Sore nipples after feeding well established

My daughter is ten weeks old and all of a sudden over the past week seems to have changed the way she latches on to my breast. We've been doing very well with breast feeding up to this point, but now I feel like we're starting all over again! She seems to curl under her top lip and not open her mouth as wide; as a result my nipples are very sore like they were in the first week. Do you have any suggestions as to why this has happened, and any advice on how to get back on track?

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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

Several things can cause sore nipples after breastfeeding has been going well. The first thing that comes to mind is thrush. Have you or your baby been treated with antibiotics? Did you have any signs of a vaginal yeast infection during your pregnancy? Are your nipples pink, swollen and very tender? Does your baby have any white plaques in her mouth (along the gums, on the tongue or on the roof of her mouth?) These can be very difficult to see. Babies don't always show symptoms. Since thrush can be painful for your baby, it can affect the way she sucks. If you think that thrush may be present, contact your health care provider. You and you baby would need simultaneous treatment for at least 2 weeks with an antifungal medication to help clear this up.

If you don't think that thrush is the culprit, have you started using artificial nipples? Some babies are confused when going back and forth between the breast and a bottle. Pacifiers can also cause difficulties in some babies, even after those early weeks. If this is the case, I would recommend gradually reducing your baby's use of bottle nipples or pacifiers and see if this helps.

Sometimes a mother has a very abundant milk supply. She may be prone to leaking and spraying milk during and even in between feeds. Her baby may seem to have difficulty nursing and may sputter and choke as her milk ejects. Babies whose moms have very abundant supplies often slide down into a poor position while nursing. This may reduce the milk flow to a more manageable level for them, but it can cause you very sore nipples. Allowing your baby to come off the first breast on her own, rather than timing a feed is almost always a good idea, but it may be particularly helpful if you are experiencing oversupply. Don't be concerned if your baby refuses the other breast for that feed. If your "unused" breast is uncomfortable, express just enough milk for comfort. Start with that breast for the next feeding.

Whatever the cause, your baby is not breastfeeding properly. She needs to be taking in a good mouthful of breast (with about one inch of the areola) as she nurses. Her lips should be flanged out, rather than folded in. See my article, Breastfeeding: Back to basics to review tips on positioning and attachment. If your daughter starts out nursing correctly and then slides down onto your nipple, you will need to gently insert your finger between her gums to break suction and start over again. One additional tip to help keep her lips flanged out as they should be: Just before nursing, place a tiny dot of olive oil on her top lip. As she attaches, the olive oil helps her lips to slide into the proper position.

If these suggestions don't help in the next few days, I would suggest working with a Lactation Consultant. To locate an IBCLC (International Board Certified Lactation Consultant) you can contact the ILCA (International Lactation Consultant Association) office. You will be referred to three IBCLC's in your area. You can reach them at:

ILCA
200 N. Michigan Ave, Suite 300
Chicago IL 60601
phone 312-541-1710
fax 312-541-1271
email ilca@erols.com

Best of luck!

Warmly,
Debbi

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