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Breastfeeding Myths

The Truth About Breast Pain

Myth #7: Severe sore nipples are always caused by incorrect breastfeeding technique.

Fact: It's true that improper infant attachment to the breast and incorrect infant suckling are leading causes of nipple pain and damaged skin. The most common mistake is a shallow infant latch-on, where the baby grasps only the tip of the nipple, rather than the entire nipple plus at least an inch of surrounding areola. An improper latch-on means that the baby is removing less milk from the breast, which in turn can cause production to decline. This can lead to painful nursing, as the baby has to work harder and longer to get more milk. Nipple pain can also inhibit a woman's let-down, making it harder to release milk.

But a faulty latch-on is not the only cause of chronic or severe nipple pain: Infection may be another culprit. Once there is a crack in the skin of the nipple, the area can easily become infected by bacteria or yeast. Without treatment (oral antibiotics for bacterial infections or an anti-fungal medication for yeast infections), soreness will persist. Your doctor can diagnose and treat infected nipple wounds, while a lactation consultant can offer expert help with correct latch-on. In addition to these measures, moisture-retaining hydrogel dressings that are made for breastfeeding mothers can help provide cooling comfort for sore nipples while the underlying cause is being treated. Similarly, ultra-pure lanolin can help soothe and promote the healing of nipple wounds.

If an infected nipple is not treated, it can lead to mastitis, a painful breast infection that occurs in about ten percent of lactating mothers. It causes pain and redness in the affected breast and flu-like symptoms. Mastitis should be diagnosed promptly and treated with antibiotics; ibuprofen can be given for pain.

Do not stop breastfeeding if you have mastitis as this can lead to a breast abscess, an extremely painful localized pocket of pus that requires drainage. Unless your baby is premature or hospitalized, it's considered safe to continue breastfeeding (or pumping if it's too painful) from the affected side. If the milk looks discolored or bloody, you can pump and discard the milk for a day or two until it appears normal, and give the baby formula.

The memory of breastfeeding my own children ranks among my most enjoyable and nostalgic parenting experiences, and I count it a privilege to help today's generation of mothers and babies share the benefits and rewards of breastfeeding. I have learned that breastfeeding success not only requires skilled practical assistance and emotional support, it also involves replacing mistaken popular beliefs with accurate and empowering information.

BabyTalk contributing editor and pediatrician Marianne Neifert, M.D., is the author of Dr. Mom's Guide to Breastfeeding and the mother of five breastfed children.