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Nipple Soreness

It's common for mums to have sore nipples in the first few days of breastfeeding

Helping a mother to overcome nipple pain

Leading causes of nipple soreness can be resolved, and is almost always a short-term problem.

Breastfeeding is not meant to hurt or to be painful; it may be tender in the first few days. However, this should improve as feeding continues. Nipple damage often starts in the early days and if not corrected may become so painful this will cause the mother to wean the baby.

Most nipple damage is due to the baby not being latched well enough for breastfeeds.

NOTEWORTHY:  Some mothers have very sensitive nipples before they become pregnant. Furthermore, this may continue after the birth. Correct positioning and attachment will also help with this problem.

Milk bleb can cause nipple soreness if not resolved

First of all, a milk bleb is a nipple pore that becomes blocked by milk collection under epidermis causing a shiny white pimple looking lump on the nipple. Consequently, epithelial growth factor in milk is thought to be responsible as it grows over the opening to the pore banking back the milk from that ductal system. Therefore, prevention is vital.

Prevention

Always inspect or enquire about white blebs before advising how to pump.

Expressing milk from a breast that has a milk bleb can cause further damage if the bleb has not been opened first

Pumping will express milk from the other ducts but may also cause serious harm to the swollen area

Bacterial infection can cause nipple soreness

The most common cause of unresolved nipple pain is a bacterial infection. Hence if the nipple damage causes cracks, blisters, etc. then the nipple can become colonised with Staphylococcus aureus as it ascends into lactiferous ducts.  Also, it is the primary organism responsible for mastitis and abscess. Bacterial infection may cause a delay in wound healing and result in premature weaning, chronic nipple and breast pain.

Candidiasis / Vasospasm (Reynaud’s Phenomenon) - a cause of nipple soreness

Candidiasis:

Candidiasis (nipple thrush) is common and can be a major cause for weaning due to being misdiagnosed or untreated

Vasospasm:

Vasospasm or more commonly known as ‘Reynaud’s of the nipple’ cause blood vessel spasms which affects blood flow to the nipple. Furthermore, pain may be associated with triphasic colour changes to the nipple after feeds

Clinically the nipple is blanched (white), followed by cyanotic appearance (purple-blue) ending with erythema as reflex vasodilation occurs (red) and blood flow returns

Finally, if pain becomes severe and weaning is imminent – what to do next

Timely intervention is required to maintain maternal desire and confidence with breastfeeding.

Allow mothers permission to rest breasts for healing to take place - this is more likely to encourage a mother to continue with breastfeeding than an expectation to continue in pain

Treat causes and refer to the appropriate health professional for assistance and support

Refer to appropriate health professional or agency for advice about expressing

Analgesics e.g. Paracetamol, Ibuprofen

In conclusion, a mum may require referral to support groups or ABA for social support and encouragement