Breastfeeding should not hurt. It should not curl your toes, is should not make you cry, it should not make you feel like giving up. If it hurts, then you need help, immediately. The following is a guideline of symptoms and possible solutions. Contact your local La Leche League Leader for more information and help.

Sore Nipples in the early weeks

  • Soreness at the beginning of feeding, but not after the milk begins to flow, indicates the mother’s latch-on technique may need to be improved
  • Soreness on the first day after birth indicates a latch on or sucking problem which is usually easier to correct in the early days before it becomes a habit.
  • Soreness during the entire nursing session could be a positioning and latch-on problem, a sucking problem in the baby, or the soreness may be caused by thrush (see more on thrush below), especially if the mother describes the pain as burning or itching.
  • Soreness after or between feedings could be due to referred pain from nipple trauma, vasospasm, or Raynauds phenomenon, especially if mother’s nipples turns white after feedings, or it could be thrush

Engorgement

Engorgement is when milk is overproduced by the mother’s body and is built up in the breast instead of being released either via nursing or pumping.
Engorgement can happen when the milk “comes in” anywhere from 3-5 days after birth. Engorgement can also happen if a baby has skipped a feeding, or multiple feedings. It can cause problems if the breast becomes so full that the baby cannot latch on properly. It is best to express some milk (either manually or with a pump) just until the breast becomes soft enough for the baby to latch on. Removing the milk from the breast is the ONLY way to relieve engorgement. Some mothers find that cabbage leaves, when folded inside the bra next to the breast, helps to relieve some soreness.

  • If weaning causes engorgement, pump/express just enough milk to soften the breast and/or to comfort. Milk production is a supply and demand system. The body will adapt quickly to the quantity of milk that is leaving the breast, until the milk has “dried up.”

Nipple Confusion

The way a baby breastfeeds, by using the tongue, jaw and mouth muscles, is different than when bottle-fed or given a pacifier. Because of this, mothers have been cautioned about “nipple confusion.” If a baby received regular bottles or pacifiers, it may cause the mother soreness while breastfeeding. It is advisable to wait about 6 weeks before introducing a pacifier or bottle to ensure breastfeeding is off to a good start, and milk supply is well established. Studies have shown that regular use of pacifiers and bottles lead to earlier weaning. If you suspect nipple confusion, discontinue use of pacifiers and bottles and see if baby’s nursing improves.

Thrush

Thrush is an overgrowth of a fungus (Candida albicans) that is naturally present in our bodies, but when our bodies are out of balance, due to illness, pregnancy, antibiotic use, or other reasons, an unhealthy overgrowth can occur. Thrush can be very difficult to diagnose and treat, especially if only one of the nursing pair is showing symptoms.

Symptoms in the mother (may have any, all or none of the following):

  • Intense nipple or breast pain that may last throughout the feeding and is not improved with better latch-on and positioning
  • Sudden onset of nipple and/or breast pain after a period of comfortable nursing
  • Itchy or burning nipples, which may look normal or may appear pink or red, shiny, flaky and /or have a rash with tiny blisters
  • Traces of white fungus in the folds of the nipple or breast
  • Cracked nipples, either a new crack or a previous crack from nipple trauma that will not heal
  • Shooting pains in the breast during or after feedings
  • Vaginal yeast infection

Symptoms in the baby (may have any, all or none of the following):

  • White patches on the baby’s gums, cheeks palate, tonsils and/or tongue (if wiped off, they may look red or bleed)
  • Diaper rash (may be simply red or red with raised dots)
  • A whitish sheen to the inside of the lips
  • Baby repeatedly pulling off the breast, making clicking sounds while nursing or refusing the breast because his mouth is sore
  • Gassiness and fussiness

Both mother and baby need to be treated for thrush even if only one is showing symptoms, because it can be passed back and forth from mother and baby.

Treatment options (check with your local La Leche League Leader or healthcare professionals for more information):

  • Nystatin -prescription treatment
  • Clortirmazole -prescription treatment
  • Genitian Violet- available at health food stores
  • Pau D’arco- available at health food stores
  • Take probiotics (acidophilus bifidus)
  • Drink more water
  • Reduce consumption of sugar and dairy products

It is best to offer short, frequent feedings offering the least sore breast first (if there is one) and to gently break the baby’s suction before taking him off the breast.

Breast Pump

Improper fit and/or use can cause nipple soreness. Consult your local La Leche League Leader, or an IBCLC for help.

THE BREASTFEEDING ANSWER BOOK. Schaumburg, IL.: LLLI, 2003; 457-463, 480-483