See Breastfeeding problems (part one).

Cracked nipples

Cracked nipples are wounds that appear on the skin of the nipple, most commonly during the first days and weeks of breastfeeding.

Feeling pain when the baby latches on can be normal at the start, but this sensation should be temporary, should not last the whole feed, and should decrease over time as mother and baby learn to know and understand each other.

The main causes can be traced back to poor positioning of the baby and an inadequate latch, with resulting suckling problems: it can happen that the baby does not open their mouth wide enough and sucks only on the tip of the nipple, or that the lower lip, which should be well curled outward, turns inward instead, or that the baby clamps the nipple between the gums; another cause could be the additional use of bottles and pacifiers, which, because of their different latch and sucking pattern, confuse the baby, who then repeats the same action at the mother's breast.

Cracked nipples appear as small linear cuts running horizontally or vertically across the nipple, or as circular abrasions; they can bleed, cause pain and provide an entry point for germs.

Management and solutions

  • Correct the baby's position, keeping their body close to the mother's, and make sure the chin and lower lip touch the breast first, that the mouth is wide open and takes in not only the nipple but also a good part of the areola, cradled by the tongue in a «spoon» shape
  • Change breastfeeding positions often and stay comfortable, with relaxed shoulders supported by something to lean on
  • Prevention through proper nipple care is helpful in keeping it hydrated and elastic:
  • Avoid washing it often or after every feed, as this removes the protective lipid layer
  • Avoid using breast pads that create a warm, moist environment, preventing the breast from drying out and encouraging bacterial growth
  • Avoid synthetic fabrics and choose white cotton instead
  • If breastfeeding is painful, stop the feed by correctly releasing the baby, slipping your little finger into the corner of their mouth with the pad facing the palate, and latch them on again
  • To reduce pain during the feed, offer the less sore breast first, since it will then receive the initial, more vigorous sucking driven by hunger, while the other breast will receive a gentler one once the baby is partly satisfied
  • After each feed, thanks to the anti-inflammatory and healing properties of breast milk, it is helpful to express a few drops from the breast, massage it and let it air out
  • To ease the pain, apply warm compresses
  • In extreme cases where these measures do not improve the symptoms, silicone nipple shields can be used temporarily until the cracks heal; in addition, to help repair deeper wounds, local or oral drug therapies can be used, such as «Newman's ointment» (it is necessary to consult a doctor and ask the pharmacist to prepare it, to be used twice a day for 1 to 2 weeks after feeding, with no need to rinse)

Homeopathic remedies

The most important remedy for this painful condition is Nitricum acidum. It is used when the cracks have sharp, knife-cut-like edges, tend to bleed easily and cause sharp pain, like a splinter stuck in the skin. It is also very useful in cases of physical exhaustion, which can also lead to anxiety or irritability (even anger) in the new mother when facing any difficult situation. In both cases (cracks or exhaustion), it should be taken at a medium-to-high dilution, 9 to 15 CH, even several times a day, spacing out the doses as improvement occurs.

If, instead, the cracks show a thick, yellowish discharge, almost honey-like, or become covered with a yellowish crust, it is more helpful to take (or add) Graphites, following the same guidelines.

Blocked ducts and mastitis

The milk ducts are small channels in the mammary gland that open at the tip of the nipple and allow milk to pass through and be released; if milk stagnates, buildups form inside them that can be felt as small, hard, grain-like lumps that block the duct and cause symptoms such as swelling, redness, warmth and, in some cases, pain and a fever below 38.5°C.

The causes are mainly insufficient drainage of the breast, feeds that are too short or too far apart, and clothing that is too tight.

If a blocked duct is not treated correctly and promptly, it can develop into mastitis, an inflammation of the mammary gland that can also be caused by a bacterial infection, for example arising from the presence of cracked nipples.

The clinical picture is the same as for blocked ducts but more pronounced, and accompanied by flu-like symptoms lasting 2 to 4 days, such as fever, exhaustion, headache, muscle aches, nausea and vomiting.

Management and solutions

Managing these problems involves many of the measures already covered for the previous issues:

  • Use warm, moist compresses and circular massage on the lump
  • Keep breastfeeding, especially from the affected breast, to drain it and reduce stagnation, varying the baby's position so as to empty every part of it
  • Start feeding from the less sore breast
  • Treating mastitis may require antibiotic therapy, which will be prescribed by the attending doctor