Nipples, Sore

This article is an excerpt from "The Nursing Mother's Problem Solver" by Claire Martin.

Some mothers have sore nipples, even if their babies seem (to an untrained eye) to be properly latched on, with textbook-style suckling. Pain always indicates a problem that needs to be diagnosed and resolved. Breastfeeding is not normally a painful experience. With some detective work, you may be able to isolate the source of your pain and remedy the problem.

If you've had pain nursing right off the bat-nipple pain that hasn't lessened since your first nursing session-there may be a problem with positioning, latch-on, or your baby's suck. It also is possible that the problem is physical. Ask the pediatrician and/or your lactation consultant to examine your baby's mouth. She may have a high palate, or a short or tight frenulum (the tissue under the tongue) that makes it difficult for her to use her tongue.

If breastfeeding already is established, and your nipples are suddenly sore, you may have thrush. To properly diagnose thrush, both you and the baby should be examined by a lactation consultant and then by your physician. Sometimes, even if you've taken medication for thrush-lotrimin, loprox, nystatin-the thrush may still be present if you and the baby haven't been treated simultaneously for at least 2 weeks. Thrush is persistent, and it can be resistant to drugs, returning after you think that you've treated it. If you do have thrush, do not treat your nipples with hydrocortisone; it only makes your nipples even more sore.

If your nipples are red and sore, but thrush has been ruled out, another possibility is eczema of the nipples. This occurs in women with a history of eczema and dry, sensitive skin, and it usually is accompanied by burning and itching.

Sore, tender nipples also can signal pregnancy, especially if you're also exceptionally tired and nauseated. Could you have a breast inflammation or infection? Did you have mastitis? Even if you treat mastitis with penicillin, the drug may not have resolved the staph infection. If your pain is caused by a persistent staph infection, ask us about dicloxacillin, which must be taken conscientiously for 2 weeks.

Could you have a bacterial infection in your nipples? Are they cracked and refusing to heal? Those infections are painful and can lead to a bout with thrush. (See Thrush).

If you've eliminated infections, inflammation, thrush, and positioning as the culprits, you should see a dermatologist familiar with breastfeeding-related problems. (Your lactation consultant, or the local La Leche League, should be able to suggest someone.)

Tips for preventing or healing sore nipples:

• Check the baby's position when she latches on. Make sure the nipple is pointing at the back of her mouth and that she's encompassing as much of the nipple and areola in her mouth as possible.
• Make sure the baby's lower lip is flanged, not sucked into her mouth. Pull down his lower lip. You should be able to see his tongue between his lower lip and your nipple.
• Use warm compresses and expressing a little milk to soften nipples hardened by engorgement.
• Use your finger to break the baby's latch suction, rather than pulling the baby off your breast.