Management of Common Breastfeeding Concerns

Sore nipples from breastfeeding may have a number of causes including:

• Improper attachment or detachment (also called latching or unlatching)
• Nursing in one position too frequently
• Engorgement

Treatments for Sore Nipples

Review basic breast care.

Check your baby’s mouth at the breast. Make sure that as much of the areola as possible is in the baby’s mouth. Make sure the baby’s tongue is under the nipple. If you need to reattach, remove the baby from your breast by inserting your finger between the baby’s gums to break the suction.

Change feeding position. Try to vary your hold each feeding, pointing the baby’s chin away from the sore spot.

Begin breastfeeding with the least sore breast. This allows the milk to letdown. Also, babies usually do not nurse as long on the second breast.

If engorged, express a small amount of milk. Perform manual expression. or use a good quality breast pump to express enough milk to soften the breast and allow the baby to latch on correctly.

Use saline soaks after each feeding. Mix ¼ tsp. salt in eight ounces of warm water. Soak for 2 minutes.

Use purified lanolin. Warm a scant amount between your fingers before applying to your nipples.

Use a hydrogel. If nipples have visible damage, use a hydrogel to promote healing.

Use medication (under your doctor’s guidance). Ask your doctor for pain medications.

Ask for help. Call your lactation consultant for additional suggestions.

Breast engorgement is characterized by a hard, tight feeling in your breasts. Breasts are also warm and tender to the touch and you may experience a mild headache and/or a low-grade temperature.

Engorgement is due to:

• The swelling of your breast tissue
• Increased lymph and blood supply
• Stretching of the transporting structures
• The presence of the milk itself

Engorgement usually occurs 3 to 5 days after delivery (when the milk “comes in”) and lasts between 24 and 72 hours.

Treatments for Engorgement

Heat. Try taking a hot bath, a warm shower, or use warm compresses on your breasts for 10 minutes, followed by manual massage before each nursing session. Do not allow shower water to pulsate on your nipples.

Massage. Gently massage your breasts and express enough milk before nursing to soften the areola. This will make it easier for your baby to attach correctly to the breast.

Frequency. Nurse more frequently (every 2 to 2 ½ hours or sooner).

Breast compression. Massage your breast in circular motions down toward the nipple as the baby nurses.

Ice. Apply ice compresses for 10 to 15 minutes after nursing to reduce swelling and provide comfort.

Support. Wear a good nursing bra both day and night.

Pump. If your baby does not nurse well enough to provide engorgement relief, express or pump enough milk to reach a point of comfort.

Consistency. Be sure to continue treatment for engorgement for 12 to 24 hours after your symptoms disappear.

If the above tips do not provide relief within 24 hours, call your lactation consultant for additional assistance.

Inverted nipples can sometimes make correct attachment/latch a little more difficult, but there are ways to help.

Treatments for Inverted Nipples

Rolling and stretching the nipple throughout the day. Tug the nipple out and roll it to the right or left several times a day.

Breast shells. Wear dry breast shells in a bra between feedings to help pull out the nipple.

Pump. Manual or electric pumps can be used to evert (pull out) the inverted nipple.

Nipple shields. As a last resort, use a nipple shield. Be sure to consult with a lactation consultant about using a nipple shield.

Notes on Nipple Shields

Nipple shields should only be used for the first few minutes of feeding to draw the nipple out. Once your nipple is everted, remove the nipple shield and place the baby on the breast.

Some babies may need the use of a nipple shield for a short period of time, while others may need it longer. As you begin to reduce your use of the nipple shield, contact a lactation consultant for tips on how to do so.

CAUTION: With continued use, nipple shields may decrease your milk supply, and additional pumping would be necessary to maintain supply. Because of this, your baby’s weight gain could be a concern, so weekly weight checks for the first 3 to 4 weeks of nipple shield usage are recommended.