Signs and Symptoms

  • Nipples feel sore, painful, burn and/or are itchy
  • Nipples appear to be abnormally pink or red, bruised, blistered, cracked, shiny, flaky and/or bleeding
  • Discharge from cracks or sores on the mother’s nipple

Assessment

  • Assess positions and latch
  • Assess for ankloglossia  (Protocol #4, p.45)
  • Assess for candidiasis (thrush), (Protocol #15, p.110)

Treatment

  • Correct position and latch
  • After breastfeeding

    • If no nipple trauma, apply expressed breast milk onto nipples and air dry (if no nipple trauma) (Protocol #4, p.42)
    • For nipple trauma, apply saline compresses to nipple and air dry (Protocol #4, p.42-43)
    • With nipple trauma, a compounded all-purpose nipple ointment (APNO), containing an antibiotic, steroid, and antifungal agent is commonly recommended but not yet researched. Note: prescription not available at TPH BF support services
  • Refer to the clinic (NOTE: Procedure(s) to address ankloglossia may not be available at all Breastfeeding Clinics)

Signs and Symptoms

  • Unilateral symptoms, localized in one area of the mother’s breast
  • Mild tenderness in one area of the breast
  • Possible palpable lump
  • Feeling well otherwise

Treatment

  • Frequent breastfeeding (at least 8 times in 24 hours) and hand expression. Start on the affected side.

Before breastfeeding

  • Gently massage towards the affected area
  • Warm moist compress to the area

After breastfeeding

  • Practice self-care
  • Avoid prolonged pressure on the breast (i.e. tight or underwire bra)
  • Analgesics as needed (not available at the clinic)

Prevent recurrences

  • Lecithin 1 tablespoon, by spoon or in food 3-4 times/day or 1-2 capsules (1200 mg) 3-4 times a day (Protocol # 4, pg. 57)
  • Refer to the clinic

Signs and Symptoms

  • Nipple pain
  • White or yellow dot on the nipple

Treatment

  • Frequent breastfeeding (at least 8 times in 24 hours) and hand expression
  • Sterile lancing (not available at the clinic) (Protocol # 5, p.56)
  • Before breastfeeding

    • Apply warm compresses
    • Gently massage affected area
  • After breastfeeding

    • Analgesics as needed (not available at the clinic)

Signs and Symptoms

  • Generalized  breast tightness and pain
  • Breasts are not compressible
  • Usually begins 3-6 days after birth
  • Breasts appear flush
  • Low-grade fever
  • Difficulty latching
  • Hands and arms may be numb and tingling if engorgement is severe

Treatment

  • Breastfeed early, frequent and without restrictions
  • Before breastfeeding
    • Hold baby skin-to-skin
    • Warm compresses to breast of warm shower
    • Gentle massage to the breast
    • Hand expression
  • After breastfeeding
    • Hand expression
    • Cool compress to breast
    • Analgesics as needed (not available at the clinic)

Signs and Symptoms

  • Unilateral breast pain
  • Red, hot and swollen breast
  • Possible red streaks and/or shiny breasts
  • Flu-like symptoms e.g. chills, aches, fatigue
  • Fever >38.4 °C

Treatment

  • At each breastfeeding, offer the affected side first
  • Before breastfeeding
    • Apply heat to the affected area for a few minutes or a warm shower
    • Gently massage the affected area
  • After breastfeeding
    • Hand expression after each breastfeeding if baby unable to latch
    • Cool compress to breast
    • Rest
    • Proper Nutrition
    • Analgesics as needed (not available at the clinic)
    • Antibiotics (if symptoms persist > 12-24 hours or mother acutely ill) as needed (not available at the clinic)

Signs and Symptoms

  • History of recurrent mastitis
  • Unilateral breast pain
  • Swelling and redness
  • Possible lump
  • Fever and feeling unwell
  • Poor response to antibiotics

Treatment

  • Requires needle aspiration or incision for drainage
  • Resume feeding on affected breast once treatment has started and if abscess does not involve the nipple
  • Before breastfeeding
    • Breastfeed from non-affected side
  • Refer to the clinic for ongoing breastfeeding support

Signs and Symptoms

  • Persistent cracked or painful nipples
  • Painful nipples that develop suddenly when breastfeeding was going well
  • Severe nipple pain that lasts throughout the entire feeding and immediately after breastfeeding
  • Sharp shooting or burning pain in the mother’s breast
  • Areola may be red, swollen, flaky/scaly, or shiny in appearance
  • Nipples may be red, sore, cracked, itchy, burning or painful
  • Recurrent mastitis

Treatment

  • Both mother and baby need to be treated
  • Consider treating partner in resistant cases
  • Frequent hand washing
  • Wash and boil, once a day, all objects that come in contact with infant’s mouth (e.g. toys, artificial nipples, droppers, pacifiers, teethers)
  • Over-the-counter treatments
    • Miconazole (topical)
    • Ketoconazole (topical)
    • Genitian violet (topical)
  • Treatments requiring a prescription
    • Nystatin (topical or oral)
    • Medication including “azole”, i.e., clotrimazole (topical), miconazole (topical), itraconazole (oral),ketoconazole (topical or oral), and fluconazole (oral)
    • All Purpose Ointment (APNO)
  • Before breastfeeding
    • Breastfeed on the pain-free side first, then switch sides
  • After breastfeeding
    • Wash breasts and nipples with clear water at the end of each breastfeeding and then air dry.
    • Apply a cool cloth for comfort.
    • Express both breasts after breastfeeding if baby is unable to breastfeed effectively

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