Some general rules of thumb and best practices to prevent nipple
irritation while breast feeding:
Use no soap on your nipples. Wash only with warm water as needed
in the shower/bath.
Avoid routine use of breast creams. If your nipples become
tender or sensitive, hand express a few drops of
colostrum/breast milk after each breast feeding and rub gently
into your nipple/areola. Air dry for a few minutes. Colostrum
and breast milk contain enzymes to soothe your nipples and heal.
If needed, ask your staff nurse or the lactation consultant for
help in learning the technique of hand expression. Lansinoh is a
safe cream to use if a breast cream is needed. Squeeze a tiny
amount from the tube onto your finger and gently dab the cream
only on the spot where needed. Lansinoh is safe to use when
breast feeding and does not need to be removed before feeding
the baby. But, Lansinoh does have a taste and an odor which some
babies do not like. Avoid using if your baby does not like the
cream on your nipple.
Air dry your nipples for a few minutes after each nursing.
Use of a nursing bra is optional. You may leave your bra off
until your breasts signal that they need the support. Support
may be needed as your milk volume builds. Underwire bras can
press on your breast tissue and prevent your breast from
adequately draining, so it is important to wear a properly
fitting nursing bra.
Use of nursing pads are optional. If needed, use only 100
percent cotton pads. Quality nursing pads may be purchased at
the area breast pump depots and local maternity shops. You may
also make your own nursing pads by cutting up old softened
cotton tee shirts or by using men's 100 percent cotton
handkerchiefs folded up inside your bra. If your breast leak
milk at night while you sleep, place folded towels on your bed
to absorb the milk and keep your bed dry.
If your nipples are painful, reddened, blistered, or cracked ask
your staff nurse and the lactation consultant to evaluate your
latch and your baby's suckle. Or contact a lactation consultant
after discharge for feeding and latch assessment.
Tenderness: Some tenderness can be normal as
you become accustomed to breastfeeding and your nipples "toughen up".
The first two weeks of breastfeeding are a learning period for you and
your baby. If your nipples are tender, hand express (squeeze out) a few
drops of your colostrum/breast milk after each nursing or as often as
every hour and spread over your tender nipples. Allow your nipples to
air dry. Some women find relief from nipple tenderness by placing a wet
tea bag over their nipple for five minutes after each nursing. If you
try the tea bag, rinse your nipple with clean warm water after each use
and allow your nipple to air dry.
Blisters: Friction and rubbing on an area can
cause blister formation—like blisters on your heel caused by breaking in
a new pair of shoes. If your nipple is not far enough back in the baby's
mouth or the baby's suckle is very vigorous, the nipple can rub against
the roof of the baby's mouth causing blisters to form from the friction
of the rubbing motion. If your latch and/or you baby's suckle is not
comfortable, ask the nursing staff for help. Arrange a lactation consult
if your comfort level is not greatly improved.
If you notice blisters on your nipple, place a clean soft cloth (baby
diaper, wash cloth, tea towel) soaked in very warm water on your nipple
for a few minutes before each nursing. Experiment with the position in
which you feed your baby, find which is more comfortable for your
nipples. Try the salt water solution and if soothing, follow the
directions and use after each nursing until the blister is resolved. If
your nipple is not greatly improved after two days of following these
suggestions, call for a consult with a lactation consultant to evaluate
your latch and your baby's suckle.
Cracked Nipples: Occasionally, nipples can
become cracked. You may notice a fine line across the face of your
nipple that may or may not bleed. The blood from the crack will dry
between breastfeedings and you may notice a crust forming along the
cracked area. Sometimes you may see blood in your baby's mouth or in
spit up. Rarely will your baby be upset form swallowing blood but call
you baby's physician if you are concerned. Ask the nursing staff to help
with your latch and to observe your baby's suckling technique.
Begin using salt water soaks to soothe your nipples. If you are in the
hospital, ask the nursing staff for a bottle of 0.9% sterile normal
saline and small disposable paper cups (similar to bathroom size Dixie
cups). After each nursing, pour some of the solution into a cup, lean
over and soak your nipple for 5 minutes. After the five minutes, discard
the cup and solution used and rinse your nipple in a small amount of
warm tap water. Air your nipples dry. Squeeze out some of your
colostrum/breast milk or use a ultra-purified lanolin breast cream
gently massaged into the affected area. Repeat after every breastfeeding
until the crack is healed.
At home, make the salt water solution by dissolving 1/2 teaspoon of
table salt in 8 oz. of boiled water. Cool the solution before using.
Make a large amount of the salt water solution and store in a clean
covered container away from young children's reach. Do not substitute
contact lens solution for the recipe due to the addition of
preservatives in the lens solution. If your nipple is not greatly
improved after 2 days of using the salt water solution, contact a
lactation consultant to evaluate your nipples and your baby's suckle.
ComfortGel hydrogel pads are available to relieve nipple soreness by
creating a moist healing environment. These pads may be helpful if your
nipples are sore, blistered or cracked. Contact Hollister/Ameda/Egnell
at 1.800.323.4060 or hollister.com
for locations near you where they can be purchased.
"White Bleb"/"Milk Blister": Occasionally you
may notices a white "blister" on the tip of your nipple that is
extremely painful. You may feel that the milk ducts behind this blister
are plugging and not draining well. To help relieve this, make the salt
water solution described above for cracked nipples. Before each
breastfeeding, make the solution fresh and warm and gently rub the
"white bleb" a few times with a clean soft cloth soaked in the solution.
Then breastfeed as usual, beginning on the affected breast first. After
the breastfeeding, soak the affected nipple in the warm fresh salt water
solution for five minutes. Use the same soaking technique as suggested
for cracked nipples. If this milk blister is still present after two
days of following the suggestions above, please call your physician to
discuss the need for an office visit to evaluate your nipple and help
your milk duct to drain. Also, contact a lactation consultant and
arrange for a home consult to evaluate your breastfeeding technique and
your baby's suckle.
Yeast (Candida Albicans): We carry yeast
normally in our bodies. Many women have a history of yeast infections.
Pregnancy makes women prone to occurrences of yeast infections. Intact
nipple skin is protection against yeast. Nipple damage from a latch or
suckle problem results in a breakdown of the skin barrier against yeast.
The use of antibiotics can result in an overgrowth of yeast. During
times of stress, yeast infections are more common. Women who are treated
with steroids or have a history of diabetes mellitus are more prone to
develop a yeast infection. The signs of yeast on your nipples and in
your breast are varied. Your nipples may suddenly become very sore
(exquisite pain), the nipples may feel itchy or look reddened or
"burned", the areola may look shiny. You may feel "shooting or stabbing"
pains in your breast.
You may notice thrush in your baby's mouth. Thrush resembles patches of
white on your baby's tongue, roof of mouth or gums. These patches are
firmly attached and will not wipe off with a soft cloth. You may notice
a yeasty diaper rash. This yeasty rash looks like a burn around baby's
anus which spreads into separate lesions. Baby may make a clicking sound
while suckling, pull off repeatedly during a feeding or refuse to latch.
Baby may be very gassy.
If you suspect a yeast infection, call a lactation consultant and
arrange a home visit. If you have signs of a yeast infection, both you
and your baby will need to be treated. You will need to contact your
physician and baby's physician for treatment. Treatment may consist of
one or more creams applied to your nipples, a liquid suspension painted
inside baby's mouth, and/or an anti-fungal pill that mother takes for
about two weeks. Deleting dairy products, yeasty breads and sugars from
your diet can be helpful while being treated for yeast. Adding
acidophilus tablets (available in the vitamin section of food
stores—follow manufacturers suggestions for dosage) and taking your
required calcium in other forms is suggested.
Breast Warning Signs
Regular self breast exam is recommended during lactation. You will
become familiar with the shape and feel of your lactating breasts if you
exam your breasts on a regular basis. Call your physicians and a
lactation consultant if you notice a change in the contour or shape of
your breast or any area in your breast which seems puffy or looks
indented. Also, call your physician immediately if the skin on your
breast resembles the peel of an orange.
For more information, call 1.866.CALL.MLH.