Sore Nipples
Introduction
The best treatment of sore nipples is prevention. The best prevention is getting the baby to latch on properly from the first day.
Sore nipples are usually due to one or both of two causes. Either the baby is not positioned and latched properly, or the baby is not suckling properly, or both. However, babies learn to suck properly by getting milk from the breast when they are latched on well. (They learn by doing). Thus, “suck” problems are often caused by poor latching on. Fungal infection (due to Candida albicans) may also cause sore nipples. The soreness caused by poor latching and ineffective suckling hurts most as you latch the baby on and usually improves as the baby nurses. The pain from the fungal infection goes on throughout the feed and may continue even after the feed is over. Women describe knifelike pain from the first two causes. The pain of the fungal infection is often described as burning, but may not have this character. A new onset of nipple pain when feedings had previously been painless is a tip off that the pain may be due to a yeast infection, but the pain may be superimposed on pain due to other causes. Cracks may be due to a yeast infection. Dermatologic conditions may also cause late onset nipple pain. There are several other causes of sore nipples.
Proper positioning and latching
(see also the handout A: When Latching)
It is not uncommon for women to experience difficulty positioning and latching the baby on. Proper positioning facilitates a good latch and good latching reduces the baby's chances of becoming "gassy", and also allows the baby to control the flow of milk. Thus, poor latching may also result in the baby not gaining adequately, or feeding frequently, or being colicky (handout #2, Colic in the Breastfed Baby). See also www.thebirthden.com/Newman.html for videos that show how to latch a baby on, how to know a baby is getting milk and how to use compression.
- Positioning — For the purposes of explanation, let us assume that you are feeding on the left breast.
Good positioning facilitates a good latch. A lot of what follows under latching comes automatically if the baby is well positioned in the first place.
At first, it may be easiest to use the cross cradle hold to position your baby for latching on. Hold the baby in your right arm, pushing in the baby’s bottom with the side of your forearm so that your hand turns palm upwards. This will help you support his body more easily, and also bring the baby in from the correct direction so that he gets a good latch. Your hand will be palm up under the baby’s face (not shoulder or under his neck). The web between your thumb and index finger should be behind the nape of his neck (not behind his head). The baby will be almost horizontal across your body, with his head slight tilted backward, and should be turned so that his chest, belly and thighs are against you with a slight tilt so the baby can look at you. Hold the breast with your left hand, with the thumb on top and the other fingers underneath, fairly far back from the nipple and areola.
The baby should be approaching the breast with the head just slightly tilted backwards. The nipple then automatically points to the roof of the baby's mouth. (See handout When Latching and the videos at www.thebirthden.com/Newman/html )
- Latching
1. Now, get the baby to open up his mouth wide. The way to do this is to run your nipple, still pointing to the roof of the baby's mouth, along the baby's upper lip (not lower), lightly, from one corner of the mouth to the other. Or you can run the baby along your nipple, something some mothers find easier. Wait for the baby to open up as if yawning. As you bring the baby toward the breast, his chin should touch your breast first. Do not scoop him around so that the nipple points to the middle of his mouth, but rather to the roof of his mouth.
2. When the baby opens up his mouth, use the arm that is holding him to bring him straight onto the breast. Don't worry about the baby's breathing. If he is properly positioned and latched on, he will breathe without any problem. If he cannot breathe, he will pull away from the breast. Don't be afraid to be vigorous.
3. If the nipple still hurts, use your index finger to pull down on the baby's chin in order to bring the lower lip out. You may have to do this for the duration of the feed, but this is usually not necessary. The pain will usually subside. Do not take the baby on and off the breast several times to get the perfect latch. If the baby goes on and off the breast 5 times and it hurts, you will have 5 times more pain, and worse, 5 times more damage. Fix the latch when putting him to the other breast, or at the next feeding.
4. The same principles apply whether you are sitting or lying down with the baby or using the football hold. Get the baby to open wide; don't let the baby latch onto the nipple, but get as much of the areola (brown part of breast) into the mouth as possible (not necessarily the whole areola).
5. There is no "normal" length of feeding time. If you have questions, call the clinic.
6. A baby properly latched on will be covering more of the areola with his lower lip than with the upper lip.
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Please see next page for the remainder of this handout.
Handout #3a. Sore Nipples. Revised January 2005
Written by Jack Newman, MD, FRCPC. © 2005
This handout may be copied and distributed without further permission, on the condition that it is not used in any context in which the WHO code on the marketing of breastmilk substitutes is violated.
