Sore nipples certainly seem to be common, but does that mean it’s normal for breastfeeding to hurt?

Simple: No!

Pain is an indicator that something is off. Pain during breastfeeding can come from a variety of things, and they are all fixable. Most women experience pain caused by poor latch. There are many causes of poor latch.

Tongue tie
Ankyloglossia is the medical term for this easily repaired oral anomaly. Tongue tie is an inherited condition that causes the tongue to have limited range of motion. Tissue under the tongue, usually the connective tissue called the frenulum, is tight, thick, or restricts movement. This is not just a breastfeeding problem. Tongue tied children can have other feeding issues including difficulty with bottles and solids as well as speech problems later in life. There are many classes or types of tongue tie. Not all are visible. To properly diagnose a tie, an LC, pediatrician, dentist, or ENT will need to do an oral exam on your baby that includes feeling inside the mouth. Since it is a heritable trait, mothers who know there is a family history of tongue tie should have their babies checked at birth. This condition is easily remedied in most cases with a short out-patient procedure.

High palate or Bubble palate
Some baby’s are born with the hard palate higher than average or with a scoop or bubble shape in the palate. This is also a heritable trait. Families with a history of orthodontic appliances like palate expanders should ask for evaluation after birth by an LC, pediatrician, dentist, or ENT. Fortunately, breastfeeding helps this palate shape improve as the baby grows. An LC can work with baby and mother on ideal positioning to end discomfort and help the baby transfer more milk.

Lip tie
Similar to a tongue tie, this oral anomaly involves a frenulum that restricts the movement of the lip. This is not just a breastfeeding problem. Children with lip ties are at risk for tooth decay after they begin solids. Fortunately, this too can be completely remedied during a simple out-patient procedure. A simple oral exam can also identify this issue.

Oversupply of Milk and/or Forceful Milk Ejection Reflex
Most moms start with oversupply. Often, the milk is released so rapidly, the tiny newborn has a hard time coordinating suck-swallow-breathe. Babies respond with a shallow, apprehensive latch, pinching or biting the nipple, or breast refusal. An LC can asses the situation and help the mother develop a unique plan for breastfeeding management to make this short period of oversupply fruitful and comfortable.

Some causes of pain are due to health concerns in the mother. Mothers delivering by cesarean or who are Group-B Strep positive may be given antibiotics at delivery. Some mothers may develop thrush, or candida infection of the nipples as a response to antibiotics. This infection can spread to the baby. It is easily treated and is not a reason to discontinue breastfeeding.

Comfort Measures for Immediate Relief

Until the LC can visit, all mothers deserve pain management. This healing protocol is a good First Aid for sore or damaged nipples.

1. Saline soaks: 1/4 to 1/2 teaspoon of sea salt to 8 ounces warm water. Make this solution and heat it to very warm. Place solution in a shot glass or tea cup and invert over nipple. The salt water will soothe pain, clean any wounds, and promote healing. Soak about 10 minutes. Rinse afterward with fresh water.

2. Nipple ointment: There are hundreds of products on the market. Lanolin and coconut oil are the favorites for many mothers. Nipples with broken skin need to be kept moisturized to prevent scabbing.

Ideally, after nursing or pumping, mom should apply the saline soak. Rinse then apply nipple ointment. This will give the nipples a rest period to benefit from the treatment.

One of the most common and unhelpful things mothers are told by well-meaning nurses, doctors, and friends is that their baby’s latch “looks good” when the mother does not feel confident that nursing is going well. The way the latch looks to the outside observer is completely unimportant. In breastfeeding a full-term healthy infant, only two things matter:

Is everyone comfortable?
Is the baby getting milk?

If you said YES to both, then nurse on proud mama!

Unfortunately, many mothers go on experiencing pain in the nursing relationship because they are told breastfeeding hurts and the latch “looks good.” Pain is not normal. Pain is your body’s way of communicating that something is wrong.

Unfortunately, many babies who are not getting enough milk aren’t evaluated to understand why. The latch may “look good” from the outside, but be ineffective at drawing milk from the breast.

So what’s going on here?
The range of reasons why a “good looking latch” is painful and not effective at transferring milk is wide. Sometimes it’s size, shape, positioning, or maturity. Some babies are born with oral anomalies that make successful latch-on difficult or impossible. These oral anomalies are tiny things that require a skilled health care provider to detect like a tongue tie, lip tie, or bubble palate. These sorts of conditions can make deep latching and adequate milk transfer very difficult. Babies like this nurse frequently, often painfully, and have low diaper count and poor weight gain is any gain at all. Breastfeeding is not working, but it can be fixed.

When the baby doesn’t transfer milk well, the common answer is “low milk supply.” It’s common to assume the mother is not making enough milk rather than check the baby thoroughly. Most experts agree that lactation failure and low milk supply are very rare, but it’s cited as the reason for breastfeeding troubles time and time again. The health care provider says, “The latch looks good! There must not be any milk there.” Again, looking at the latch from the outside tells nothing.

So what does a mother do when breastfeeding hurts and babe isn’t getting milk?

Babies with “hidden” latch problems most often can breastfeed beautifully with a little help from a trained LC, ENT, pediatric dentist, or pediatrician. Mom and baby should work with one of these specialists to identify the cause of the latch-on problem. The specialist will feel inside the baby’s mouth and evaluate the anatomy and sucking. The specialist will do much more than just “look” at the latch. Until the cause can be determined, mom can work with an LC to create a temporary breast-milk feeding plan to feed the baby and protect mom’s long term milk supply. It’s important to remember that oral anomalies are fairly common and most babies can go on to breastfeed full term.

“20years ago, the World Alliance for Breastfeeding Action (WABA) launched its first World Breastfeeding Week (WBW) campaign with the theme: “Baby-Friendly Hospital Initiative”. So much has happened in these 20 years, it is time to celebrate but also to look back, understand what has happened and why. Then plan what more can be done to support all women to be able to optimally feed and care for of their infants and young children.” — for more info visit worldbreastfeedingweek.org

You can find a Latch On event where your baby can be part of the many babies around the world who are simultaneously nursing. In the Atlanta Metro:

The Big Latch On in Catersville:

324 West Cherokee Avenue

Cartersville, GA 30120

The Big Latch On 2012-Gwinnett County Peer Counselors

Friday  03 August 2012 10:00 – 11:00

Motherhood Maternity @ Discover Mills @ 5900 Sugarloaf Pkwy, Lawrenceville, GA 30043, USA

 

Big Latch On 2012 Cobb County

 Friday 03 August 2012 10:00 – 11:00

Tramore Park @ 2150 East-West Connector, Austell, GA 30106, USA

The Big Latch On – Metro Atlanta

 Friday 03 August 2012 10:00

Henry Family and Sports Chiropractic Clinic @ 2290 Ben Hill Rd, Atlanta, GA 30311, USA