Common breastfeeding problems

Mastitis and breastfeeding

Mastitis means inflammation of the breast but not necessarily infection of the breast. The first signs tend to be redness and swelling of the breast. It is worth starting the self help measures as soon as you suspect any sign of inflammation.

Prevention

• Avoid long gaps between feeds – if you are reducing your feeds, cut down gradually if possible.
• Don’t let breasts become overfull- feed or express.
• Avoid tight clothing or bra.
• Avoid indenting the breast with fingers if support is required.

Signs

• Red, swollen area, usually painful on breast.
• Lumpy engorged breast which can be hot to touch.
• Pain in the breast.
• Flu like symptoms that can start very suddenly.
• You may not have all the symptoms listed.
• Antibiotics are NOT always needed.

Self help measures

• It is important to continue breastfeeding from both breasts.
• Feed the baby more frequently or express between feeds if your breasts are uncomfortably full.
• It may help to try and express after a feed to ensure the breast is soft.
• Ensure good positioning and attachment – ask you Midwife, Health Visitor or Peer Supporter if unsure.
• Feed from the  sore side first.
• Try feeding in different positions which may help your baby attach and feed more effectively.
• Before feeding it often helps to soften your breast by expressing a little milk  so baby finds it easier to feed well.
• Gently massage the affected area.
• Warm or cool compresses may help relieve discomfort.
• Rest.
• You may take Paracetamol and Ibuprofen for the pain (Ibuprofen should not be taken by women who have asthma, stomach ulcers or are allergic to aspirin).
• Continue to drink fluids and eat a light diet.

If signs and symptoms continue despite trying the above, it is important that you go and see your Midwife, Health Visitor or GP as antibiotics may be needed.

Thrush

Thrush can sometimes occur if you or your baby are taking antibiotics and if there has been any damage to the nipple. However, thrush can occur at any time. If you suspect you or your baby may have thrush please speak to your Midwife, Health Visitor, Peer Supporter or GP for further advice and possible treatment.

Candidal infection of the nipple is very painful. The symptoms are

• variable for example: some mothers say the nipple burns; is itchy; is extra sensitive; stings; have associated deep breast pain, feel that needles are being driven from the nipple into the breast tissue.

Observation sometimes shows a shiny areola; blanched or bright pink, fiery red nipples, persistent sore or cracked nipples even though fixing and positioning has been corrected The mum may inform you that she has a strong history of having been prone to thrush. The baby may have signs and symptoms of oral or buttock thrush, vaginal thrush in mum. 

Thrush is associated with:

• Prone to thrush infection.
• Treatment with antibiotics for mother or baby.
• Anaemia.
• Generally run down.

Self Help Treatment

The diagnosis of candidial infections on the breast is difficult. Swabs of the mother’s nipples and the baby’s mouth are useful to confirm the presence./absence of fungal or bacterial infection (commonly Staph. Aureus).

Treatment of the surface of the nipple, the baby’s mouth, and oral treatment for the mother (when necessary to treat deep breast pain), should be undertaken simultaneously to achieve relief from symptoms of confirmed candidial infection.

 Presenting symptoms which suggest the presence of candidial infection of the breast:

•  Previous pain free breastfeeding
•  Positive swabs for candida from maternal nipples and infant mouth
•  Bilateral pain.
•  Pain which begins after a breastfeed has finished and continues for up to an hour afterwards
•  Absence of red area on the breast
•  Absence of high temperature.

If a mother reports sore nipples during breastfeeding the first action should ALWAYS be to re-examine and improve attachment. This needs to be carried out by a skilled practitioner. It is unethical to treat a mother and baby with medication inappropriately or unnecessarily, particularly if such use is outside of product licence.

DIAGNOSIS SHOULD BE CONFIRMED BY NIPPLE/ORAL SWABS CULTURED FOR FUNGAL AND BACTERIAL INFECTION.

Treatment of the baby:

• There is evidence that the use of miconazole oral gel is preferable to nystatin suspension with greater efficacy within a shorter period.
• Fluconazole oral suspension may be used to treat oral symptoms in the baby but use is recommended for infections which do not respond to topical therapy (BNF).

Treatment of the mother:

• Miconazole 2% cream applied SPARINGLY to the nipple and areola after each feed. There is some anecdotally reported that using 1% clotrimazole cream as an alternative is associated with allergic reactions.
• Miconzole gel and nystatin suspension have been reportedly applied to treat nipple candidiasis – they are NOT.
• Pharmacologically designed to penetrate the skin of the nipple and application is unlikely to be effective.
• For nipples which are very red and inflamed a mild steroid cream can be used to facilitate healing. Miconzole 2% plus hydrocorti-sone cream 1% may be useful (DAKTACORT).

If symptoms of pain do not improve or deep breast pain develops, oral treatment with Fluconazole may be necessary in addition to topical treatment of mother and baby. Fluconazole should not be prescribed for mothers whose babies are under 6 weeks of age.

See the Breastfeeding Network website for Dosage of Fluconazole

Tongue Tie

Tongue tie (also known as ankyloglossia) is caused by a tight or short membrane under the tongue (lingual frenulum).  The tongue tip may appear blunt or forked, or have a heart-shape appearance.  The membrane may be attached at the tongue-tip, or further back. 

It is estimated that over 10% of babies are born with tongue tie.  It is more common in boys than in girls and, in 50% of affected babies, there is a close family member with a tongue tie.

Many tongue ties are minor and do not require treatment. However a tongue tie that is interfering with breastfeeding may require assessment with a view to possible treatment (frenulotomy). Some bottle fed babies will also benefit from tongue tie release. The assessment should be carried out by someone with experience in this field.

If you think your baby may have a tongue tie please contact your midwife or health visitor or you could contact the infant feeding team on 0161 419 4430.