Newborn Care Guide
Management of Sore Nipples
Many women find that their nipples are somewhat sensitive and tender for the first week or two, especially when the baby first latches on at each feeding. This usually goes away after about 2 weeks. If cracking, blisters, or bleeding occurs, the doctor may order additional treatment.
Proper positioning and latch-on, as well as breaking the suction properly when removing the baby from the breast, will prevent nipples from cracking, bleeding or becoming painful. IF YOU ARE HAVING THESE PROBLEMS, PLEASE CONTACT A LACTATION NURSE at 288-8263 or 288-8440.
Here are few suggestions:
- Feed your baby on the less-inflamed side first
- Change positions frequently by either cradle position, football or clutch position, or lying down position.
- Breastfeed frequently every 1 1/2-3 hours to keep baby from getting too hungry.
- You may want to begin with the breast that hurts the least, to give your milk time to "let-down" on the more painful breast.
- You may use either warm water or wet compresses on your nipples for 15-30 seconds prior to latch-on, depending on your personal preference.
- Applying a covered ice cube to the nipple before feeding may decrease the pain and also help the nipple firm up a little more and make it easier for your baby to latch on.
- Express a few drops of breast milk to stimulate let-down before latch-on.
- Massage your breast while nursing to stimulate the flow of milk.
- Relaxation techniques before and during breastfeeding, such as deep breathing or listening to soft music, will help with let-down and increase your comfort level.
- Always release the suction before removing the baby from your breast.
- Normal daily bathing with water is enough to cleanse your nipples. No soap, alcohol, or other drying agents should be applied to the nipples.
- It is not a good idea to use creams, ointments, or vitamin E oil on sore or cracked nipples as this seals out the air and prolongs the healing time.
- Using nipple shields may make the problem worse because they interfere with adequate emptying of the breast and markedly reduce the amount of milk that the baby receives.
- After nursing, express a few drops of breast milk, massage into your nipples, and let your breasts air dry. If your nipples are dry, you may massage lanolin cream into your nipples. You do not have to wash this off before you nurse your baby. (Avoid other creams because ingredients could irritate you or your baby).
Engorgement
Engorgement is a temporary swelling of the breasts in response to increased blood flow and rapid accumulation of milk when it comes in. Usually occurs between 2 to 5 days following the birth of your baby. If you become engorged, it can be very difficult or painful to nurse your baby.
Signs & Symptoms
- Breasts feel full, heavy, and swollen
- Breasts are sensitive to touch
- Nipple may flatten and be hard for baby to grasp
- You may have a slight fever (99 -101 degrees), feel general aches, or have a slight headache.
- Breasts may feel warm and bra will fit snugly Severe engorgement can be quite painful. Your breasts may feel rock hard, hot to the touch, and the skin may appear shiny. Engorgement is best prevented by frequent nursing (at least once during the night) and offering both breasts at each feeding.
Managing Engorgement
- Breast engorgement can be prevented by breastfeeding your baby frequently (8-12 times in 24 hours). Avoid artificial nipples, supplements or pacifiers (unless medically indicated), for at least the first 2 weeks of nursing. If you miss feedings, hand express or pump the breast milk. Wean your baby gradually.
- Apply very warm moist towels or take a warm shower about 10 minutes before you breast feed your baby.
- Follow the moist heat with breast massage. Massage from the outer parts of the breast toward the nipple or with small circular motions once-or twice around the breasts. Next, hand express or pump a little milk to soften the areola and make it easier for the baby to latch.
- Massage the breasts during feedings to encourage milk flow.
- After nursing your baby, apply cold compresses or ice packs to your breasts for 10-15 minutes to relieve discomfort and decrease swelling. Cold packs provide temporary pain relief but do not relieve engorgement.
- If these measures do not relieve engorgement within 12-24 hours, it may be necessary to empty your breast(s) with an electric breast pump like the one used at the hospital. Contact Your Lactation Nurse for assistance with breast pumps.
Not Enough Milk
- If you are concerned that you do not have enough milk, nurse your baby longer and more frequently.
- Avoid nursing your baby on a schedule.
- Avoid giving formula, water or juices. Supplementing the baby will fill him/her up, and decrease the amount of your milk he/she will use.
- Be sure and eat a well-balanced diet, drink to thirst (a large glass of juice or water every time you sit down to nurse), and get plenty of rest.
Plugged Ducts
A tender lump in your breast or nipple area may be plugged duct. This can occur if milk is not being removed on a frequent and regular basis or if the milk is being obstructed in its flow to the nipple. To prevent plugged ducts:
- Wear comfortable nursing bras without underwires.
- Nurse your baby frequently and alternate positions.
Management
- Before feeding your baby use warm moist compresses over the area and gently massage the area toward the nipple during the soaks and while nursing to loosen the plug.
- Begin feeding on this breast and position the baby's chin close to the plug to help empty the duct.
- Change baby's position at breast at each feeding to help drain all areas of the breast.
- Get plenty of rest.
- If this does not resolve in 12-24 hours, or if the area becomes red, warm, tender or if you have a temperature of 100.4 or higher, call your healthcare provider or go to the emergency room.
Mastitis (Breast Infection)
Plugged ducts can lead to breast infections or "mastitis." Mastitis is not usually seen in the hospital setting. It occurs most often during the 2nd and 3rd weeks following birth, although it may develop at any time. It is more common in mothers nursing for the first time and usually affects only one breast. Most often it is caused by bacteria carried on the hands of the mother. It then enters through a crack or blister.
Mastitis can make you feel like you have the "flu," and can make you generally miserable. Areas that become red, streaked, hot to the touch, or very tender, accompanied by a fever can indicate mastitis. If you have these symptoms, you will need to be seen by a doctor. DO NOT STOP NURSING!!!!
Signs & Symptoms
- Red, hot, sore area on a tender breast
- Fever greater than 101 degrees
- Flu-like symptoms
- Red streak up the breast, sudden breast pain
Management
- See your doctor for antibiotic therapy
- Get as much rest as possible.
- Continue to nurse your baby frequently (every 2-3 hours) unless abscess forms & ruptures.
- Use warm compresses or a heating pad on your breast before nursing your baby.
- Nurse your baby on the affected breast first.
- Keep the breast empty; if you are unable to nurse, you will need to pump the breast.
- Eat a balanced diet.
- Mastitis can usually be resolved within 24 to 48 hours.
If you need to pump your breast
If your infant is premature or ill and is in the Neonatal Intensive Care Unit (NICU), you can pump your breasts and eventually breastfeed.
- You will need a good pump, preferably a high quality electric pump with double pump accessories.
- Double pumping decreases your pumping time by half and increases your milk production.
- You will need to maintain CLEAN accessories and wash your hands well before pumping.
- A pumping schedule will need to be established: Pump every 3 hours during the day and every 4 hours at night. Single pump for 15-20 minutes on each breast, or until the breast is empty. Double pump for 15-20 minutes, or until the breasts are empty.
- Expressed breast milk for an infant in NICU will need to be frozen in sterile bottles.
- The Lactation Nurse will give you a supply of these bottles. The Lactation Nurse will give you complete instructions on the proper storage of expressed breast milk (EBM).
- Expressed breast milk for healthy infants may be stored in the refrigerator for 48 hours and for 3-4 months in the back of the refrigerator freezer compartment.
- Store breast milk in 3-4 oz. bottles.
- Always date your breast milk and use the oldest milk first.
- Thaw frozen breast milk by placing it in a pan of warm water. DO NOT thaw the milk in the microwave.
page last modified on: 5/7/2013