SIGNS:

Breast or nipple soreness can occur during or between breastfeedings. Nipples are pink, red or purple. Look for a break in the skin at the base of the nipple or on top of the nipple. Thick, yellow material draining from the damaged area can be a sign of infection.


CAUSES:

Nipple soreness often occurs during the first few days of breastfeeding when the baby latches on and draws the nipple and areola into his mouth. If the baby is positioned correctly on the breast, the soreness will only last a few seconds. If the baby is positioned incorrectly, the soreness will continue and nipple damage can occur. Other causes of nipple soreness include breast engorgement, breast infections, and the misuse of nipple shields, breast creams, or breast pumps.


RECOMMENDED TREATMENT:

     Put a warm compress on the sore breast before each
         breastfeeding. A warm washcloth, a warm shower or tub bath,
         or soaking the breast in a pan of warm water works well.

     Position the baby correctly on the breast. Turn your baby on his
        side or tuck him under your arm so that his head and chest are
        facing your breast. Use pillows to support the baby at the level of
        your breast. Tickle his upper and lower lips with your nipple until
        his mouth opens wide. Position the baby's lower lip against your
        breast and quickly but gently place the baby on the breast. Don't
        let him nibble his way on. Your nipple will point toward the roof
        of the baby's mouth. Do not lean forward. Bring the baby to you.
        His tongue should be over his lower gum, between his lower lip
        and the breast. His lips should turn out, like a fish, and lie flat
        against the breast. His chin should press firmly into the breast.
        His nose and cheeks should gently touch the breast.

     If necessary, express a small amount of breastmilk or colostrum
         to soften the breast before you allow the baby to latch on.

     Breastfeed on the least sore breast first. When a let-down reflex
         occurs and milk begins to flow, move the baby to the sore
         breast and breastfeed only long enough to relieve the fullness
         and soften the breast.

     If necessary, limit the breastfeeding time on the sore breast and
         breastfeed more often, every 1-2 hours.

     Hold the baby close to prevent unnecessary pulling on the
         breast. Break the suction before removing the baby from the
         breast.

     After each breastfeeding, put a small amount of colostrum or
         breastmilk on the areola and nipple of each breast. Air dry
         nipples after each breastfeeding or dry gently with a soft cloth.

     Do not wash the nipples before each breastfeeding. Even water,
         used often, will dry the skin. Avoid soaps, creams, lotions, and
         oils. If the nipples crack or bleed, put a small amount of
         modified lanolin on the damaged area after each
         breastfeeding.

     If soreness, cracking, or bleeding continues, stop breastfeeding 
         for 24 hours to let the nipple(s) heal. Hand express or pump to
         relieve fullness during this time. If only one breast is sore,
         continue to breastfeed on the other breast.

      Thick, yellow material draining from the damaged area can be a
          sign of infection. Call  your doctor, lactation consultant, or nurse
          for treatment.

     If necessary, take acetaminophen or ibuprofen for pain.


PREVENTION:

     Use only clear water to wash your breasts.

     Limit the use of soaps, creams, lotions, and oils.

     Whenever possible, air dry your nipples after each
          breastfeeding.

     Change breast pads frequently. Do not use pads with plastic
          liners.

     If your nipples are sore, put a few drops of colostrum or
         breastmilk on the areola and nipple after each breastfeeding.

     If your nipples become cracked or bleed, put a small amount of
         modified lanolin on the damaged area after each
         breastfeeding.

     Position the baby correctly on the breast. If necessary, hand
         express or pump to soften the breast and relieve fullness.

     Breastfeed as long as the baby wishes on the first breast before
         offering the second breast.

     Begin each feeding on the breast offered last.

     Breastfeed every 1-3 hours during the day and every 2-3 hours
         at night. If you delay or skip feedings, hand express or pump to
         relieve fullness.

     Use 2-3 different breastfeeding positions each day.

     Break the suction before removing the baby from the breast.