Last week I saw three mums with very sore nipples. All the baby's were different ages and it was making breastfeeding a rather unpleasant experience :-( One baby was a week old, another was 2 months and the third one was three months old. All three of them had mechanical problems. One had a short tongue, another had a tongue tie and the third had a short tongue and a mum with undersupply caused by the short tongue. So what can you do? Looking at the cause is really important
Check the latch, is it a good latch?
Does your baby have a tongue tie?
Then a trip to your GP or Paediatrician is a good idea and a referral for a laser or snip to the tongue tie. The reason being that you will probably get poor milk transfer by the baby not being able to bring the tongue over the gum line and this can lead to undersupply by the baby not stimulating the milk ducts. Also mastitis is a risk as the baby cannot drain the breast effectively. Never mind the ouch factor from sore nipples. Tongue tie is a classic cause of sore nipples. This photo below of a one month old baby shows a tongue-tie.
A great local option is either the tongue tie clinic at Westmead Children's Hospital (referral needed from your GP) or an orthodontic surgeon in Dural/Baulkhan Hills called Laurie Kobler (Integrity Dental). In Gymea and Randwick there's a paediatrician, Dr Anthony Dilley who snips the tongue tie under ultrasound. All you need is a referral letter from your GP.
If it's a short tongue or a receding lower jaw/chin then time will change this usually. As the baby grows their tongue usually grows as well and they learn to compensate as the tongue moves forward to cover the gum.
Always hold the baby in close to the breast as this will help keep the baby correctly attached and prevent them coming off onto the nipple.
More info and resources on tongue tie can be found at:
Helpful resources from your pharmacy
- Sometimes nipple shields are a great option till the problem resolves. I know a lot of midwives and nurses and lactation people don't like them but I think they can save the day and help a mother continue breastfeeding. Good nipple shields are the silicone ones produced by Medela or Pigeon. http://www.medela.com.au/breastfeeding/products/breast-care/contact-nipple-shield
- Using Lansinoh can really help as we know now that moist wound healing is the way to go and that applies to sore nipples too. If sore nipples are allowed to dry out they will not heal as well. http://www.lansinoh.com
- Something else that can help soothe very sore nipples is Hydrogel breast discs from Rite Aid. You can store them in the fridge and they provide soothing relief.
Always check your problem isn't caused by oral thrush in the baby or nipple thrush.
See my previous blogpost on this: https://nurtureparenting.com.au/thrush-oral-and-napkin/
Things to watch out for
- When baby is feeding ensure you have baby's with a wide mouth before latching baby, try and get the tongue out as far as possible. Keep baby close to the breast to ensure they are not coming off on the nipple. A lot of the milk ducts are under the areola, not the nipple.
- Watch the feed and listen for clicking noises or a dimple in the cheek, this can indicate an incorrect latch and means baby needs de-latching and repositioning.
- Listen for swallowing of milk.
- Observe for wet (4-5 a day) and dirty nappies. The wet nappies should feel heavy. If there are urates this can indicate underfeeding or a slightly dry/dehydrated baby. Urates are a pinkish orange colour and are easier to see in baby boy's nappies as they tend to wee in the same place! Read more on poos, wees and nappies here: http://www.cyh.com/HealthTopics/HealthTopicDetails.aspx?p=114&np=122&id=2272
- Is baby satiated and happy?
- Keep an eye on their weight and weigh weekly until you and your health professional is happy with the progress.
- Jaundice can be an indication of low supply sometimes but it can be a normal process as well as in physiological jaundice and breast milk jaundice. Both of which are extremely normal.