Dear Doctor,

I just had my first child. She is only a week old. However, my breasts hurt so much when I try to feed her. I noticed that the nipple area is sore and sometimes the pain is so unbearable that I’m forced to give her formula. I really want to breastfeed my child but is there anything I can do to lessen the pain? Ruby

Dear Ruby

Have the breasts been painful since day one, that is, when you started breastfeeding? Does it hurt on touch? Is there associated fever? The answer to these questions will help realise the underlying cause of the breast pain after feeding, in your case.

Usually a new mother may latch the baby improperly on the breast nipples due to inexperience. The suction caused by the suckling of the baby will cause pain, if he is not latched correctly. One should try to reposition the baby and if pain continues even after that, then other causes of breast pain should be considered.

Infection of the breast tissue or nipple can cause inflammation, manifesting as pain, red streaks over the breast or the entire breast may become red and painful to touch. Infection can be bacterial, where there is associated fever, chills, and body ache and at times, even nausea and vomiting. Fungal infection of the breasts or nipple would manifest as shooting or burning breast pain, either during or after feedings. There may be pain deep within the breast or strong pain in the breasts or nipples that does not improve even after properly latching the baby on the breast. Cracked or itchy, burning or painful nipples that look red, flaky or has rash with blisters, is yet another indicator of fungal infection. The infection can be detected on physical examination and confirmed by suitable investigations. Treatment of bacterial infection is by antibiotics and anti-inflammatory drugs. Cold compression would also help in easing the pain. Fungal infection would need anti-fungal drugs for cure. Breast shield can also be used in between feeds. This would prevent the sore breast or nipples from being hurt by clothes worn. Wearing lose clothes is also helpful.

One or more milk ducts may get clogged with milk, if they are not evacuated properly. This will cause feeling of heaviness and pain in the breast tissues. There is also risk of secondary infection setting in the blocked milk duct, which will aggravate the pain. To avoid this situation, it is advisable to give frequent feeds to the baby. After he is satiated and removed from the nipples, both breasts should be compressed manually in all four quadrants to ensure that milk ducts are completely emptied. A breast pump can also be used for this purpose.

Dr. Rachna Pande is a specialist in internal medicine. rachna212002@yahoo.