Breastfeeding problems and solutions: breast and nipple care

• Getting help 
• Sore nipples 
• Nipple infections 
• Blocked milk ducts 
• Mastitis 
• Breast refusal 
• Biting 

Getting help

If you’d like some help with breastfeeding, support services are available. Your maternal and child health nurse, GP or the Australian Breastfeeding Association (ABA) can help and support you with breastfeeding your baby. They can also help you find a lactation consultant if you need one.

An Australian Breastfeeding Association (ABA) counsellor can also help – phone the National Breastfeeding Helpline on 1800 686 268.

You’re bound to get lots of different advice – take the advice of the person you trust most, and stick with it.

Sore nipples

The most common reason for sore and damaged nipples is your baby not attaching properly to your breast. 

You can expect some tenderness in the first few days of breastfeeding, but it’s not normal to feel actual pain. If you’re in pain, you have at least two options. You could seek help from a maternal and child health nurse, ABA breastfeeding counsellor or lactation consultant. Or you could try the baby-led method of attaching your baby.

• A calmer baby will be gentler on your nipples, so try to offer your baby a feed before she’s crying with hunger. You can also start the feed on the breast that’s least sore.
• A damaged nipple hurts most at the beginning of the feed, before your milk lets down. The pain usually eases when the milk’s flowing, so try to trigger your let-down before your baby attaches to the breast. To trigger your let-down, you could try looking at your sleeping baby, thinking about a tender moment, or massaging your breast with a warm, wet cloth.
• An experienced lactation consultant or paediatrician can examine your baby’s mouth. There could be a tongue tie or something else about the shape of your baby’s mouth that might affect his ability to breastfeed.
• If you can, avoid using teats, bottles or dummies. Babies need to suck differently on breasts and bottles, and they can get confused if they’re being offered both in the early days of breastfeeding.
• Nipple shields might help with sore nipples in the short term, but they can sometimes create more problems than they solve. If you want to try a nipple shield, it’s a good idea to work with a lactation consultant.
• If your nipples are very sore, express your milk either by hand (the gentlest method) or with a good-quality breast pump on a gentle setting. Feed your milk to your baby by cup or spoon until your nipples feel better.
• Nipple creams rarely help, unless they’re prescribed for a medical reason (for example, an infection). A few drops of your own milk – expressed by hand at the end of a feed and spread over your nipple – is the best ‘nipple cream’.

The problem of sore nipples doesn’t usually last. It’s worth talking to an ABA counsellor or your child health nurse if the soreness doesn’t get better each day. 

Sore nipples that develop after a period of comfortable feeding are most likely caused by a bacterial infection, thrush infection or both. In this case, you should talk to your GP. There’s also more information about nipple infections below.

Even if you’re finding it too painful to feed your baby, you still need to keep your milk moving by expressing it. If you don’t take the milk out regularly, your breasts might become engorged and you’ll be at risk of mastitis. Not emptying milk regularly will also reduce your milk supply.

Nipple infections

Sometimes, cracked nipples can get infected with bacteria (Staphylococcus aureus or ‘staph’), thrush (Candida albicans) or both. It can be difficult to diagnose which of these is causing problems. Sometimes, women might develop nipple thrush after they’ve had a course of antibiotics.

Symptoms of nipple infection might include sore nipples and shooting pain in the breast. Not only is nipple infection particularly painful, but it can also be passed back and forth between mother and baby.

Research hasn’t come up with a standard treatment for nipple infection. Different doctors treat it differently, depending on their own clinical experience. If the doctor suspects thrush, treatment is likely to involve an oral gel or drops for baby’s mouth and an ointment for your nipples. Sometimes there might be another ointment for baby’s bottom. The doctor might also prescribe antifungal tablets for you.

If staph is suspected, the doctor might prescribe antibiotic ointment and/or possibly oral antibiotics for you. Some doctors might prescribe a combination treatment for the nipples.

Blocked milk ducts

If a sore lump appears in your breast but you otherwise feel well, you probably have a blocked milk duct.

Try these tips straight away to ease the problem:

• Feed frequently to empty the affected breast.
• Give your baby the affected breast first. Gently massage the lump towards the nipple.
• Have a hot shower and massage the breast under water to help break up the lump.
• Use a warm compress before the feed to help soften the lump – try a warmed (not hot) heat pack, wrapped in a soft cloth and held to your breast for a few minutes.
• Make sure your feeding position allows the milk to flow ‘downhill’ from the blockage to your nipple.
• If your baby doesn’t clear the blockage by feeding, try expressing by hand.
• Place an ice-pack or chilled cabbage leaf on your breast to relieve pain after a feed.
• Check that your bra isn’t too tight. You might even want to remove it during feeds.
• Check that your baby is positioned and attached correctly.
• If you can’t clear the blockage within 12 hours, or you start to feel unwell (as if you’re coming down with the flu), see your GP – you might have mastitis.

Mastitis

It can be normal to have swollen breasts in the first few weeks of breastfeeding. But if you have an inflamed, sore, swollen or red breast, or if you have the chills or feel like you have the flu, you might have mastitis. 

If you think you might have mastitis, follow the same tips as for a blocked milk duct. In addition:

• See your GP as soon as possible. You’ll probably be prescribed antibiotics to help both the inflammation and the infection. You can keep breastfeeding while taking these.
• Try to keep feeding until your symptoms have cleared, because there’s a risk of developing a breast abscess if you stop breastfeeding during this time. Express your breastmilk if you’re too sick to breastfeed right now. Even if you have an infection, the breastmilk is still safe for your baby to drink.
• Get plenty of rest.

You might also want to try the following steps:

• Go to bed, rest and try to get someone to look after you and your baby. Take your baby to bed with you if necessary (for guidance on safe co-sleeping, see our article on sharing your bed with baby).
• Warm your sore breast with a warm cloth or hot shower before feeding. This helps trigger the let-down reflex, which can help clear blocked milk ducts and relieve pain.
• Vary feeding positions, so that all your milk ducts are being emptied. Sometimes mastitis can start from one or two ducts that aren’t being emptied fully.
• Apply cold packs after the feed.

It’s common for the supply in a breast with mastitis to drop a little. With frequent feeding during and after your illness, this will sort itself out.

Mastitis can make you feel very sick, but you’ll get better quickly with the right treatment.

Breast refusal

• Your baby has a cold.
• Your baby is uncomfortable or in pain.
• Your baby is having trouble attaching.
• Your baby is overstimulated, overtired or distracted (this is normal in older babies – try breastfeeding in a quiet place).
• Your milk tastes different, possibly because you’re taking medication, are experiencing hormonal changes (you might be about to have a period again) or have eaten something unusual.
• Your milk flow is faster, lesser or slower to let down than usual.
• Your baby might have a strong preference for one breast.

Most of these causes of breast refusal will either go away on their own or can be sorted out with a few simple changes to your routine. None of them means you have to give up breastfeeding.

You might want to try the following to help get your baby on the breast:

• Try a new feeding position – see our illustrated guide to breastfeeding positions.
• Express some milk into your baby’s mouth. This might encourage her to feed.
• Try walking and feeding at the same time.
• Give your baby a breastfeed after his bath, when he’s warm and relaxed.
• If your baby has just refused a breastfeed, try distracting her – show her some toys, sing a song or walk outside for a while. Then try to breastfeed again.
• Play some relaxing background music.
• Feed in a rocking chair.
• Offer a feed when your baby is first stirring from sleep or even still asleep.

Biting

As babies get older, they get more playful – and they get teeth. It’s almost physically impossible for a baby to bite while sucking, but he might find it fun to bite your nipple once he’s finished (particularly if he thinks you’re not paying him enough attention!).

If your baby does bite, say ‘No’ calmly and firmly, and remove her from the breast. If you get too cross, your baby might think you’re playing a game – or it might frighten her.

Some babies might bite because they can’t wait to start feeding and your let-down is slow. In this case, it might help to express a small amount of breastmilk to trigger your let-down before you offer the breast.

Luckily, biting is usually a passing phase. You can also try offering your baby something else to chew on, like a teething ring. Some mothers switch to expressing if their baby keeps biting, but try to avoid this.

Take care if the bite breaks the skin on your nipple, because this can lead to infection.

Video: Breastfeeding challenges

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Breastfeeding doesn’t always come naturally. It’s a skill that needs to be learned – by you and your baby. Even when you and your baby are getting it right, it can be uncomfortable, or even painful, in the beginning.

This short video features parent stories about common breastfeeding challenges, including mastitis, engorgement and attachment. These mums and dads also talk about the emotional effects of these challenges. They offer helpful tips for overcoming them.

 

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