Physical Address
304 North Cardinal St.
Dorchester Center, MA 02124
A central goal of The Academy of Breastfeeding Medicine is the development of clinical protocols for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient .
TO PROVIDE EVIDENCE-BASED GUIDANCE in the diagnosis, evaluation, and management of breastfeeding women with persistent nipple and breast pain.
Among breastfeeding women, it can be challenging to distinguish pathologic pain from discomfort commonly reported in the first few weeks of breastfeeding. In this protocol, we define persistent pain as breastfeeding-associated pain lasting longer than 2 weeks. We are not addressing acute or recurrent mastitis as it is covered in ABM Protocol #4 Mastitis, Revised March 2014.
Pain and discomfort associated with breastfeeding are common in the first few weeks postpartum. (II-2) (Quality of evidence [levels of evidence I, II-1, II-2, II-3, and III] is based on the U.S. Preventive Services Task Force Appendix A Task Force Ratings and is noted in parentheses.) Since this is a common cause for early breastfeeding cessation, the mother–baby dyad should be evaluated by a lactation specialist. Beyond this early period, reports of pain generally decline, but as many as one in five women report persistent pain at 2 months postpartum. While initial discomfort with early latch may be considered physiological, pain severe enough to cause premature weaning should not. In one study of 1323 mothers who stopped breastfeeding during the first month postpartum, 29.3% cited pain and 36.8% identified sore, cracked, or bleeding nipples as an important reason. Several authors have found a relationship between breastfeeding-associated pain and postpartum depression. (II-2, III)
These studies suggest that breastfeeding-associated pain is linked with significant psychological stress; thus, mothers presenting with pain should be evaluated for mood symptoms and followed closely for resolution or treatment as needed. Timely identification and appropriate management of persistent breastfeeding-associated pain are crucial to enable women to achieve their infant feeding goals.
Although the literature on persistent nipple and/or breast pain is limited and the differential diagnosis is extensive, a number of etiologies and management strategies are emerging, most of which are based on expert opinion ( Table 1 ). The highly individual nature of the breastfeeding relationship combined with the complexity of the lactating breast, including its anatomy, physiology, and dynamic microbiome, adds challenges to the clinicians’ efforts.
Condition | Symptoms/signs | Management |
---|---|---|
Infant ankyloglossia | Ongoing nipple damage and an infant with restricted tongue movement due to a tight lingual frenulum |
|
Breast pump trauma/misuse | Nipple or soft tissue injury/bruising |
|
Eczematous conditions |
|
|
Psoriasis |
|
|
Superficial bacterial infection associated with skin trauma |
|
|
Bacterial dysbiosis |
|
|
Candida infection |
|
|
Herpes simplex |
|
|
Herpes zoster | Pain and vesicular rash following a dermatome |
|
Vasospasm | Shooting or burning breast pain with blanching and other color changes (purple or red) of the nipple associated with pain |
|
Allodynia/functional pain |
|
|
Recurrent plugged (blocked) ducts | Localized tender cord of tissue, usually a few centimeters in size, which is usually reversible with expression |
|
Oversupply | Breast fullness, milk leakage |
|
Become a Clinical Tree membership for Full access and enjoy Unlimited articles
If you are a member. Log in here