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Nipple
Discharge
It is fairly common for the breasts to
discharge small amounts of blood during pregnancy and lactation. During pregnancy
and lactation, breast tissue grows rapidly. Rapid tissue growth can lead to
irritation of the breast ducts, causing bloody nipple discharge. This discharge
should not interfere with breast-feeding. If the discharge persists after
breast-feeding has stopped or is particularly bothersome, it should be further evaluated
by a physician. Click here to learn more about nipple
discharge.
Nipple
Confusion
Nipple confusion can occur during the
first few weeks after childbirth. The baby becomes “confused” between the
mother’s nipple and an artificial nipple of a bottle. Babies with nipple
confusion will not latch on to the mother’s nipple and become fussy when a mother
tries to breast-feed. The best way to avoid and treat nipple confusion is to delay
the introduction of bottles until a few weeks after childbirth.
Breast
Pain
While 80% of women experience mild
breast pain during the first few days of breast-feeding, pain usually subsides within a
few weeks. Chronic breast pain during nursing should be
reported to a physician or certified lactation consultant for clinical evaluation.
Persistent breast pain while nursing
may result from:
- Improper positioning. Leaning over
the baby can lead to breast and back pain.
- Engorgement.
- Strong milk ejection reflexes. The
actual process of expelling milk from the breast is called milk-ejection reflex (or
let-down). Milk is ejected from the breast into the baby’s mouth.
Normally, women feel a mild tingling sensation during milk ejection. However, some
women have strong milk ejection reflexes and experience a painful tingling or stinging
sensation during breast-feeding. This usually subsides after the first few weeks of
nursing.
- Nipple blanching (also called
vasospasm). The nipples turn white during and often in between breast-feeding. Many women
report burning sensations in the nipples. Nipple blanching may be relieved with warm
compresses and good breast support.
- Mastitis
(breast infection).
Nipple
Soreness
Nipple soreness is common during the
first few days of breast-feeding but usually subsides soon thereafter. If a woman is
experiencing persistent nipple pain, she should consult a physician or certified lactation
consultant.
Sore nipples are usually not related to
how often or how long a woman breast-feeds her child. Rather, sore nipples are most
commonly caused by improper positioning. The baby needs to take in approximately one
inch of the areola (pigmented region surrounding the nipple) when feeding on the
mother’s nipple.
Techniques that may help reduce sore
nipples include:
- Changing positions at each feeding.
- Breast-feed often for shorter intervals.
- Ask a physician about taking over the
counter acetaminophens such as Tylenol to relieve discomfort.
Sore nipples may also result from a
problem with the baby’s mouth such as thrush. Thrush is a yeast
infection. See the section below on thrush for more information.
Rarely, a baby’s receding chin or
a short frenulum in the baby’s mouth causes sore nipples. The frenulum is the
small band of tissue that connects the underside of the tongue to the floor of the
mouth. If the frenulum is too short, the baby is not able to grab the nipple
properly with his mouth. He or she will grab the nipple with the tongue, causing
soreness. If this is the case, some physicians will clip the baby’s frenulum to
loosen the tongue. The procedure is quick and does not cause much pain to the baby.
Other physicians feel this procedure is not necessary. If the baby has a receding
chin, sore nipples can usually be avoided if the baby is nursed in alternate
breast-feeding positions.
Inverted or Flat Nipples
Many women have inverted or flat
nipples and do not know it because the nipples will only turn inwards or flatten in the
baby’s mouth. To determine whether a woman has inverted or flat nipples, she
can cup her hand under her breast and press the breast together at the areola tissue (the
pigmented region surrounding the nipple). If the nipple turns inward or flattens,
the nipples are inverted or flattened.
The most common way to
“correct” inverted or flat nipples is to use breast shells before or in between
feedings. Plastic shells are worn directly on the breasts, and the nipple shows
through a hole. Shells help control the tissue around the nipple and cause the
nipple to push forward instead of inward. Women should talk to their physicians
before using breast shells.
Thrush
Thrush is a yeast infection that
develops in the baby’s mouth and is characterized by white patches on the baby’s
tongue, gums, and cheeks inside the mouth. Thrush may also appear as a red rash or
dots on the baby’s behind. Thrush most commonly results from antibiotics taken
by the mother or baby. Thrush can be treated by over the counter medications such
as nystatin ointment. Mothers should talk to their physicians on how best to treat
thrush.
If the baby has thrush, everything that
enters the baby’s mouth (except the breast) must be sterilized, including pacifiers,
breast pump parts, or toys the baby may chew on.
Jaundice
Jaundice is an accumulation of
bilirubin, a yellowish pigment, in the baby’s blood. The skin of a baby with
jaundice may be slightly yellow in color. Jaundice is common and is usually not
serious. Babies are usually treated under bilirubin lights immediately after birth
if they have jaundice. Another type of jaundice called late-onset or breast milk
jaundice may occur several days after birth.
New research has shown that
breast-feeding may not need to be stopped while a baby has jaundice. Babies who are
being treated with bilirubin lights can usually be feed bottled breast milk during
treatment.
Additional Resources and References
- So That's What They're For:
Breastfeeding Basics by Janet Tamaro (1998) provides extensive information on
breast-feeding in an easy-to-read, comprehensive, and humorous format. Click here
for pricing and ordering information.
- For additional resources, please visit
the breast-feeding section of the Imaginis.com Breast Health Bookstore at http://www.imaginis.com/bookstore/breasthealth/nursing.asp
Updated: June 29, 2008
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