• improper position of baby
• improper feeding techniques
• improper nipple care

A simple change your baby's position while feeding can sometimes relieve nipple soreness. Some breastfeeding mothers report nipple soreness only during the initial adjustment period. Comfortable breastfeeding takes time and experience.

Nipple soreness may be caused by incomplete suction release at the end of your baby's feeding. You can help a baby learn to release, and reduce your discomfort, by inserting a finger into the mouth to break the suction at the end of the baby's feeding.

Excessively dry or excessively moist skin can also cause nipple soreness. Moisture may be due to wearing bras made of synthetic fabrics which increase sweating and hinder evaporation. Using soaps or solutions that remove natural skin oils can cause excessively dry skin.

Nipple soreness can also be caused by your baby chewing or biting on the nipples. When your baby begins teething, the gums will swell, itch, and hurt. Biting and chewing seems to help relieve this discomfort. To comfort your baby and reduce the desire to chew on or bite your breast, provide something cold and wet to chew on for a few minutes before breastfeeding. A wet washcloth from the refrigerator will work well for this purpose. The cold will help numb painful gums and may give relief throughout the feeding. You may want to allow time to chew on another cold, wet washcloth before feeding on the other breast begins.

BREAST ENGORGEMENT or BREAST FULLNESS
Breast engorgement is caused by congestion of the blood vessels in the breast. The breasts are swollen, hard, and painful. The nipples cannot protrude to allow the baby to latch on correctly and nursing is difficult.

Engorgement is different from breast fullness. Breast fullness is the gradual accumulation of blood and milk in the breast a few days after birth and is a sign that your milk is coming in. Breast fullness doesn't impair efficient breastfeeding because the breast tissues can be easily compressed by the baby's mouth.

Nurse often (eight times or more in 24 hours) and for at least 15 minutes for each feeding to prevent engorgement. To relieve breast engorgement, express milk manually or with a pump. Electric breast pumps work best. Alternate taking warm showers and using cold compresses to help relieve the discomfort.

LET-DOWN REFLEX
The let-down reflex is a normal and necessary part of breast feeding. Hormones (prolactin and oxytocin) control the reflex and allow milk produced in the milk glands to be released into the milk ducts. Pain, stress, and anxiety can interfere with the reflex. This will cause the retention of milk within the milk glands which then causes additional pain and anxiety. The treatment for this includes relaxation and ensuring comfortable positions for you and your baby while nursing. Reducing distractions during nursing, gentle massage, and applying heat to the breast will also help. You should discuss prolonged problems with your health care provider.

INADEQUATE MILK SUPPLY
The baby's milk demand or milk use determines the mother's supply. Frequent feedings, adequate rest, good nutrition, and adequate fluid intake can help maintain a good milk supply. Checking weight and growth frequently is the best way to ensure your baby is taking enough milk. If you have concerns about how much breast milk your baby is consuming, consult your physician.

PLUGGED MILK DUCT
A milk duct can become plugged if the baby does not feed well, if the mother skips feedings (common when the child is weaning), or if a constricting bra is worn. Symptoms of a plugged milk duct include tenderness, heat and redness in one area of the breast, or a palpable lump close to the skin. Sometimes, a tiny white dot can be seen at the opening of the duct on the nipple. Massaging the area and gentle pressure can help to remove the plug.

BREAST INFECTION
A breast infection (mastitis) causes aching muscles (feeling much like the flu), fever, and a red, hot, tender area on one breast (where the infection is located). Consult your doctor if you develop these symptoms. Breast infections most commonly occur in mothers who are stressed, exhausted, have cracked nipples, plugged milk ducts, breast engorgement, who have skipped feedings, or wear a tight (constrictive) bra. Treatment frequently includes medications for the infection (antibiotics), frequent nursing, moist warm compresses to the infected area, rest, and wearing a comfortable bra between feedings.

THRUSH
Thrush is a common yeast infection that can be passed between the mother and the baby during breastfeeding. The yeast (called Candida albicans) thrives in warm, moist areas. The baby's mouth and the mother's nipples are perfect places for this yeast to grow. A yeast infection can be difficult to cure but fortunately this is uncommon. Yeast infections frequently occur during or after antibiotic treatments.

Symptoms of yeast infection in the mother are deep, pink nipples that are tender or uncomfortable during and immediately after nursing. Symptoms of thrush (an oral yeast infection) in the baby include white patches and increased redness in the baby's mouth. The baby may also have a diaper rash, a change in mood, and will want to suckle more frequently. Contact your physician to get a prescription for an anti-fungal medication for every affected member of your family.

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