Lactation help with information on prevention and treatment of breast infections,
mastitis, engorgement, nipple confusion, overactive milk supply, plugged milk
ducts, sleepy baby, sore nipples, yeast and thrush.
Breast Infections
Mastitis is an infection of the breast usually following an untreated plugged
milk duct. Watch for chills, fever, and flu-like symptoms. Use the same
techniques as for a plugged milk duct and call the doctor for an antibiotic.
If you have been wearing tight-fitting or under wire bras, treat yourself to
a supportive nursing bra that won't plug your milk ducts.
Remember...heat, rest, empty the breast.
Cracked Nipples
If nipples are cracked or bleeding, follow the steps above for sore nipples,
but use breast shells to keep the skin from pulling away when you change
bra pads. A little blood won't hurt the baby because breast milk is blood
product. A new product is now available that had been used to treat
burn victims in the past. These types of hydrogel pads are extremely
helpful in healing wounded nipples as is a high quality nipple cream.
Engorgement
If you are experiencing difficulty with breast pain or latch-on 3 to 5 days
postpartum, it is probably due to engorgement. Advil is safe for breastfeeding
and contains an anti-inflammatory that may reduce some swelling and
discomfort. Your best friend during this time is a hot compress. Turn the
tap water and let it run until hot. Take two disposable baby diaper and
swipe it under the tap three or four times. Mold the diapers around your
breast. Repeat this procedure before each feeding. Commercial hot
packs are also available, but the diapers work just as well so you may
want to save your money for a good breast pump. If the areola is still
too hard for the baby to grasp, use a quality breast pump for three to five
minutes before latching the baby on. If the baby goes to sleep before
emptying the breast, finish pumping afterward. Take heart!
Engorgement normally only lasts for 48-72 hours.
Nipple Confusion
Nipple confusion can occur when a baby is given a bottle before they
have learned to breastfeed well. It is important to wait to feed breast milk
from a bottle until the baby is at least 4-6 weeks old and is latching on
and nursing well. If nipple confusion occurs, one remedy is to follow
these steps. Purchase a nipple shield and change the bottle nipple to
a wide mouth silicone style like Avent. For 24-48 hours, turn the baby
tummy to tummy with you and with your bra flap down, hold the bottle
tight against your breast while feeding. Once the baby stops fighting
being held tightly, use a nipple shield on your breast to get them to
take your nipple. Drip breast milk onto the tip of the nipple shield or
fill the nipple shield with milk while holding your finger over the holes
prior to putting on the breast in order to give the baby the immediate
gratification he or she is used to with the bottle. This process will take
several days, but be patient and don't show stress or the baby will
sense your tension.
See more info on the topic of Nipple Shields in our Q & A list.
Plugged Milk Ducts
Plugged milk ducts feel like a pebble or a pea under the skin or areola.
They are best treated with hot compresses, breast massage during
feeding , and pumping after the feeding. Place the baby's chin toward
the plug if possible, massage from behind the plug towards the nipple,
and pump for ten minutes after each nursing until resolved. Make sure
you are not wearing a nursing bra that is too tight or that has an under
wire pushing into your milk ducts.
Sleepy Baby
This is a common concern for newborn infants. First I would take a
look at any painkillers you are taking. Pain medication from the hospital
can cause the baby to be sleepy. Tylenol, Advil, and Aleve are all safe
for breastfeeding and will not make the baby sleepy. Next, be aggressive.
New moms tend to be very gentle, but newborns don't always know
when they are hungry, so you have to wake them up every two to three
hours with no more than one five hour stretch in any 24 hour period.
Techniques for waking a baby include, stripping him/her down to a
diaper, using the clutch/football hold so the baby is more upright,
washing their face before nursing, changing their diaper, rubbing
their hands, face, feet, or back. My personal favorite is alternate
breast massage. As soon as the baby stops sucking or swallowing
and begins to fall asleep. Massage the breast from underneath
towards the nipple. This wiggles the nipple and "milks" the breast
into the baby's, reminding him or her to start nursing again.
Sore Nipples
Early onset of nipple soreness can be due to a number of things.
Poor positioning, poor latch-on, not breaking the suction properly,
bras and pads that aren't cotton or changed infrequently, or bad
breast pumps. Make sure that the baby's ear, shoulder, and hips
are aligned. Make sure the baby has 1 - 1 1/2" of the areola in
his/her mouth. Make sure you break the suction when you take the
baby off the breast by releasing the seal with your finger. Keep the
baby from slipping down by supporting the breast during the entire
feeding. Use a firm pillow or nursing pillow to the baby's body from
becoming too heavy to hold. Air dry the nipples after each feeding.
Use expressed milk or hospital grade lanolin sparingly on sore spots.
Hydrogel pads or nipple cream can also be used to speed healing.
Use only 100% cotton or paper, breathable nursing pads and change
them frequently. Nipples may still be uncomfortable for a few seconds
after latch-on, but they should be getting better daily.
Nipple Shields
The most common misconception is that nipple shields are a barrier
to protect your nipple from pain if the baby latches on incorrectly or
if you already have an abrasion. This is a myth. If the baby latches
on wrong to your nipple, he will also latch on and cause pain through
a nipple shield. Nipple shields are a tool for use if the baby is nipple
confused and should be used for short term transition from bottle to breast.
If nipple shields are used for more than 3-4 days, it is imperative to double
pump twice a day for 10-15 minutes to offset the decrease in milk supply
that they will cause.
Yeast - Thrush
Vaginal yeast infections are something every woman wants to avoid.
Mothers may get yeast infections on their nipples as well if the conditions
are right for yeast to overgrow. Antibiotics are the culprit in many situations.
If you find yourself on an antibiotic for any reason or if your baby has thrush,
it is important to protect yourself from a yeast infection by limiting wheat,
refined sugar, honey and of course alcohol in your diet. Acidophilus is a
supplement that can be helpful in maintaining normal intestinal flora.
If you do get a yeast infection on your nipples, symptoms may include a
red "sunburned" area around the nipple covering part of the areola, white
bumps on this nipple or areola, OR you may have neither of these visible
signs, but you have sharp shooting burning pains even in-between
feedings, not just when the baby latches on. Healing always necessitates
that you and the baby are treated simultaneously. If the pediatrician has
prescribed oral Nystatin for oral thrush or Nystatin cream for a yeast diaper rash,
these products can be used on your nipple as well. Diflucan may be prescribed
by your OB-GYN or family doctor, but if you have topical symptoms, treat them
as well with cream or Gentian Violet. If you are using over-the counter-medications,
Monistat cream can be used on your nipples after the baby nurses and on the
baby's bottom. The baby's mouth would need to be treated with Gentian Violet
which is a purple substance obtained at a pharmacy. It usually comes in 1% solution,
but need to be diluted to .5% by using half Gentian Violet and half water. If using
Gentian Violet, it is not necessary to use another product on the same area.
Paint the baby's mouth or your nipples with the diluted solution. Wait for the
purple to disappear before re-applying. Do not apply more than three times! If
you are using a cream instead, you may want to rinse the nipples in a glass
bowl filled with warm water and a tablespoon of vinegar.
To prevent yeast from re-occurring:
Do not freeze breast milk for later use. Spores with become active again
when defrosted. Use breathable disposable bra pads like the Motif or Lansinoh
Disposable pads. Many other brands are not 100% paper and will greenhouse
the yeast. Change them with every feeding. Boil plastic or silicone items like bottle
nipples, bottles, and breast pump parts with each use. Use as few of these
items at this time as possible because they will need to be replaced near the
end of your treatment. Treat both mom and baby until both no longer
exhibit symptoms. Then treat for three days after that point to prevent recurrence.
During this time, discard and replace bottle nipples, breast pump parts that
touch the milk, plastic bottles, pacifiers, etc. Never loan out your breast pump
or use another mom's used personal breast pump. It is just like sharing
underwear, a toothbrush or a swimsuit! Take Acidophilus, eat plain vanilla yogurt,
limit refined sugar, wheat, honey and alcohol in your diet for two weeks after
the yeast infection.
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