Breastfeeding Concerns: Symptoms & Treatment

Updated July 2024

**Updated June 17, 2019 – Information on gentian violet removed to reflect Health Canada’s warning of potential cancer risk associated with gentian violet

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.43)
    • 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

  • 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 # 6, 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)
  • refer to 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

**Updated June 17, 2019 – Information on gentian violet removed to reflect Health Canada’s warning of potential cancer risk associated with gentian violet

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)
  • 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
  • refer to the clinic for ongoing breastfeeding support

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