engorgement, the baby will suck harder in an attempt to get the milk. This extra strong suction, applied to such a small surface area, can cause blistering.

Solutions:
Seek help to correct the Latch-on and Positioning problems that cause sore nipples.
Often, simple positioning changes can fix the problem.
Please see: www.lactation-911.com/how-to-breastfeed-deep-latch-technique/

Manage engorgement or low milk supply problems. (Please see article ‘Engorgement’ elsewhere in this Blog.)

Gentle cleansing is good first-aid for any cut in the skin surface. Wash your nipples with a mild, non-antibacterial soap during your daily shower. Rinse well.
Your own milk feels soothing and can be healing and antibacterial to sore nipples.

If the nipples become too painful to allow breastfeeding, hand expression, or a gentle, effective breast pump, will protect your milk supply, and provide milk for your baby, until healing takes place.

Broken skin can become infected. Your Health Care Provider may recommend a safe, topical medication to resolve the problem.

If Mastitis (breast infection) occurs, oral antibiotics can be prescribed that are safe for use by breastfeeding Moms.

*Sore nipples that do not heal despite good positioning and latch-on usually have an underlying infectious component.

Fungus lives in cracks in the skin and may not present the typical symptoms of white plaques (thrush) in the infant’s mouth, and red, flaky or shiny skin of your nipples.
Abrasions and cracks usually harbor some bacteria, in particular, Staphylococcus aureus.

Usually, the pain of infection is due to the inflammation, associated with the infection, rather than the infection itself. The use of cortisone will help with pain, while healing takes place.

See the use of “all purpose nipple ointment,” a combination of anti-fungal, antibacterial and anti-inflammatory ointment, safe for baby, for complex causes of nipple pain.

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All Purpose Nipple Ointment (APNO) developed by Jack Newman MD FAAP International Breastfeeding Centre Toronto, Ontario, Canada

– Mupirocin 2% ointment 15 grams

– Betamethasone 0.1% ointment 15 grams

– Miconazole powder compounded to 2%

– Total 30+ grams

Apply sparingly, after feedings 4 times daily.
Do not wash or wipe it off prior to the next feeding.
Prescription required, prepared by a compounding pharmacist.

http://www.nbci.ca/index.php?option=com_con tent&view=article&id=12:candida-protocol&catid=5:information&Itemid=17

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All Purpose Nipple Ointment (APNO) developed by Dr Thomas Hale Texas Tech University Health Sciences Center Professor of Pediatrics Author of Medications in Mother’s Milk.

– Hydrocortisone Ointment 1%

– Polysporin Ointment or triple antibiotic ointment (Use polysporin with caution as it can cause allergic dermatitis, especially on inflamed skin.)

– Bactroban is another choice, but requires a prescription)

– Miconazole Cream

Mix in equal amounts and apply to the affected nipple area after feedings.
All ingredients are available over the counter.

http://www.nctba.org/medical-professionals/all-purpose-nipple-ointment-from-prescription-to-over-the-counter/

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Suggestions for preventing sore nipples:

Check positioning and encourage your baby to open wide when Latching on.

Offer your baby short, frequent feedings, to encourage a less vigorous suck.

Nurse on the least sore side first, if possible.

When removing your baby from your breast, break the suction gently by pulling on baby’s chin or corner of mouth.

Warm, moist compresses applied to your nipples (if a yeast infection is not present) may be soothing.

Freshly expressed breastmilk, applied to your nipples, will not only soothe your nipples, but also reduce the chances of infection, as human milk has antibacterial properties. (Do not use if thrush/candida is present.)

Moist Wound Healing has been shown to be very effective for healing sore nipples. Keeping your nipples covered with a medical grade (100% pure) modified Lanolin ointment or Hydrogel dressing will encourage any cracks to heal, without scabbing or crusting. (Do not use if thrush/candida is present.)

Use care when applying Herbal preparations.
Remember: Anything you apply to your nipples must be safe for the baby to “eat!”
Some can be toxic to the baby, or have strong odors that lead to breast refusal, or can trigger allergic reactions.
*Please consult your Health Care Provider or Lactation Consultant.

Avoid early use of bottles and pacifiers.

Frequent breastfeeding (8-12 feeds per 24 hours) will prevent the baby from sucking too vigorously due to hunger.

Soften engorged breasts with hand expression or pumping to help baby latch on. A brief warm shower before expression might be soothing to some Moms.

Express a little milk first, to stimulate the let down reflex, before Latching.

Use relaxation techniques before and during feedings.

Check the baby for conditions such as tongue-tie that can contribute to sore nipples.

Breastfeed on the least sore side first. Limit feeding time on the sore nipple if necessary. (Finish emptying the breast with hand expression or a breast pump).

To remove the baby from the breast, place a clean finger between the baby’s gums. This will prevent the baby from clamping down on the nipple.

Avoid synthetic bras and plastic-lined pads.

Avoid the use of Vitamin E on the nipples. This can be toxic to the baby.

Avoid the use of tea bags. Tea bags have been the subject of a number of studies; they appear neither to prevent nor reduce nipple soreness (Lavergne 1997). Furthermore, the tannic acid in the tea can act as an astringent causing drying and cracking, rather than healing.

At one time, it was recommended that a hair dryer or sunlamp be used on sore nipples. Research has now shown that this promotes drying and further cracking and is not advised.

Keep pads and bras dry. Drop bra flaps and allow air to circulate.

Multiple-hole breast shells hold fabric off of sore nipples and allow air circulation.

Avoid the use of nipple shields, because, although they sometimes help temporarily, they often do not.
In fact, they may often increase the degree of trauma to the nipples.
They may also cut down the milk supply dramatically, and the baby may become fussy and/or not gain weight well.
Once the baby is used to them, it may be difficult to get the baby back onto the breast.

Other Less Common Causes of Nipple Pain

Early Onset Nipple Pain is usually caused by ineffective Latch and the complications thereof.

Late Onset Nipple Pain

Fungal infections of the Nipple (due to Candida albicans) may also cause Sore Nipples

Yeast overgrowth or Candida is a common after effect of antibiotics.
If either you, or your baby, have been on antibiotics, this is a risk-factor for developing thrush/yeast-overgrowth/candida in both of you.

The pain from the fungal infection often goes on throughout the feed and may continue even after the feed is over.

Mothers often describe pain from a poor Latch or ineffective sucking as a ‘knife-like’ pain.

The pain of the Fungal Infection is often described as ‘burning,’ but it does not have to be burning in nature.

The skin often looks bright red and shiny, and may or not be flaky. Baby’s mouth may or may not have white, cheesy patches on the inside of his or her cheeks and a white coated tongue.

Cracks may be due to a Yeast infection.

Onset of nipple pain, when feedings had previously been painless, is a tip-off that the pain may be due to a Candida infection, but a Candida infection may also be superimposed on other causes of nipple pain, so that there was never a pain-free period.

Holistic Remedies for Candida include:
Eating Pro-biotic acidophilus (suggest brand PB8™ or Garden of Life™) taken according to the dosage on the label.
Eating yogurt (LOTS of PLAIN yogurt) helps to re-populate the intestines with the “good” bacteria that compete with yeast.
Drinking Chamomile tea and/or tincture of Myrrh seem to have anti-fungal properties. The Chamomile tea must be made from the flowers, not the stems and leaves.
Grapefruit Seed Extract (GSE), 2-3 drops in 8 oz of purified water, taken internally by Mom, fights yeast.
Product “Yeast Defense” by, Nutrition Now™ contains Caprylic-acid, proven to kill yeast.
Boost the immune system by increasing your intake of Garlic.
Medical treatment prescribed by your doctor may include:
Nystatin oral suspension as prescribed by your doctor.
Antifungal cream on your nipples as your doctor prescribes.
Gentian violet ½% solution applied to the Baby’s mouth, and on Mom’s nipples, twice-per-day, for three days. This will stain everything.
Diflucan tablets may be prescribed. Usually mom gets a 200 – 400mg dose the first day and half of that much for the next 10 – 14 days.
Your doctor may recommend All Purpose Nipple Ointment, that contains an antifungal, antibacterial and a steroid cream and can be compounded by your Pharmacist.
*Homeopathy is safe for Mother’s and Babies and can be very effective in boosting the immune system against Yeast overgrowth or Candida.
Please see your Homeopath for more information on a Homeopathic Remedy that is right for you! www.classichomeopath.com

See: All Purpose Nipple Ointment (APNO) above.

*Continue Yeast treatments until 2-weeks after the last symptom has disappeared in Mom and Baby.

Other Yeast Tips:
Do not use Lansinoh™ emollient during a Yeast infection.
Wash your bra and washable pads daily.
Do not use antibacterial soaps.
Hang in sunshine to dry.
Change pads as soon as they get wet.
Do not reuse disposable pads.
Wash your hands well. Use warm soapy water and lots of friction for at least 15-seconds.
Use paper towels for hand drying, then discard them, since yeast can live on a moist towel.
Use a bath towel only once, and then wash it.
Do Not Freeze Milk collected during a Yeast infection.
Boil all plastic/rubber/silicone items that come in contact with the Baby’s mouth, Mom’s breast, or Mom’s milk for 20-minutes per day.
Replace rubber parts weekly, if possible.
Use a solution of ¾C bleach and one gallon water to disinfect surfaces of the diaper changing station.
You may opt to use white vinegar, in a spray bottle to clean, in lieu of bleach water.

Vasospasm (which is due to irritation of the blood vessels in the nipple from poor Latching and/or a fungal infection) may also cause sore nipples.

“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 color, 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 then the nipple may turn white again and the process repeats itself.

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 color).

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.

The best treatment for this Vasospasm is the treatment of the other causes of nipple pain (Proper, deep, off-center Latch).
If the main cause of the nipple pain is corrected, the Vasospasm also usually disappears.

Heat (hot washcloth, hot water bottle, etc.) applied to the nipple immediately after breastfeeding may prevent or decrease the reaction.

Supplementing with Vitamin B-6, Multivitamin complex, can also be used, as can Magnesium and Calcium, in equal parts.

On occasion, oral medication (nifedipine), is used to prevent this type of reaction.

*Homeopathic Medicine is safe for Mother’s and Babies and can be very effective in treating Vasospasm or Raynaud’s.
Please see your Classical Homeopath for more information on a Homeopathic Remedy that is right for you! www.classichomeopath.com

www.lactation-911.com/homeopathy-and-breastfeeding/

I hope that you found the information contained here helpful.

Remember! Sore and painful nipples are very treatable!
.. and is rarely a reason to discontinue breastfeeding!

References:
Centuori S, Burmaz T, Ronfani L, Fragiacomo M, et al: Nipple Care, Sore Nipples, and Breastfeeding: A Randomized Trial, J Human Lact 1999; 15(2):125-130.
Fetherston C: Mastitis in lactating women: physiology or pathology? Breastfeeding Review 2001, 9(1):5-12.
Lawrence R and Lawrence R: Breastfeeding: A guide for the medical profession, Fifth Ed. Mosby, St. Louis.1999. Pg. 259-261.
Livingston V and Stringer J: The Treatment of Staphyloccocus Aureus Infected Sore Nipples: A Randomized Comparative Study, J Human Lact 1999, 15(3):241-246.
Riordan J: The effectiveness of topical agents in reducing nipple soreness of breastfeeding mothers, J Human Lact 1985;1(3):36-41.
Spangler A and Hildebrandt E: The effect of modified lanolin on nipple pain/damage during the first ten days of breastfeeding, Int J Childbirth Ed 1993; 8(3):15-19.
Woolridge M: Aetiology of sore nipples, Midwifery 1986; 2:172-176.
Wilson-Clay B and Hoover K: The Breastfeeding Atlas 1999, Lactnews Press, Austin, Tx. Pg. 10-12, 17-21.
Zeimer M, Paone J, Schupay J, and Cole E: Methods to Prevent and Manage Nipple Pain in Breastfeeding Women, West J Nurs Research 1990; 12(6):732-744.
Zeimer M and Pigeon J: Skin Changes and Pain in the Nipple During the 1st Week of Lactation, JOGNN 1993; 22(3):247-256.

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