Sore Nipples causes, relief, thrush Breast Pain engorgment, plugged ducts, mastitis Milk Supply Issues not enough, over active let down Nursing Strikes and Weaning help and information When Your Baby Bites causes, solutions Jaundice you should keep breastfeeding Latch-on, positioning, engorgement, and other situations that may cause problems when you are beginning to breastfeed, are discussed in Breastfeeding Basics.

Sore Nipples
Moderate nipple tenderness is normal for many women in the first week of breastfeeding. But it should not be severe or last more than a couple of days. The most common cause of sore nipples is improper positioning or a poor latch on. (Links to additional information about position and latch are below)

If you are experiencing sore nipples and you have double checked both positioning and latch, you may have thrush. Thrush is a yeast infection that can travel between your breast and your baby's mouth. If you or your baby took antibiotics during or after birth, you have an increased chance of thrush. Thrush can make nursing very painful, but it is usually easily treatable. You must seek treatment if you suspect thrush.
See: Thrush for more information about symptoms, treatment and relief.

Blisters, cracking, bleeding and/or pain that is persistent during or in between feedings is not normal. Check with a lactation consultant, your doctor or La Leche League if you have any of these problems.

A crack or split in your nipple can be excruciating and again is often caused by improper positioning, latch-on, or removal from the breast. For relief until they heal, try the tips below.

The use of ointments and creams for sore nipples is fairly controversial. If you do choose to try an ointment to soothe the pain, keep in mind the following information. Do not use anything that may be toxic. A product called Lanisoh is available in many stores and through the La Leche League. It is a purified Lanolin. A potential drawback to Lanolin is the possibility of an allergic reaction (your skin or your baby). Do not use a lanolin based ointment if you are sensitive to wool. Vitamin E oil is an often mentioned remedy. If you decide to use it, do so sparingly and well before nursing. Vitamin E is a fat soluble vitamin and could accumulate in your baby's liver. Safe levels for infants have not been determined. I don't recommend it. Petroleum based salves will prevent your skin from breathing while alcohol containing products will be too drying. You may be better off in the long run not using any special products on your breasts. No salve or product has been proven to aid in the healing of sore nipples.

These tips may be helpful while you fix the source of the pain:

• Alternate positions at each feeding. Rotate between various holds like the cradle, football, and laying down to find the most comfortable positions for yourself. Use pillows to bring the baby up to the height of your breast to reduce tugging and pulling on your nipple.
  
  
• Nurse more frequently. Your baby won't be as hungry and may nurse less vigorously. Offer the less sensitive breast first.



• Be sure to release the suction before taking her off the breast by inserting your finger gently into the side of her mouth between your breast and her tongue.



• You could try rubbing your nipples with ice before feeding to slightly numb them.



• Keep your nipples dry and expose them to air whenever you can. You might try drying them with low heat from a hair dryer.
  
  
• Applying a small amount of breastmilk when you are done nursing, then letting it air-dry before covering yourself up might help.



• Avoid using soap on your breasts. It can be very drying.



• Change your breast pads frequently if you are using them, to keep your nipples from soaking in the dampness.



• If your breasts are engorged, try expressing a little milk before feedings. Engorged breasts make it difficult for your baby to latch on. Expressing a little milk by hand or breast pump can help make the latch-on easier.



• Soaking your nipples in a solution of salt and water (1/4 teaspoon of salt per cup of water) for 15 minutes or so between feeding may help heal them. If you have a crack in the nipple this may be too painful.
  
  
• Try using deep breathing, soft music or other relaxation techniques during breast-feeding. I probably should have tried this when I suffered cracked nipple when my daughter was a month or so old. Instead, every time I fed her I chanted a "mantra" that went something like this: "Ouch, oh-my-God-this-hurts *expletive deleted* oh, ooh, ooooh, ouch *another expletive deleted* this hurts..." I'm not sure if it really helped or not but it did seem to help me get through the initial pain.
  
  
• If severe trauma to the nipple is present, it may be necessary to remove the baby from the breast for a couple of days while you use a pump to express milk for feedings. If the pain has gone this far you likely will have sought professional help already.

See also: Jack Newman's article, Sore Nipples

For positioning and latch information see: Breastfeeding Basics and Dr. Jack Newman's article, Breastfeeding: Start Right

Breast Pain
If you suspect your breast pain is due to engorgement, read Let-down and Engorgement in the Breastfeeding Basics section.

Plugged Duct
A milk duct can become blocked by a mass of thickened milk or cells. Localized tenderness, swelling or a small, hard lump in the breast are symptoms of a plugged duct. Not consistently changing your baby's position, missing feedings, constant pressure from a tight bra and certain sleeping positions (side or stomach) are thought to be common causes of a plugged duct. If not dealt with, a plugged duct could develop into mastitis or a breast infection.

To help unclog the plug:

• Continue to breastfeed.
  
  
• Ensure that your baby is properly latched on and well positioned (See: Breastfeeding Basics) so that she is thoroughly draining the milk ducts with each feeding. Nurse as often as possible on the affected side to help drain the clogged duct.
  
  
• Though current wisdom seems to indicate that this is unnecessary, you can try to position the baby so that her chin is over the lump. You might find the football position or lying down the easiest way to accomplish this.
  
  
• Massage the lump on your breast firmly between and during feedings.
  
  
• Apply warm compresses and/or stand in the shower with the spray directly on the sore area.

If the pain (or the lump) doesn't go away within 2 to 3 days, you need to visit a lactation consultant or your doctor.

For more information see: Plugged Ducts and Mastitis by Dr. Jack Newman

Mastitis
Mastitis is an inflammation of the breast that may, or may not, be due to infection. Mastitis is caused by a blockage (of milk) in the ducts of the breast. Common symptoms are:

• One breast that's tender and warm to the touch with a red patch or red streaks
  
  
• Headache
  
  
• Fever (often 100 degrees or more)
  
  
• Flu like symptoms, fatigue and general body aches

Below are some ways to relieve mastitis. If after a couple of days, you still have a fever, unrelieved pressure in your breast, or significant pain, please see your doctor. You may need antibiotics. (If so, see my tips for avoiding and treating thrush. Thrush is often triggered by antibiotic use and will be hard to take immediately following mastitis!) If your doctor tells you you can't nurse with mastitis, take this advice with a BIG grain of salt. Extremely rarely will nursing need to be halted because of an infection. Consult a lactation consultant or your local LLL chapter before you stop nursing and when you are well, you may want to consider switching to a more breastfeeding friendly physician. (For more on this see: How to Tell if Your Doctor is NOT Supportive of Breastfeeding and You Can Still Breastfeed....)

• Ensure that your baby is properly latched on and well positioned (See:Breastfeeding Basics) so that she is thoroughly draining the milk ducts with each feeding. Nurse as much as possible on the affected side to help drain the clogged duct. You may feel the need to use a pump or hand express to provide additional relief. You can freeze the milk for later use. Don't neglect the other breast....you don't want to have milk build up in that side too. Remember to nurse as frequently as possible.
  
  
• Massage the sore area on your breast deeply between and during feedings.
  
  
• Apply warm compresses and/or stand in the shower with the spray directly on the sore area.
  
  
• Sleep as much as possible. Impose total bedrest on yourself if you possibly can. Set yourself up with snacks and plenty of water and take the baby to bed with you to encourage extra nursing and allow you to rest easier.
  
  
• Vigorous arm movements may help loosen up the blockage.
  
  
• Tylenol, unless contrindicated by your docter every 4 hours will help your headache and other pains if you need it.
  
  
• Do not stop breastfeeding! One study concluded that "lactation can and perhaps should be continued during treatment as it may speed recovery and will not adversely affect the infant" In addition the study says that "Weaning in these circumstances may be emotionally traumatic to mother and baby. It can be delayed safely until both are naturally ready..."
  (A.C. Thomsen et al., "Course and Treatment of Milk Stasis, Noninfectious Inflammation of the Breast, and Infectious Mastitis in Nursing Women" American Journal of Obstetrics and Gynecology, Vol. 149 (1984), pp. 492-495.)

For more information see: Plugged Ducts and Mastitis

Nursing Strikes and Weaning

What if I Want to Wean My Baby?
by Diane Wiessinger MS, IBCLC
A wonderful article about weaning...or rather why you may want to reconsider it.

I am still in the process of gathering/writing information on this topic. In the meantime, please see the following links. You can use your browser back button to return to Parentingweb

Nursing Strike FAQ
From L.L.L.IŻ

Chronicle of a 40 Day Nursing Strike
An amazing story with links to other stories.

Nursing Strike or Ready to Wean?
Causes, descriptions, solutions, article from L.L.L.I.

Natural Weaning
A wonderful article/description from a mom of two

A Natural Age of Weaning
Article by Katherine Dettwyler, PhD.