Thursday, October 2, 2014

Ouch! Nipple Pain, Damage & Infections

By To-wen Tseng. Originally posted on San Diego County Breastfeeding Coalition's Blog. 

Nipple pain, damage, and infections can happen to any breastfeeding mother. According to a 2008 research published on Pediatrics, pain is one of the major reasons why women stop breastfeeding. At the most recent San Diego County Breastfeeding Coalition general meeting, Vicki Wolfrum, RN, CNM, IBCLC, discussed these breastfeeding challenges with her colleagues.

Breastfeeding is not supposed to be painful. Wolfrum said many mothers came to her with nipple pain and said, “I waited for a while before seeking help because they told me it’s supposed to be painful in the first few days.” However, Wolfrum said, “That is not true!”

She said, “If breastfeeding is extremely painful, something is not right.”

Sensitivity during the first week is normal. For example, during the first one to three days after birth, mother’s nipples are extra sensitive because of estrogen, a hormone. However, anything more than the normal sensitivity is not right and needs to be investigated.

Wolfrum recognized three common causes of nipple pain: mechanical problems such as poor latch, poor positioning, and disorganized suck; nipple problems such as flat, inverted, or short nipples; diseases such a bacterial infection, inflammatory breasts, and eczema.

Ankyloglossia can also present as nipple pain.

Poor positioning is much more common then imagined. Not leaning back, mother slumped forward, baby below the breasts, baby handing on nipple, and baby’s head twisted can all be considered poor positioning.

“The best first latch is skin to skin touch. The first thing is to get the mother comfortable, and then just put baby on the chest and he will find his way to the breasts. It works a lot of the time,” said Wolfrum, “Bring baby to the breasts, not breasts to the baby.”

Poor or shallow latch is also common. While latching well, the baby’s mouth should be widely open and the lops should be flared.

Ankyloglossia is another common cause of mild to severe nipple trauma and pain. “If there is ‘pinch’ with every suck, pain from first latch, severe pain when no trauma evident, persistent pain regardless of great latch, post feed crease and nipples of great latch or linear scabs on nipples,” Wolfrum explained, “then it’s probably ankyloglossia.”

She shared a classic story with her fellow IBCLCs, “a mother with her third baby is feeling extreme pain in nipples. Her pediatrician told her to stop breastfeeding for three days to let her nipples healed. She did, and the nipples were healed,but she still had pain. Then a lactation consultant told her that she had thrush because the baby’s tongue was white. she asked her OB for Diflucan but nipples were continually painful.”

When Wolfrum saw the mother, the baby was 4 weeks old and the mother was ready to quit breastfeeding. She found that the baby had posterior tongue tie and labial tie.

The mother had her baby laser frenotomy of both tongue and lip. There was an immediate relief. In one week the baby was sucking peacefully with loud swallows.

However, Wolfrum reminded that not all ties cause nipple pain and the decision for frenotomy should be carefully discussed with doctors.

The coalition’s Dr. James Murphy (MD, FAAP, FABM, IBCLC) also pointed out that thrush is a mouth infection, but it is perfectly normal for a baby’s tongue to be white. White tongue doesn’t necessary mean thrush.

Some nipple pain can be relieved by natural remedies, while others require medication. Common treatment for nipple healing and comfort includes lanolin, lanolin mixed with breast milk, hydrogel gel pads, APNO (all-purpose nipple ointment), miconazole cream, and epsom salt bath.

Wolfrum recommended using lanolin and breast milk mix and hydrogel gel pads together, “Mothers often ‘ahhhhhh’ with use of hydrogels!”

Cute, but incorrect breastfeeding position--mom not leaning back, baby's mouth not widely open.

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