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Breast and nipple care

  • Wash your hands with soap and water before each feeding.
  • Bathe and wear a clean, supportive bra every day. Use plain water and
    no lotions on your nipples. See Sore Nipples if you experience discomfort.
  • Applying some of your own breast milk to the nipple and areola (dark area around the nipple) after nursing helps protect and sooth your nipples.

Flat or inverted nipples Breastfeeding

Babies nurse the areola not the nipple, so flat/inverted nipples may not cause any problem with breastfeeding at all.

Treatment is only necessary if the baby cannot grasp the areola.

You can try:

  • Placing the thumbs on opposite sides of your nipple and spread outward. Rotate around the areola using a spreading motion. This can help the nipple "pop out."
  • Nipple rolling - grasp the nipple between thumb and forefinger and roll before each feeding.

Engorgement may flatten nipples. Review Engorgement.

Sore nipples

Sore nipples sometimes occur in the first week of breastfeeding. Here are some ways to avoid getting sore nipples and to treat nipples should they
become uncomfortable:

  • Check your positioning. The most common cause of sore nipples is incorrect positioning. See Positioning.
  • Make sure your baby has a proper grasp on your areola, not your nipple. Reposition if sucking is painful. The baby needs to latch on well behind
    the nipple.
  • If only one nipple hurts, start the feeding on the unaffected side.
  • You may use hand expression before feeding the baby to stimulate letdown so the baby doesn't have to suck so hard in the beginning.
  • Continue cue-based feeding and at least every 3 hours. A very hungry baby sucks harder.
  • Review Nipple Care.
  • Avoid plastic liners in your bra.
  • To remove infant from your breast after feeding, place your finger in between baby's gums. This releases the strong suck and prevents irritation of the nipple.
  • Apply your own milk to your nipples and areola after nursing and let air dry.  Lanolin ointment may also be beneficial.
  • If your nipples become cracked or scabbed, consult your doctor and/or lactation specialist.

Engorgement

The best way to prevent and/or lessen engorgement is to breastfeed your baby frequently, at least every 2 hours. Feeding your baby as soon as possible after giving birth and maintaining a consistent feeding schedule may help prevent engorgement.

If engorgement occurs, try these measures:

  • About 5-10 minutes before feeding, place warm packs on breasts to increase the flow of milk, or take a warm shower with breasts facing the water. Now, massage breasts to increase milk flow.
  • If your breasts are full and firm, your baby may have difficulty grasping the area behind your nipple (areola). You can hand express until milk flows easily and the areola becomes softer.
  • Engorgement will usually get better within 12 hours with aggressive treatment. Offer your breast to your baby at least every 2 hours until engorgement subsides.

Plugged Ducts

Symptoms:

  • localized, hard painful area on breast(s)
  • red area
  • deep ache or itch

Causes:

  • tight bra
  • infrequent feedings
  • weaning too fast
  • early introduction of solid foods
  • mom is stressed or tired

Treatments:

  • Nurse, nurse, nurse. Feed frequently and for longer periods - start with the affected side.
  • Drink plenty of fluids.
  • Rest.
  • Apply warm packs to breasts before and after breastfeeding, and massage lump before you nurse and during the feed.

Mastitis

Symptoms:

  • same as plugged duct with fever, chills, nausea, vomiting, flu-like aches; call your doctor immediately if you have these symptoms
  • cracked nipples

Causes:

  • normal germs from baby's mouth
  • unresolved plugged duct
  • persistent, unresolved engorgement

Treatments:

same as plugged duct, plus antibiotics prescribed by your doctor

Do not stop nursing! In the event that you do stop nursing, you must pump to empty the breasts until mastitis has resolved.