Tips for preventing and healing tender nipples.
Despite your best intentions, you're ready to give up: Breastfeeding has rendered your nipples a cracked and painful mess, and you can't take it anymore. Instead of treasuring those intimate moments of nursing your baby, you've come to dread them. But it doesn't have to be this way.
"Prolonged nipple pain is not normal and is usually quite fixable," says Christina J. Valentine, M.D., medical adviser for neonatal nutrition and lactation at Columbus Children's Hospital in Columbus, Ohio. Mild discomfort is normal in the first few days of breastfeeding, particularly when the baby latches on, Valentine adds. Tenderness that lasts longer than a week, or throughout the entire breastfeeding session, indicates a problem.
To avoid discomfort, research proper techniques before you have your baby. (Take a class at your local hospital or through La Leche League International, 800-LALECHE, lalecheleague.org; also pick up a good book, such as the American Academy of Pediatrics' New Mother's Guide to Breastfeeding.)
And if problems do arise, address them immediately. "Don't wait a month to get help," says pediatrician Jack Newman, M.D., head of the Newman Breastfeeding Clinic in Toronto. "The earlier you catch a problem, the easier it is to fix." (To find a lactation consultant near you, contact the International Lactation Consultant Association at 919-861-5577, ilca.org.)
In the meantime, here's a look at the five most common causes of nipple pain, along with tips on what you can do to prevent—and ease—the discomfort.
1. Poor Latch The most common cause of nipple pain is a poor latch. Such discomfort is piercing, immediate and short-lived; it typically occurs as soon as your baby starts nursing and gradually subsides during the feeding. When he's nursing, you'll want to keep his head level with your breast; any lower and he'll pull down on the nipple, which can irritate it. If necessary, place a pillow under the baby to elevate him to breast level. Also try gently pushing the baby's chin down so he can get more of your breast in his mouth--which should be wide open to take in the entire nipple and a good portion of the areola.
2. Ankyloglossia (aka "Tongue Tie") Ankyloglossia is a relatively common condition in which the frenulum, a bit of tissue that attaches the tongue to the floor of the mouth, is too short to allow for proper tongue movement. This can contribute to sore nipples. Look to see if the tip of your baby's tongue is heart-shaped or if you can't easily fit your finger between his tongue and the floor of his mouth. If so, discuss this with your pediatrician; a simple procedure can fix the problem.
3. Yeast Infection If your nipple pain is burning or stabbing and does not decrease as feeding progresses, it is likely due to a yeast infection known as candidiasis. Yeast grows in warm, dark, moist places, putting nursing nipples at high risk.
To prevent candidiasis, use washable cotton breast pads instead of plastic-backed disposable brands; change and wash them, as well as your bra, frequently. In addition, keep the area as dry as possible by exposing your breasts to air in between feedings. "Hold a hair-dryer, placed on the cool setting, approximately 10 inches from your breasts to dry the area before putting your bra back on," Valentine suggests. Also avoid using soap on the breasts and wiping harshly, which can over-dry your nipples and lead to cracking.
To soothe sore nipples, whether caused by a poor latch or candidiasis, Newman recommends using all-purpose nipple ointment (see "Relief for Sore Nipples" at left). Calendula ointment, grapefruit seed extract or even olive oil may also be comforting. "Anything greasy can help," says Newman.
While nipple products containing lanolin can be helpful for some women, all-purpose nipple ointment is usually more effective, Newman says, because it contains an antibiotic, a steroid and an anti-fungal medication. He cautions women with known wool allergies not to use lanolin products, though he adds that these will not trigger wool allergies in babies.
If you have candidiasis, it also may be helpful to take a lactose-free acidophilus supplement two or three times a day.
4. Vasospasm If you have corrected the latch and ruled out tongue-tie and candidiasis, you may be experiencing vasospasm of the nipple. Symptoms include burning or throbbing pain and your nipples turning white immediately after feeding. Related to the circulatory condition known as Raynaud's, which affects up to 22 percent of reproductive-age women, vasospasm is caused by excessive blood-vessel constriction due to temperature change. The condition needs to be medically managed, usually with oral medications that are safe for nursing babies.
5. An Unusual Suspect Chronic nipple pain can mean you're pregnant. If the pain lasts well after a feeding, you may want to take a pregnancy test.
Some women worry that nipple pain may be caused by breast cancer, but this is extremely rare. "Pain is usually a late symptom of breast cancer," says Newman, "and there would be other signs such as a lump or inflammation." Still, to be on the safe side, see your doctor if your symptoms are isolated to one breast and do not clear up with regular treatment.