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Management of Common Breastfeeding Concerns

Common Breastfeeding Concerns

Some new mothers experience setbacks in the breastfeeding process. Outlined below are several common issues related to breastfeeding and ideas on how to alleviate or eliminate the problem.

Sore Nipples

Sore nipples may have a number of causes including: improper attachment or detachment, nursing in one position too frequently, and/or engorgement.

Treatment for sore nipples

  • Review Basic Breast Care
  • Check your baby’s mouth at breast, making sure that as much of the areola as possible is in the baby’s mouth. Make sure the baby’s tongue is under the nipple. If you need to reattach, remove the baby from your breast by inserting your finger between the baby’s gums to break the suction.
  • Change feeding position for each feeding, pointing the baby’s chin away from the sore spot.
  • Begin breastfeeding with the least sore breast. This allows the milk to letdown. Also, babies usually do not nurse as long on the second breast.
  • If engorged, perform manual expression or use a good quality breast pump to express enough milk to soften the breast and allow the baby to latch on correctly.
  • Use saline soaks after each feeding (¼ tsp. salt in eight ounces warm water). Soak for 2 minutes.
  • If using purified lanolin, warm a scant amount between your fingers before applying.
  • If nipples have visible damage use a hydrogel to promote healing.
  • Ask your doctor for pain medications.
  • Call your lactation consultant for additional suggestions.

Engorgement

happy baby crawlingBreast engorgement is characterized by a hard, tight feeling in your breasts. Breasts are also warm and tender to the touch and you may experience a mild headache and/or a low-grade temperature. Engorgement is due to the swelling of your breast tissue, increased lymph and blood supply, stretching of the transporting structures, and the presence of the milk itself. Engorgement usually occurs 3 – 5 days after delivery (when the milk “comes in”) and lasts between 24 and 72 hours.

Treatment for Engorgement

  • Take a hot bath, a warm shower, or use warm compresses on breasts for 10 minutes, followed by manual massage before each nursing session. Do not allow shower water to pulsate on nipples.
  • Massage breasts and express enough milk before nursing to soften the areola. This will make it easier for your baby to attach correctly to the breast.
  • Nurse more frequently (every 2 – 2 ½ hours or sooner).
  • Massage breast in circular motions down toward the nipple as the baby nurses.
  • Apply ice compresses for 10-15 minutes after nursing to reduce swelling and provide comfort.
  • Wear a good nursing bra both day and night.
  • Be sure to continue treatment for 12 – 24 hours after your symptoms disappear.

If above tips do not provide relief within 24 hours, call your lactation consultant for additional assistance.
If your baby does not nurse well enough to provide engorgement relief, express or pump enough milk to reach a point of comfort.

Inverted Nipples

Inverted nipples can sometimes make correct attachment a little more difficult, but there are ways to help this.

Treatment for inverted nipples

  • Roll and stretch the nipple throughout the day – tugging the nipple out and rolling it to the right or left several times a day.
  • Wear dry breast shells in a bra between feedings to help pull out the nipple.
  • Manual or electric pumps can be used to evert (pull out) the inverted nipple.
  • As a last resort, use a nipple shield. Be sure to consult with a lactation consultant about using a nipple shield.
  • Nipple shields should only be used for the first few minutes of feeding to draw the nipple out. Once the nipple is everted, remove the nipple shield and place the baby on the breast. CAUTION: With continued use, nipple shields may decrease the milk supply and additional pumping is necessary to maintain supply. Another concern may be baby’s weight gain. Weekly weight checks for the first 3 – 4 weeks of nipple shield usage are recommended.
  • Some babies may need use of a nipple shield for a short period of time, while others may need it longer. As you begin to wean from the nipple shield, contact a lactation consultant for tips on weaning.