When you feel pain in your nipples while your baby is suckling, you probably find it hard to believe that breastfeeding can be pleasant not only for the little snacker, but also for his mum. However, although they are so common amongst breastfeeding mums, painful nipples are not natural and mean something is wrong. The most common cause of this condition is incorrect grasping of the nipple by the baby or an incorrect suckling technique, and sometimes both.
The nipple is grasped incorrectly when the baby takes only the nipple into his mouth, without an areola. Then he sucks too shallow, and squeezes the nipple with his gums, while it should be held deep in his mouth (near the soft palate) and not at the gum level. This shallow grasp of the nipple leads to its regular chaffing, biting and crushing. Nipples treated this way can crack, bleed and hurt both during breastfeeding and after it.
Incorrect grasping and suckling by the baby can be easily recognized by the following signs:
nipple taken out of baby's mouth is flattened on one side (similarly to a tip of a new lipstick);
nipples are raw - painful, cracked, bleeding;
when your baby is suckling, you can hear smacking or clucking;
baby purses his lips while suckling;
suckling baby draws in his cheeks and lips;
baby's chin does not touch the breast, his head craned backward;
baby does not eat his fill, slowly gains on weight and is restless;
often, local stases occur in breasts.
Here several possible reasons for incorrect breast grasping by the baby:
Complete ankyloglossia – when the baby was born with the tongue tethered to the floor of the mouth, he could not practice suckling during his fetal life. Usually, already at a birthing room an abnormally short frenulum will be "released" (undercut), so that the baby's tongue can move freely in his mouth. The innate suckling reflex tells the baby what to do when his mum gives him the breast. However, sometimes such children move their tongue backwards during suckling, and exposed gums bite the too-shallowly grasped nipple.
Abnormally short frenulum of the tongue - can block tongue movements, and it will not fully cover bottom gums to protect the nipple against their pressure. When your baby has this problem, frenectomy may be necessary. This is a painless procedure, and takes a few seconds.
Incorrect position of the breastfeeding mum – the breast should not be given to the baby, but the baby should be latched on the breast. Otherwise, the mother does not sit comfortably, but her back is hunched, and she leans over the baby. It is not possible to maintain this position for longer, as it is uncomfortable for the spine, so the feeding mum will surely try to straighten up a bit, and then she pulls her breast up withdrawing it slightly from the baby's mouth, which results in shallower grasp. Also a position, in which the baby does not face the breast but must turn his head to reach it does not facilitate breastfeeding.
Giving a pacifier or a bottle – is usually disorienting for the baby, as the breast suckling technique differs from suckling of pacifiers or teats. The pacifier does not have to be massaged with a tongue on a bottom (because milk will not flow anyway), it can also be crushed or bitten. When the baby is given breast alternately with a pacifier or a bottle with an incorrect teat, he may treat the breast less gently, injuring the nipples.
Pushing a breast into not fully opened baby's mouth – may damage the nipple, and also the nipple alone is in the baby's mouth, without areola.
Pain felt by the baby during suckling - in some cases the baby grasps the nipple too shallowly or sucks incorrectly (or not at all), because suckling is painful to him. Several reasons can be behind this situation: painful aphthas in the mouth, painful ear, painful teething, and sore throat. Another reason of too shallow grasp and problems with suckling can be a blocked nose. This is the case when the baby has a cold, or possets often, with milk sometimes coming through his nose, blocking it.
To heal the painful or raw nipples, you have to remove the cause of your problems. Try our tips:
When incorrect suckling is caused by problems with the frenulum, you must visit a lactation clinic. A visit to a clinical speech therapist may also be necessary, to learn how to stimulate baby's tongue to correct movements.
Work on feeding position – both you and your baby should be comfortable. The baby must face your breast, so he does not have to turn his head.
Do not give a pacifier or a bottle to the baby, until he develops a correct grasp and suckling movements.
Do not push the breast by force into the baby's unopened mouth. (Read: how to latch the baby on correctly). Also, do not allow the baby to suck in your breast, like spaghetti.
Do not pull your breast out of closed baby's mouth. Delicately insert a clean finger of your free hand into a corner of the baby's mouth and calmly unlock his gums, so you can take out the breast without pain.
When your nipples are painful for more than 10 seconds after latching the baby on, stop feeding and start everything again, this time paying attention to correct grasping of the nipple by the baby (the nipple together with its areola).
Do not wait with feeding until the baby starts to cry. A very hungry baby grasps the breast greedily and sucks nervously.
When you suspect canker sores, earache, sore throat, teething or blocked nose to cause problems with feeding, take the baby to a doctor.
What to do with painful, sore, cracked or bleeding nipples:
After feeding, smear some of your milk on the nipples and ensure access of air to them. When possible, air your raw nipples, leaving your breasts naked, without a bra and a blouse, even for several minutes.
When you put on the bra, use lactation pads to ensure constant access of air to raw nipples and to avoid direct contact between the wound and the bra textile which can stick to it. You can buy special silicone pads (ventilated breast shells) or make them out of small plastic kitchen sieves with their handles cut off.
Wear loose-fitting clothes (bras, blouses, shirts) of natural fibers.
When smearing your own milk and airing does not help, you can use an ointment from a pharmacy. There is a wide selection available, so ask a pharmacist for advice. Remember, the ointment may be sensitizing and limit air access to the wound, delaying the healing process. Before applying the ointment check, if it has to be washed away before giving the breast to the baby. Even when it does not have to be washed away, wipe the top layer with a clean tissue, so baby's lips do not slip on a greased surface, additionally hurting the nipple.
Rinse the breast with marigold infusion.
When the nipples are so painful that it makes breastfeeding impossible, take a painkiller containing paracetamol or ibuprofen about 20 minutes before feeding. Even when the nipples are bleeding, you can still breastfeed your baby. Blood from the wound will not harm him. When the baby grasps the breast deeply and the raw nipple is not bitten by his gums, you should not feel any pain during feeding. However, the moment you give the breast to the baby may still be painful.
When you are not able to breastfeed the baby due to a very strong pain, extract milk regularly with a breast pump and give it to the baby in a way not interfering with breast suckling, until the nipples are healed.
When the wounds do not heal and you feel increasingly worse, consult a doctor or a lactation advisor/consultant. Maybe a bacterial or fungal infection has developed in the wound. (See what to do in such cases in the chapters: Fungal infection, Bacterial infection). Raw nipples that are difficult to heal may also lead to milk stasis or mastitis.