Painful nipples during breastfeeding
If mum’s nipples hurt while she breastfeeds, encourage her to:
- Check the positioning of her baby
- Dry her nipples carefully after feeding
- Place dry breast pads in her bra to keep her nipples dry and replace them when they get damp
- Avoid using soap on her breasts
- Try expressing a little milk and rubbing it into her nipples after each feed, allowing them to dry naturally
Sore and swollen breasts
If a mum produces more breast milk than her baby needs, her breasts may become tender, full and heavy. This is known as ‘engorgement’. Engorged breasts can be uncomfortable for her and difficult for her baby to latch onto.
- Suggest she tries to gently express a little breast milk before a feed to ease the pressure.
- Ask her to check her bra isn’t too tight
- Encourage her to feed her baby regularly
Hard and lumpy breasts
This may mean she has a blocked milk duct.
- Suggest she tries a warm flannel or shower to soften breast tissue
- Encourage her to feed ‘on demand’
- Suggest she massages any lumps in her breast towards her nipple whilst she’s breastfeeding
- Demonstrate the different feeding positions she could use to empty different parts of her breast
Hot and painful breasts and flu-like symptoms
She may have mastitis.
What is mastitis?
Mastitis is an inflammation of the breast that can lead to an infection. Symptoms include areas of the breast feeling painful, red and swollen. Mums may also experience flu-like symptoms, such as chills, fever or aches. There are two types of mastitis; non-infectious mastitis and infectious mastitis.
What causes it?
Non-infectious mastitis is due to a blocked milk duct or problems with breastfeeding.
This can lead to infectious mastitis, which is caused by bacteria. The vigorous pull and tug of the infant's suck while breastfeeding can cause the nipples to become sore, cracked, or irritated. This creates a tiny opening in the breast, through which bacteria can enter. The presence of milk, with high sugar content, gives the bacteria an excellent source of nutrition. Under these conditions, the bacteria are able to multiply, until they are plentiful enough to cause an infection within the breast.
Mastitis usually begins more than two to four weeks after delivery of the baby. It is a relatively uncommon complication of breastfeeding mothers, occurring in only approximately 3% to 5% of nursing women.
The most common bacteria causing mastitis is Staphylococcus aureus. In 25-30% of people, this bacteria is present on the skin lining normal, uninfected nostrils. It is probably this bacteria, clinging to the baby's nostrils, that is available to create infection when an opportunity (crack in the nipple) presents itself.
How to avoid and treat mastitis
- Feeding ‘on demand’ will keep mum’s milk flowing, which in turn will help to unblock any blocked milk-ducts
- Asking her to massage any hard lumps in her breast towards her nipple while she’s breastfeeding will also help unblock any blocked milk-ducts
- Suggest she tries different feeding positions to empty different parts of her breast
- Encourage her to get lots of rest and drink plenty of water
- Check her baby is in the right position when feeding
- If necessary, an antibiotic can be prescribed to mum that’s safe for her to take while breastfeeding
Oral thrush
What is oral thrush?
Oral thrush, also known as candidiasis, is an infection of the mouth caused by a yeast called Candida albicans.
What are the symptoms?
Oral thrush usually causes white, creamy or yellow raised spots on the surface of the pink membranes in the mouth. These are sometimes described as having a 'cottage-cheese' or 'curd-like' appearance, and can be confused with milk residues on a baby's tongue after a feed.
The spots can be scraped off, leaving a tender, red area beneath, which may bleed. The spots are usually limited to the mouth but may spread down the throat. They're not usually very painful but may interfere with feeding.
Severe thrush may be a sign of an underlying illness but this is rare in small babies.
What causes it?
The yeast Candida albicans is all around us. Most people have some on their skin and it can be found in the mouths of more than half of us, but it doesn't usually cause any problems.
However, if the immune system is weakened or the normal environment of the mouth changes (if the healthy bacteria are killed, for example, or if too little saliva is produced or the acidity of the mouth changes) then candida yeasts may grow and cause symptoms.
Oral thrush is common in newborn babies but rarely linked to any serious problems. In children and adults, exposure to the factors that encourage the growth of candida may lead to thrush.
These factors include anything that reduces natural resistance, such as general illness, viral infections, antibiotics (which kill off the protective bacteria in the mouth) and other medications, including the steroids often used in asthma treatments.
How is it treated?
In most cases, especially in babies, thrush can be diagnosed simply by looking at the spots. In difficult cases, a sample may be scraped off and sent to the laboratory for analysis.
If there are predisposing causes (especially in older children or adults) these should be investigated and treated first. Otherwise, treatment consists of anti-fungal medicines such as Nystatin (which can be given as drops) or Miconazole.
It's unusual for a breastfeeding baby to develop thrush, but if this happens the mother should use an antifungal cream on her nipples to prevent cross-infection between mother and child.
In bottle-fed babies, the bottle teats should be thrown away and new ones bought because the yeast may get into the teats and cannot be easily eradicated. Babies often have to have antifungal cream on their bottom too, as it is another area that candida often grows in.
Oral thrush usually responds quickly to these treatments. If it persists, it may be necessary to check for any underlying illness that could be causing it.