Several problems common to breast-feeding mothers can be prevented or eased through simple techniques or addressed with common, simple treatment options.
Sore nipples
Most women will experience some degree of nipple soreness in the first days of breast-feeding. Discomfort that occurs at the onset of breast-feeding and is relieved by feeding is normal. It is caused by the stimulation of the nipple by the hormone oxytocin, which stimulates milk let-down. True nipple soreness, in which the nipples appear red and are tender to the touch, is rare and is probably caused by the baby’s improper grasp on the nipple and areola (pigmented area surrounding the nipple) while feeding.
Correcting the baby’s position on the breast is the most important tactic for preventing and relieving sore nipples. A physician, nurse, or lactation consultant can assist in assessing and correcting an infant’s grasp of the nipple. Sore nipples can progress to more painful, cracked, and fissured nipples. As the condition worsens, the nipples are more susceptible to infection. In addition to correcting the baby’s position, there are a number of self-help measures frequently recommended for the relief of sore nipples. These are most effective when begun at the onset of symptoms.
Check the position of the baby on the breast; the infant’s tongue should be under the nipple and the mouth should grasp both the nipple and part of the areola. Vary the position of the breast-feeding infant with each feeding to avoid soreness of a particular area of the nipple.
The infant should be fed on demand; an overly hungry infant may suck harder, causing nipple soreness. Mothers with sore nipples should begin each feeding on the side that is least sore, switching to the sore breast after the let-down reflex has occurred. The infant should not be allowed to suck on an empty breast, which can cause damage to the nipple. If the nipples are sore, a breast-feeding session of ten minutes on each side should be sufficient to nourish the baby.
Ice packs applied to the breasts prior to breast-feeding can have a pain-relieving effect. Allowing nipples to air-dry after nursing can help to reduce nipple soreness.
In the case of cracked nipples, the application of an ointment or cream can aid healing. Ointments or creams allow the skin’s internal moisture to heal deep cracks and fissures while keeping the skin pliable.59 A frequently recommended and safe ointment for cracked nipples is medical grade, purified anhydrous lanolin (derived from wool fat). The nipples should be patted dry prior to application of a small amount of lanolin.
Engorgement
Engorgement is a common condition that occurs as blood and lymphatic flow to the breasts greatly increases, leading to congestion and discomfort. The pain associated with engorgement can range from mild to severe. Engorgement typically occurs on the first full day of milk production and lasts only about 24 hours. The breasts may feel firm and hot to the touch and the skin may appear reddened. As with other conditions, the best remedy is prevention. Many health professionals believe frequent breast-feeding (at least every three hours) will successfully prevent engorgement. This is probably true for most women. However, the physical changes associated with initiation of breast-feeding may eventually lead to engorgement in some women. If engorgement occurs, the best remedy is to breast-feed frequently. This can relieve the engorgement and prevent the condition from worsening.
Doctors often recommend additional options for women with engorgement. A well-fitted bra can relieve some of the discomfort of engorgement. Applications of moist heat may encourage flow of milk from the breasts. Women may apply hot packs to the breasts just prior to breast-feeding. Other suggestions include frequent warm showers or alternating hot and cold showers. Cold packs applied to the breasts after breast-feeding can provide a slight pain-relieving effect.
Some infants will have a difficult time correctly latching on to an engorged breast. This can lead to inadequate nourishment and sore nipples. Expressing some excess milk, manually or with a pump, just prior to breast-feeding may relieve this difficulty. Women may also express milk after the infant has finished feeding to relieve any remaining sense of fullness. Massaging the breasts while breast-feeding may encourage milk flow from all the milk ducts and help to relieve engorgement.
Mastitis
Mastitis is inflammation of the breast that is frequently caused by an infection. The infected breast may feel hot and swollen. The breast may be tender to the touch, and fever, fatigue, chills, headache, and nausea may be present. Some women feel as though they have the flu. A breast infection requires prompt medical attention. Complete bed rest is important for a speedy recovery, and antibiotics are frequently prescribed. In addition, doctors often provide further guidelines for treating mastitis.
A woman should continue breast-feeding from both breasts; the milk from the infected breast is still good for the baby. Moist heat over the painful breast can be helpful, and cold applications after breast-feeding can help alleviate swelling and pain. Breast-feeding women should also avoid constricting or under-wire bras that may irritate the infected breast.
Who can breast-feed?
Breast-feeding is the best food for babies, and most mothers will be able to breast-feed their infants. However, there are some uncommon situations in which breast-feeding is not in the best interest of the infant.
Galactosemia is a rare metabolic condition that leads to an inability to break down galactose, one of the components of milk sugar (lactose). Infants with galactosemia should not breast-feed, but should be fed a special formula without lactose.60
Phenylketonuria (PKU) is another rare metabolic disorder, in which a newborn is unable to break down the amino acid phenylalanine. The resulting build-up of phenylalanine in the system can be harmful. There is some disagreement regarding whether it is safe to breast-feed infants with PKU. Some sources recommend against breast-feeding the infant with PKU.61 However, breast milk is low in phenylalanine and there is evidence that the exclusively breast-fed infant with PKU will not have damaging levels of phenylalanine accumulate in the bloodstream. A mother interested in breast-feeding her infant with PKU should work closely with a doctor. Close monitoring of the infant’s blood phenylalanine levels will be necessary.62
For infants in the United States and other developed countries born to mothers infected with the human immunodeficiency virus (HIV) it may be safer not to breast-feed.63 However, there is controversy over this issue. Some researchers have found HIV in human milk, indicating that there is the potential for passing the virus to a healthy baby while breast-feeding. Other studies indicate a very low risk of actually passing the infection to the baby through the breast milk.64
Additionally, a mother with untreated active tuberculosis should not breast-feed her infant. And the infant whose mother abuses drugs should not be breast-fed.65