Common Breastfeeding Problems

Prevention and Treatment of Cracked Nipples, Mastitis,Thrush

Dec 20, 2008 Hayley Nichols

Discusses the symptoms, prevention and treatment of breastfeeding problems that cause pain in mother and/or baby, such as sore and cracked nipples, mastitis and thrush.

When going well, breastfeeding should be pain-free. There are self-help as well as medical measures to help breastfeeding problems that may occur, allowing the mother to continue breastfeeding without pain. The important thing to remember is that stopping breastfeeding will not help, and may actually worsen, the problem.

Sore and Cracked Nipples

This is often caused by problems with the attachment of the baby to the breast. These issues can be addressed by seeing a breastfeeding counselor – search for one through local health services or La Leche League.

The UNICEF pamphlet "Off to the Best Start: Important Information about Feeding Your Baby"[UNICEF, 2007] suggests ways of checking for proper attachment, including:

• Baby's head and body should be in a straight line.
• The mother should hold the baby close.
• Baby should tilt his head back.
• Baby's nose should be opposite the mother's nipple.
• Baby should come to the breast chin first and have a large mouthful of breast
• The nipple should go towards the roof of baby's mouth.
• There should be more skin visible above the baby's top lip than below his bottom lip.
• Baby rhythmically takes long sucks and swallows.

Treating Cracked Nipples

According to Patricia Wise in "Treatments for Cracked Nipples" [New Digest, May 2002], the following treatments are effective:

• Lanolin ointments (e.g. Lansinoh or Purelan) are soothing as well as healing.
• White soft paraffin, i.e. Vaseline, is also effective, but it does not allow air to pass through the wound.
• Applying expressed breast milk to the area.

Mastitis Symptoms

Mastitis means inflammation of the breast. As with cracked nipples, difficulties with attachment can be a root cause, by making the breast less likely to drain well. The symptoms are:

• A red area on part of the breast, may be painful to touch
• Lumpy breast that that feels hot to the touch
• The whole breast aches and may become red
• Flu-like symptoms, which can start very suddenly and get worse very quickly: increased temperature, aching, shivering

Prevention and Treatment of Mastitis

• Avoid suddenly going longer between breastfeeds, cutting down gradually instead.
• Avoid having overfull breasts, and express using hands or a breast pump, if they start to feel too full.
• Avoid pressure on the breast from clothing and fingers, e.g. don't wear tight-fitting bra's.
• At the first sign of any red area on the breast, start the following self-help measures:
• Continue breastfeeding: the quickest way to get better as it drains the breast, and it is completely safe for the baby. Feed from the sore side first.
• Feed the baby more frequently or express between feeds if breasts feel too full.
• Express gently after feeds so that the breasts are kept as well drained as possible, until the symptoms are better.

Thrush Symptoms

Thrush is a yeast infection affecting a mother's breast. It is often caused by antibiotics or nipple damage.

The mother sometimes shows no symptoms, but these signs are usually present, according to the 2003 Breastfeeding Network pamphlet "Thrush and Breastfeeding":

• Sudden start of breast and/or nipple pain after days or weeks of pain-free breastfeeding
• Shooting pains in the breast
• Cracked nipples that don't heal
• Loss of colour in nipple or areola
• Pain in both breasts occurs when the baby transfers the infection while feeding.

Symptoms in the baby include:

• Creamy white patches in the mouth or on tongue, that do not rub off
• White sheen on baby's tongue that doesn't rub off
• Baby keeps pulling off or away from the breast while feeding
• Baby seems unsettled and unhappy
• Nappy rash

Thrush Treatment

Thrush should always first be identified by a medical professional, breastfeeding support person or midwife. This is because the symptoms can be confused with signs of poor attachment of baby to breast. A doctor will prescribe miconazole cream to the mother and miconazole oral gel to the baby. Here are some self-help measures:

• Carry on breastfeeding – get support if necessary.
• Follow good hygiene – wash hands after each nappy change, use separate towels for each family member, and sterilise anything baby sucks on.
• Acidophilus capsules can help restore the 'good bacteria' that keeps thrush under control

Most breastfeeding problems can be successfully treated with self-help measures and support, but if mastitis symptoms have not improved after 12-24 hours, a doctor should be consulted for possible antibiotic treatment, and thrush should always be diagnosed by a professional.

The copyright of the article Common Breastfeeding Problems in Infants & Toddlers is owned by Hayley Nichols. Permission to republish Common Breastfeeding Problems in print or online must be granted by the author in writing.

Breastfeeding Should be Pain-Free