Cracks in the nipples during breastfeeding
A young mother can not always just breastfeed. What problems can arise during this period and how to solve them?
Ekaterina Komar Neonatologist, Research Institute of Obstetrics and Pediatrics, Rostov-on-DonThe abrasions and cracks in the nipples are a condition characteristic of the first weeks of the postpartum period, when lactation becomes established and the mother and the baby adapt to breastfeeding. It occurs, as a rule, within the first 3-4 days after the birth of the child and can persist for the first month.
First on the surface of the skin areola (okolososkovoy pigmentation) there are scrapes, which under adverse circumstances become abrasions. Further on the place of abrasions there are cracks - deeper damage to the skin of the nipple. Cracks - this is a linear violation of the integrity of the skin on the nipple, located radially (from the center of the nipple to its periphery in the radius of the areola). If, in the event of cracks, no measures are taken to treat them and prevent the development of the inflammatory process, then in the mammary gland inflammation and mastitis may develop, since the non-healing crack is the entrance gate of the infection. This is facilitated by the fact that the mother in the postpartum period is in a state of some immunodeficiency, which causes a greater than usual predisposition to all sorts of diseases and infections.
In addition, the appearance of cracks in the nipples causes severe soreness even in a state of rest, and in the process of feeding, pain sensations are amplified many times, which makes feeding extremely difficult.
Why do cracks appear on the nipples?
The causes of the appearance of abrasions and cracks in the nipples are not so many. First of all, this is because the skin of the areola, which is very thin and vulnerable, has not experienced such intense exposure before, suddenly undergoes a prolonged load. To a greater degree, the risk of abrasions and cracks in the nipples is exposed to young mothers nursing their first-born. This is due to the fact that with repeated childbirth the nipple skin is somewhat rougher, more trained than with the first ones. In addition, during the feeding of the second child, the mother has some experience that helps her to avoid this unpleasant and dangerous complication.
To contribute to the occurrence of abrasions and cracks in the nipples may also be a factor, such as the temperament of a newborn baby. In women, whose cases suck with special activity, abrasions and cracks occur more often than in moms sucking babies.
An important role is played by the condition of the mother's skin. If the skin is dry, sensitive, then the risk of abrasions and cracks is much higher: this skin is less protected from traumatic effects, it quickly develops wounds and abrasions that heal longer than in women with normal skin.
Dry skin can be due to hereditary factors, caused by hypovitaminosis (a deficiency in the nursing mother of certain vitamins, in particular, vitamins B, A and C).
Another cause of dry skin and, as a result, abrasions and cracks in the nipples is improper skin care of the breast. Too frequent washing, especially using soap, treating the skin with solutions of antiseptics cause its dehydration, which significantly increases the susceptibility to traumatic factors.
On the other hand, the constant contact of the nipple skin with moisture also contributes to the occurrence of cracks. This situation arises in cases when from the dairy nipples of the nipples there is a more or less constant leakage of milk (the so-called galactorrhea).
A very common cause of cracking of the nipples is an incorrect technique of applying to the breast, as well as an unreasonable feeding regime, for example, too long - for more than 20 minutes. If the baby does not completely grasp the nipple while feeding, but only the upper part of the nipple, the baby does not receive the required amount of milk. Such sucking is completely ineffective and causes negative emotions in hungry crumbs, which, depending on the temperament of the newborn, can cause either rejection of the breast or especially active (aggressive) sucking. The result of the latter is a fairly rapid occurrence of abrasions and cracks in the nipples.
Prevention of cracks in the nipples
Measures to prevent abrasions and nipple cracks stem from the causes that cause them:
Rational breast care: Do not wash your chest with soap before each feeding. Moreover, it is not worth treating it with an alcohol solution of greenery - both can cause drying of the skin and the development of cracks in the nipples. A daily common hygienic shower is enough. It is better to wash your breasts with a liquid pH-neutral soap. After showering, the breast should be gently dabbed with a soft cloth (do not rub it with a towel so as not to injure the nipple). After each feeding, the nipple must be dried - let it dry on its own, and not wipe with a napkin or towel. Do not wash off the milk after the nipple, since, when dried, it is perfectly absorbed into the skin, moisturizing it and providing natural fats.
After feeding, it is recommended that the nipple be treated with one of the means to prevent the appearance of cracks (PURELANE, BEEPANTEN, sea buckthorn oil, SALKOSERIL OIL, etc.)
Use of special pads for bras: they absorb the emanating drops of milk, protecting the nipple from permanent contact with moisture.
Rational feeding regimen: in the first days, when an insignificant amount of colostrum is allocated from the breast, and the newborn's needs in nutrition are still small, do not keep the baby at the breast for a long time. These days, the feeding should not last longer than 10 minutes. During this time, actively sucking newborn sucks the necessary 10-30 ml of colostrum, while he does not have time to injure the nipple. In the next days, when the transitional milk begins to emanate from the breast, when its amount increases in parallel with the increasing needs of the child in nutrition, the duration of feeding can be from 20 to 30 minutes. A positive role in this period is played by feeding the child in a free regime, since if the child is more often applied to the chest, it sucks it more calmly, becomes saturated faster, thereby less injuring the still tender, not adapted to the permanent effect of the nipple. Neither in this period, nor in the subsequent it is not necessary to let the baby systematically use the breast as a dummy. In exceptional cases, of course, it is possible to calm the child with the breast, even if he is not hungry, but this measure should not be abused, especially during the first month of breastfeeding, when the risk of nipple cracks is particularly great.
Correct technique of applying to the breast: if, putting the baby to the breast, the mother experiences a sharp pain in the nipple, which does not yet have cracks, then the baby has seized the nipple incorrectly, not completely. If you continue feeding, when the child sucks only the upper part of the nipple, this will inevitably lead to an abrasion on the nipple. In this case, it is necessary to interrupt feeding by taking the nipple from the child. It is very important not to pull the nipple out of the baby's mouth - this action further injures the nipple. Gently pick up the nipple from the sucking baby, you can by pressing your finger on the nipple so that the baby gets into the mouth of the air. Then you need to try to give the nipple in such a way that the baby gets as much of the nipple as possible - the areola. To do this, stroke the baby on the cheek with his index finger, he will open his mouth wide, while with the other hand, grip the nipple between the index and the thumb horizontally and insert the nipple into the open mouth. The main criterion for the correct grip of the nipple is that sucking does not cause the mother acute pain.
Vitaminotherapy: regular intake by the mother of special multivitamin preparations for nursing helps to prevent the occurrence of hypovitaminosis and the treatment of already developed, resulting in a healthy elastic skin (including nipples), resistant to damage and capable of rapid healing. Admission of multivitamin preparations must begin already during pregnancy.
Treatment of cracks in the nipples
In the event, when abrasions of the nipples have already arisen, urgent measures should be taken to treat them and prevent the occurrence of cracks. When a fracture occurs on the site of the abrasion, treatment should include not only measures that accelerate healing, but also an intensive prevention of inflammatory complications in the mammary gland.
As a temporary measure, which reduces friction and further injury to the nipple during feeding with already existing abrasions, during feeding, you can use special silicone covers. Feeding with the patch is much less painful and traumatic for the mother. It is sensible to continue feeding for several days with the use of pads, in order for the healing to be complete.
At occurrence of grazes and abrasions of a nipple it is necessary to process after each feeding with ointments on the basis of lanolin (PURELAN, etc.). These ointments are good because they do not cause an allergic reaction in the child and when using them, the breast can be washed before boiling with boiled water without using soap. With the same purpose, you can use aloe and calanchoe juice, sea-buckthorn oil, moistening them with sterile wipes and applying them to the damaged nipple in the intervals between feedings and overnight.
If, despite all efforts, nipple cracks could not be avoided, and treatment with these drugs within 1-2 days does not lead to improvement, it is necessary to consult a gynecologist to continue treatment under his supervision. It should be remembered that cracks pose a threat not only to the condition of the mother, but also put the child's health at risk, since in the case of the development of an inflammatory reaction in the area of a crack, he can be infected. In some cases, because of the increased sensitivity and extreme soreness, a woman can not give a baby a breast, during the treatment of deep nipple cracks, it is necessary to stop breastfeeding. Breast should be emptied with a gentle sparing expressing and feeding the child expressed milk from a spoon. All manipulations with the breast: the treatment of the nipples, pumping - it is necessary to perform only carefully washed hands or breast pump, drain the chest, which has cracks, only with sterile wipes to avoid additional infection. Linen, in contact with the breast, must be changed daily and ironed with a very hot iron, every 2 hours, change the gasket. You can also use special pads for chest ventilation, which do not allow you to touch the skin to the nipple skin, creating a kind of air cushion around the nipple, which helps to heal the injuries as quickly as possible.
Usually cracks in the nipples with proper treatment and uncomplicated flow heal for 5-7 days, after which you can return to the previous mode of feeding, without forgetting the measures to prevent the occurrence of cracks.