Blanched nipples: Will blanched nipples recur with your next baby?

I had a very difficult time breastfeeding my son. I worked with a lactation specialist for four months, who after spending many sessions and hours with me, suggested that I might have vasospasm of the nipples -- or "frostbite." Do you have any more information on this seemingly rare phenomenon. I am expecting my second child? Is this likely to recur? Are there any precautions, suggestions?

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ABOUT THE EXPERT

Debbi Donovan

Debbi Donovan is a Board Certified Lactation Consultant, as well as a retired La Leche League Leader. For more than a decade, Debbi... Read more

I'm very sorry to hear that you experienced such difficulties breastfeeding. Nipple vasospasm will not necessarily recur with your next baby.

Not a lot is known or is in the literature, about nipple vasospasm, or blanched nipples. In this condition, the nipple tips whiten (blanch) following a feed. This is usually accompanied by pain, which may be severe. The pain does not occur during the vasospasm (when arteries contract briefly, limiting the blood flow), but with vasodilation or vasocongestion. The affected area may turn red, or purplish as blood flow returns. The mother may experience pain that she describes as hot, burning, or prickly. The affected area may feel cooler than surrounding areas.

Some medications, such as theophylline and terbutaline, have been associated with vasospasm, as have nicotine and caffeine. There may also be an allergy association.

Blanched nipples may be caused by something as "simple" as proper positioning and attachment. When a baby is poorly positioned at the breast, or for one reason or another is having difficulty breastfeeding, the baby may "chomp", or clamp down on the breast while nursing (possibly to grab hold or elicit milk ejection.) Mothers may perceive this as biting. Trauma to the nipple intensifies the pain. A mother may find her nipple tips appear whitened (and may also be creased and/or crunched) following a feed, rather than round and pink in color.

Nipple vasospasm may be associated with Raynaud's Syndrome - a vasospastic disorder (Lawlor-Smith L & C. Br Med J.1997;7081[314]:644). In people with this syndrome, a spasm can occur in the small blood vessels that supply the extremities (e.g. hands, toes, nose, ears...) As described above, the affected area blanches. Blanching is followed by vasogongestion and pain, as the arteries over-relax, and blood flow returns to the area. This response is often triggered by exposure to cold or emotional stress, though the cause of Raynaud's Syndrome is still not known. People with Raynaud's are advised to guard against trauma to the skin (such as cuts and bruising.)

It is very important that if you do begin experiencing pain (other than initial latch-on discomfort in the first five days of so of breastfeeding) that you work with an IBCLC. Making sure that your baby is properly positioned and attached is the first -- and most important -- step in insuring comfortable breastfeeding.

If you experience pain due to nipple vasospasm:

  • Use warm compresses on your breasts while nursing and following a feed.
  • Don't allow yourself to become chilled -- keep a warm blanket nearby when you nurse.
  • Hand-express a bit of milk to start your milk flowing before putting your baby to your breast. This may help to prevent your baby from clamping down on your nipple.
  • Ask your health care provider about using ibuprofen about one half hour prior to nursing for pain relief.
  • Some mothers are helped by the use of niacin, calcium, magnesium or nifedipine. Discuss these options with your health care provider.

My very best wishes for comfortable nursing with your baby!

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